Paper

Impact of the Change in CMS Billing Rules for Erythropoietin on Hemoglobin Outcomes in Dialysis Patients
Norma J. Ofsthun, J. Michael Lazarus

Fresenius Medical Care North America, Lexington, Mass., USA

Address of Corresponding Author

Blood Purif 2007;25:31-35 (DOI: 10.1159/000096394)

  Key Words

• Anemia
• Dialysis
• Erythropoietin
• Hemoglobin
• Medicare

  Abstract

On April 1, 2006, new Centers for Medicare and Medicaid Services (CMS) rules for billing erythropoietin (EPO) for dialysis patients went into effect. Two key provisions of the rules were to cap the dose for a single patient at 500,000 IU/month and to mandate a 25% reduction in dose for patients whose latest hemoglobin (HGB) or hematocrit (HCT) in the prior month exceeded 13 g/dl or 39%, respectively. The purpose of this article is to document the effect of the rules change on HGB outcomes in a single large dialysis provider whose computer system was modified to enforce the rules. HGB and EPO doses for 5 months following the implementation were analyzed retrospectively. The most noteworthy observation is that while the rule appears to have reduced the percentage of patients with an HGB of >13 g/dl slightly, it has also increased the percentage of patients with HGB in the medically undesirable range of <11 g/dl.

Copyright © 2007 S. Karger AG, Basel

  References

1.

Uehlinger DE, Gotch FA, Sheiner LB: A pharmacodynamic model of erythropoietin therapy for uremic anemia. Clin Pharmacol Ther 1992;51:76-89.

2.

Ofsthun N, Labrecque J, Lacson E, Keen M, Lazarus JM: The effects of higher hemoglobin levels on mortality and hospitalization in hemodialysis patients. Kidney Int 2003;63:1908-1914.

3.

Collins AJ, Ma JZ, Xia A, Ebben J: Trends in anemia treatment with erythropoietin usage and patient outcomes. Am J Kidney Dis 1998;32(6 suppl 4):S133-S141.

4.

Lacson E Jr, Ofsthun N, Lazarus JM: Effect of variability in anemia management on hemoglobin outcomes in ESRD. Am J Kidney Dis 2003;41:111-124.

  Author Contacts

Norma J. Ofsthun, PhD
Fresenius Medical Care North America
95 Hayden Ave.
Lexington, MA 02420 (USA)
Tel. +1 781 402 9553, Fax +1 781 402 9727, E-Mail norma.ofsthun@fmc-na.com

  Article Information

Published online: December 14, 2006
Number of Print Pages : 5
Number of Figures : 5, Number of Tables : 0, Number of References : 4

  Publication Details

Blood Purification

Vol. 25, No. 1, Year 2007 (Cover Date: December 2006)

Journal Editor: Leunissen, K.M.L. (Maastricht)
ISSN: 0253-5068 (print), 1421-9735 (Online)

For additional information: http://www.karger.com/BPU

  Drug Dosage / Copyright

Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center.