Impact of the change in CMS billing rules for erythropoietin on hemoglobin outcomes in dialysis patients

Blood Purif. 2007;25(1):31-5. doi: 10.1159/000096394. Epub 2006 Dec 14.

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.

Publication types

  • Evaluation Study

MeSH terms

  • Anemia / drug therapy*
  • Centers for Medicare and Medicaid Services, U.S. / legislation & jurisprudence*
  • Darbepoetin alfa
  • Erythropoietin / analogs & derivatives*
  • Erythropoietin / economics
  • Erythropoietin / standards
  • Erythropoietin / therapeutic use
  • Health Policy
  • Hematinics / economics
  • Hematinics / standards
  • Hematinics / therapeutic use*
  • Hemoglobins / analysis*
  • Humans
  • Kidney Failure, Chronic / drug therapy
  • Kidney Failure, Chronic / economics
  • Medicare / economics*
  • Medicare / standards
  • Practice Patterns, Physicians' / statistics & numerical data
  • Renal Dialysis / economics*
  • Renal Dialysis / standards
  • Retrospective Studies
  • United States

Substances

  • Hematinics
  • Hemoglobins
  • Erythropoietin
  • Darbepoetin alfa