Epogen

DeLana_RN, BSN, RN · Feb 27, 2007

Interesting topic. When I left outpt dialysis more than 2 years ago, hgb 13 was the absolute cut-off for giving Epo because Medicare wouldn't pay otherwise; we would get in big trouble if this was missed. I probably don't need to tell anyone what else we had to do with Epo (make sure we got every molecule of overfill out of each vial :rolleyes: ) - it always has been the biggest source of revenue for outpt providers (and I'll be the first one to admit that Medicare reimbursement rates are just too low).

I don't know what has happened in the meantime, but we are getting pts in the hospital with hbg/hct never before seen in a dialysis pt! Hgb of 14, 15 or even more, and the pt still receives a (low) dose of Epo in his/her clinic! What's up with that?! I have no idea. My guess: Medicare continues to pay

I do know that we are keeping track of these pts and their comorbidities and admitting diagnoses now (e.g. MI, stroke - which could be related to the high hgb according to the FDA). Often, the nephrologists order (or agree, if we bring it to their attention) to waste the pt's blood after dialysis. It's a drop in the bucket, but at least helps temporarily.

Maybe someone who has worked in outpt more recently knows what's going on regarding the continued Epo dosing. All I know - after reading recent reports - is that it's not a good thing.

Shouldn't the pt's well-being be more important than revenue?!

DeLana

LPN2RNBSN · Feb 28, 2007

This is quite disturbing what you are saying. I have been trying to follow the recent Epogen (in the media)... Even the House Ways and Means Committee met recently to discuss this issue of overusage of Epogen. You can read the transcript at their website. Just search house ways and means committee. Is your hospital reporting the data to Amgen. I know they have a form that if a patient is hospitalized with high hgb that they want to know. How can physicians place patients at risk especially when they are aware (with recent studies conducted) of negative patient outcomes. What does this say about the industry, at large. Are patients lives not valued as they should be. I know this does not occur in every facility but with what you are saying, there seems to be continued misuse. Once hgb gets to certain level, dose is to be cut otherwise no payment. The patients you are getting are they from one unit, or several units. Is this unit a large chain? non profit? just curious. You might want to get involved anonymously in order to save lives.

DeLana_RN, BSN, RN · Mar 1, 2007

All local clinics are owned by a very large, for-profit national company. We have just recently started tracking excessively high hgb data, the local nephrologists (there's only one group practice) are aware of our concerns.

I'll have to ask some questions regarding use of this data; I'll get back to you when I find out more.

DeLana

P.S. At the hospital, we immediately put Epo on hold if hgb is 13 or more, no matter what the outpatient unit did (normally, we use the same dose the pt received at the clinic).