OPINION

Imagine being told there is a treatment that could help you postpone organ failure, maintain your independence, and potentially avoid having to spend hours each week being hooked up to a machine — only to learn that Medicare makes it hard for your doctor to offer it.

For too many Americans living with chronic kidney disease, that is not a hypothetical. This is the consequence of a Medicare reimbursement system that has failed to keep pace with medical innovation.

As a physician and a member of Congress for more than two decades, I have seen firsthand how smart policy can transform patient outcomes.

Treatments that were out of reach decades ago are now a standard of care.

Yet, for the 35 million Americans living with chronic kidney disease (CKD), one of the most widespread and costly conditions in the country, our system has not kept pace.

CKD is now the ninth leading cause of death in the United States, affecting more than one in seven American adults. Nine in 10 patients do not know they have it, while tens of millions more are at risk.

The disease is common, deadly, and a growing public health issue.

Kidney disease costs Medicare approximately $150 billion annually, straining our healthcare system through inefficient treatment options and payment systems that prioritize late-stage care over early intervention.

That misalignment has real consequences for patients.

Without early screenings and management, CKD progresses to end-stage kidney disease, where patients face a stark choice: maintenance dialysis therapy, where half of patients will die in five years, or join a kidney transplant waitlist of nearly 90,000 names that grows every ten minutes and may exceed a patient’s own life expectancy.

Under the Biden administration, CMS escalated the crisis by implementing a bundled payment system that reimburses kidney care under Medicare, incentivizing cost containment over patient outcomes.

As a result, patients are steered toward dialysis where they face low survival odds.

The effects of the new rule were immediate, drastically disrupting access to critical medications, undermining transplant readiness, and putting costs ahead of patient outcomes.

Now, CMS is doubling down on a policy proven to be ineffective.

The agency's new proposed rule for its End-Stage Renal Disease (ESRD) Prospective Payment System increases payments to dialysis facilities, throwing billions of Medicare dollars into a system designed to treat kidney disease after it strikes.

CMS is choosing the status quo over structural reforms that give patients more options in the beginning stages of the disease.

Kidney disease is uniquely suited for early prevention and innovative therapies that promise to slow or prevent disease progression entirely exist.

Screening for key risks such as diabetes and hypertension, coupled with routine monitoring, can identify CKD before meaningful treatment opportunities are lost.

But outdated reimbursement models slow the adoption of early interventions that could change the trajectory of this disease.

During my time in Congress, I worked across the aisle to call for the restoration of Medicare kidney transplant patient access to post-treatment monitoring tests. I worked for over 10 years on legislation to extend immunosuppressive drug coverage for kidney transplant patients.

This work reinforced a commitment to addressing kidney disease. Now, we need the proper policy infrastructure to match it.

Give President Donald Trump credit.

In 2019, before a packed auditorium in the Ronald Reagan International Trade Center, he signed an executive order to advance American kidney health and reduce the number of patients developing end-stage renal disease.

That executive order set a critical precedent. Now in his second term, his administration has an opportunity to build upon that initial work.

Most critically, the Center for Medicare and Medicaid Services can modernize Medicare's bundled payment system for end-stage renal disease.

The current model promotes cutting costs, but it discourages the adoption of cutting-edge medical technologies.

Patients deserve a policy environment that rewards early intervention and preservation of renal function, over late-stage management, after the damage is done.

The measure of a quality healthcare system is not how it responds to a crisis, but how it prevents one.

Kidney patients should not have to become the sickest version of themselves before our system initiates.

It is time to confront the failures undermining kidney care access and rebuild policies that reflect the standard of care kidney patients deserve.

Michael Burgess, M.D., represented Texas’s 26th Congressional District as a Republican from 2003-2025 and previously practiced as a doctor of obstetrics and gynecology for more than 25 years.