I've seen major CMS payment shifts reshape an industry before, and it's about to happen again. In 2026, the way Medicare pays for kidney care is set to be transformed, based on a proposed rule published in July 2025[23]. For every provider, investor, and patient in the field, the clock is ticking. The coming reforms will reward the innovators who have been preparing for years and will create enormous challenges for those who have failed to adapt.
A System Under Pressure
The current system simply can't last. Over 37 million Americans have chronic kidney disease, and in 2019 Medicare spent $87.2 billion on CKD plus $37.3 billion on ESRD[24]. That's roughly 7% of the entire Medicare budget spent on about 1% of its beneficiaries[25]. CMS knows the only way to fix this is to change the incentives—to shift from a model that pays for more dialysis sessions to one that pays for better patient outcomes.What's Changing in 2026
The new rules are built around a few key pillars:1. Smarter Payments: The system will finally be adjusted for patient complexity, rewarding providers who can keep sicker patients stable.
2. Focus on Quality: Incentives will be tied to what actually matters: fewer hospital readmissions and a bigger push for home dialysis.
3. Emphasis on Home Dialysis: CMS wants to triple the rate of home dialysis adoption by 2028. It's a better experience for patients and more cost-effective.
How Smart Companies are Already Adapting
The winners in this new world aren't waiting for 2026. They're already operating under the new rules. Renal Care 360° is using predictive analytics to find patients in the early stages of kidney disease, long before they need dialysis. Getting ahead of the disease is perfectly aligned with the new CMS goals[26]. Sanderling Renal Services, which operates 14 dialysis clinics in six states[27], built its entire model around home-based care. Their remote monitoring helps keep patients stable at home, avoiding costly hospitalizations—a key metric in the new system.The Coming Shakeout
This shift will divide the industry. The winners will be those who invested in population health technology and robust home dialysis programs. The losers will be the facility-focused operators still clinging to a volume-based business model. For anyone in the kidney care space, the message is clear. The 2026 reforms aren't just a tweak; they are a fundamental rethinking of the entire field. The companies preparing today will own the market for the next decade.References
- CMS Calendar Year 2025 ESRD Prospective Payment System Final Rule, https://www.cms.gov/newsroom/fact-sheets/calendar-year-2025-end-stage-renal-disease-esrd-prospective-payment-system-pps-final-rule-cms-1805-f ↩
- Centers for Disease Control and Prevention, Chronic Kidney Disease Basics, https://www.cdc.gov/kidney-disease/about/index.html (chronic kidney disease statistics) ↩
- National Kidney Foundation Medicare Information, https://www.kidney.org/patients/medicare (Medicare ESRD coverage information) ↩
- Renal Care 360° portfolio description, https://pharosfunds.com/renal-care-360.php ↩
- Sanderling Renal Services locations, https://pharosfunds.com/sanderling.php (14 clinics in 6 states) ↩