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

  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