[HM2Viking]

NEW YORK (Reuters Health) - The organization status and ownership of a dialysis facility appears to influence the dose of epoetin that patients with anemia are given, new research suggests. Specifically, the study results indicate that bigger "for-profit" chain facilities use larger dose adjustments and aim for higher hematocrit levels, which indicate levels of red blood cells, compared with nonprofit facilities.
...

Epoetin therapy for anemia in patients undergoing dialysis is the single biggest Medicare drug expenditure, "totaling $1.8 billion in 2004," add Dr. Dennis Cotter, from the Medical Technology and Practice Patterns Institute in Bethesda, Maryland, and colleagues.
...
In a related editorial, Dr. Daniel W. Coyne, from Washington University School of Medicine in St. Louis, comments that "this report comes at an opportune time given the recent US Food and Drug Administration advisory warning that epoetin and darbepoetin result in a 'an increased number of deaths and of non-fatal heart attacks, strokes, heart failure, and blood clots when...adjusted to maintain...hemoglobin more than 12 g/dL."
...
Regardless of anemia status, patients at large for-profit dialysis chain facilities received higher epoetin doses than did those at nonprofit facilities. On average, the larger facilities administered an extra 3306 units of epoetin per week.

http://www.sciam.com/article.cfm?ali...modsrc=reuters

It sounds like the for profit dialysis centers are really farming the government without really increasing the quality of care.

[traumaRUs]

Well, I'm an APN in two for-profit dialysis units but am employed by the nephrologists. I do some of the anemia management which includes epo doses. We strive to keep our hgbs between 11 and 12 which is the current guideline. It is not the for-profit dialysis unit that sets the standard, it is the medical director and nephrologists who staff the units.

[HM2Viking]

The concern that I had was that if medications are being overused without reasonable justification of direct client benefit or IAW current guidelines that it could have the appearance of impropriety on the part of the centers and associated practitioners. In other words overprescription of a needed medication as a means to pump up reimbursements. When the drug costs of dialysis are 1.8 BN/year US $ then it is a reasonable question as to whether patients are being treated to achieve (according to the article) current guidelines of HGB 12 g/DL. The other point of the article was that excessive use of epoetin had serious potential adverse cardiac effects. Excessive treatment was both expensive and potentially dangerous to patients. Isn't EBP all about providing safe and effective treatmetn to patients?

[traumaRUs]

Yes, and in the facilities where we practice (11 facilties with 1000 patients), we keep our epo doses to manage the hgb between 11 and 12. No appearance of impropriety because there is none.

[HM2Viking]

Originally Posted by traumaRUs

Yes, and in the facilities where we practice (11 facilties with 1000 patients), we keep our epo doses to manage the hgb between 11 and 12. No appearance of impropriety because there is none.

No offense was intended by my original posting....

And this is a personal milestone. Post #1000 for me.

[wmarat]

Unfortunately, that's true

[traumaRUs]

Wow...congrats...no offense taken. I do think in the past we did keep Hgb artificially inflated but the billing occurs higher up than me and I was never pushed to give more epo.