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?

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.

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

I actually don’t! Beth?

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.