Hgb

Discussions for Patients, Family, and Friends HD For Patients
#1

On the subject of dosing epo for Hgb, my home dept. wants Hgb between 11-12. Seems sometime back I read that this does not apply to home patients. Can someone remind me what the criteria is?

#2

Hi Jane,

Home dialysis (PD or HD) patients who give themselves EPO are not subject to the Medicare policy about reducing payment to clinics by 25% for hemoglobin levels that go over the target. The policy is here: http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM5700.pdf.

We are trying to find out whether there is a policy that DOES apply to folks at home, since this does not.

#3

Thanks so much Dori and do you know the medical reason home patients are exempt?

#4

I actually don’t! Beth?

#5

The recommended Hgb / Hct range for home patients is the same as for in-center HD patients – 10-12 g/dL or Hct of 30-36%.

I suspect that CMS chose not to penalize facilities that treat home patients by reducing their reimbursement for higher Hgb/Hct levels. Home patients are not seen as often – some aren’t seen monthly and some don’t have their labs drawn monthly. If the clinic doesn’t know that Hgb/Hct levels are going up, the clinic can’t reduce the EPO dose as quickly as the clinic would reduce the dose for an in-center patient who is seen 12-14 times a month.