# Hgb

**URL:** <https://forums.homedialysis.org/t/hgb/1966>\
**Category:** HD For Patients\
**Created:** [January 28, 2009, 2:00pm UTC](https://forums.homedialysis.org/t/hgb/1966 "2009-01-28T14:00:21Z")\
**Posts on this page:** 5\
**Page:** 1

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**Author:** ![Jane](https://forumcdn.homedialysis.org/letter_avatar_proxy/v4/letter/j/ecb155/32.png) [@Jane](https://forums.homedialysis.org/u/Jane)\
**Post date:** [January 28, 2009, 2:00pm UTC](https://forums.homedialysis.org/t/hgb/1966/1 "2009-01-28T14:00:21Z")

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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?

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**Author:** ![Dori\_Schatell](https://forumcdn.homedialysis.org/letter_avatar_proxy/v4/letter/d/a183cd/32.png) [@Dori\_Schatell](https://forums.homedialysis.org/u/Dori_Schatell)\
**Post date:** [January 28, 2009, 3:45pm UTC](https://forums.homedialysis.org/t/hgb/1966/2 "2009-01-28T15:45:34Z")

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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](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.

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**Author:** ![Jane](https://forumcdn.homedialysis.org/letter_avatar_proxy/v4/letter/j/ecb155/32.png) [@Jane](https://forums.homedialysis.org/u/Jane)\
**Post date:** [January 29, 2009, 9:22am UTC](https://forums.homedialysis.org/t/hgb/1966/3 "2009-01-29T09:22:38Z")

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

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**Author:** ![Dori\_Schatell](https://forumcdn.homedialysis.org/letter_avatar_proxy/v4/letter/d/a183cd/32.png) [@Dori\_Schatell](https://forums.homedialysis.org/u/Dori_Schatell)\
**Post date:** [January 30, 2009, 9:43am UTC](https://forums.homedialysis.org/t/hgb/1966/4 "2009-01-30T09:43:37Z")

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I actually don’t! Beth?

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**Author:** ![Beth\_Witten\_MSW](https://forumcdn.homedialysis.org/user_avatar/forums.homedialysis.org/beth_witten_msw/32/541_2.png) [@Beth\_Witten\_MSW](https://forums.homedialysis.org/u/Beth_Witten_MSW)\
**Post date:** [January 31, 2009, 11:43pm UTC](https://forums.homedialysis.org/t/hgb/1966/5 "2009-01-31T23:43:12Z")

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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.