If you're a clinician thinking about opening a dialysis center, the single most important number in your entire business plan isn't your build-out cost or staffing budget — it's your payer mix.

Medicare's ESRD PPS bundled rate (the fixed per-treatment payment covering dialysis, drugs, and labs) is roughly $270-300 per treatment depending on your wage index and case-mix adjustments. That sounds fine until you realize it's often close to your actual cost per treatment. The economics of a new center are made almost entirely on your COMMERCIAL payer mix — commercial insurers can reimburse 3-5x the Medicare bundled rate for the same treatment.

This is why site selection isn't just about proximity to nephrologists or population density — it's about the insurance profile of the population you're serving. A location surrounded by working-age, commercially-insured patients (even if smaller in raw population) can outperform a larger Medicare-heavy area by a wide margin.

Before you sign a lease or apply for your CON/licensure, pull payer mix data for your target zip codes. It will change which locations you should actually be considering.

Curious what payer mix assumptions others here are underwriting to — drop your market below.