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New Health Affairs Article Reveals How Medicare Payment Rules Violate Biological Laws, Worsen Kidney Care Disparities

via Business Wire

Physical Laws Framework Shows ESRD Bundle Policies Ignore How Kidneys Function, Harming Minority Communities Most

The National Minority Quality Forum (NMQF) today announced the release of the second article in its groundbreaking Health Affairs series on the Physical Laws Framework (PLF)—a scientific approach that evaluates healthcare policies based on whether they align with the fundamental biological laws governing human health and disease.

The new article, "Payment Systems Violate the Physics of Life: How ESRD Bundle Policies Disrupt Biological Order in Minority Communities," demonstrates how Medicare's payment structure for end-stage renal disease (ESRD) directly contradicts the biological requirements of kidney function, creating measurable harm particularly in Black and Hispanic communities.

What is the Physical Laws Framework?

The Physical Laws Framework (PLF) recognizes that human biology operates according to immutable natural laws — just as gravity governs physics, specific biological principles govern how diseases progress, how organs function, and how treatments must be timed. PLF provides a scientific standard for evaluating whether healthcare policies work with or against these biological realities. When policies violate these laws, they don't just create inefficiencies—they accelerate disease progression and shorten lives.

"The kidneys maintain a precise biochemical balance that keeps us alive. This isn't negotiable—it's physics," said Dr. Frita Fisher, nephrologist and co-author of the article. "When payment policies prevent patients from getting phosphate binders when their bodies need them, we're not just delaying care—we're disrupting fundamental biological processes."

Key Findings: Biology vs. Bureaucracy

The article reveals how Medicare's decision to bundle oral phosphate therapies into dialysis center payments creates a direct conflict with biological necessity:

  • Biological Reality: Phosphate levels must be controlled continuously, not just during dialysis sessions. Patients need immediate access to medications when biochemical imbalances occur.
  • Policy Contradiction: The bundling policy forces patients to obtain critical medications only through dialysis centers, eliminating pharmacy access and creating dangerous gaps in treatment.
  • Equity Impact: Black Americans comprise 35% of dialysis patients but face the greatest barriers under this system, as they are more likely to rely on pharmacies and long-term care facilities now excluded from dispensing these life-sustaining medications.
  • Innovation Blocked: Advanced treatments like XPHOZAH, which can dramatically improve medication adherence and phosphate control, become effectively inaccessible under the bundled payment model.

"This is what happens when economic models ignore biological laws," said Dr. Janice Desir, Co-Chair of NMQF's Nephrologists for Equitable Kidney Care. "The policy assumes patients can wait for their next dialysis appointment to get medications, but elevated phosphate levels don't wait—they cause immediate, cumulative damage to blood vessels and organs."

A Scientific Path Forward

"The PLF gives us an objective, scientific standard for healthcare policy," said Gary A. Puckrein, PhD, President and CEO of NMQF. "Just as engineers must respect the laws of physics when building bridges, healthcare policymakers must respect the laws of biology when designing payment systems. This isn't about opinion—it's about measurable biological reality."

The article is part of a 15-part Health Affairs series running through March 2026. Each installment applies PLF to different healthcare challenges, demonstrating how aligning policy with biological laws can reduce disparities and improve outcomes.

Join the National Dialogue

NMQF invites healthcare leaders, policymakers, clinicians, and patient advocates to engage with the Physical Laws Framework:

Upcoming Events:

  • August 13: LinkedIn Live discussion with article authors
  • August (tentative): Webinar: "Applying Biological Laws to Payment Policy"
  • November 5-6: Cancer Equity Summit featuring PLF applications

About NMQF:

Founded in 1998, the National Minority Quality Forum (NMQF) is a United States-based health care research, education, and advocacy organization whose mission is to reduce patient risk and advance health equity by ensuring optimal care for all. NMQF utilizes data and research to support and mobilize healthcare organizations, leaders, policymakers, and patients in advocating for biologically-aligned care that reduces hospitalizations, disabilities, and deaths while promoting high-quality, long lives, particularly for the most vulnerable. For more information, visit www.nmqf.org.

Contacts

Media Contact:

Adjoa Kyerematen

Vice President, Public Affairs and Communications

National Minority Quality Forum

akyerematen@nmqf.org | (202) 220-8505