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Medicare Dialysis Payment Proposal Ignores Patient Race

Last Updated: April 24, 2009.

A new Medicare reimbursement scheme for patients on hemodialysis would shortchange centers for treating black patients who often need extra medication to increase hemoglobin levels, according to a study published online ahead of print April 23 in the Journal of the American Society of Nephrologists.

FRIDAY, April 24 (HealthDay News) -- A new Medicare reimbursement scheme for patients on hemodialysis would shortchange centers for treating black patients who often need extra medication to increase hemoglobin levels, according to a study published online ahead of print April 23 in the Journal of the American Society of Nephrologists.

Areef Ishani, M.D., of the Minneapolis Medical Research Foundation, and colleagues studied a group of 12,002 Medicare beneficiaries (> 67 years old) who began hemodialysis in 2006 and who had never taken erythropoiesis stimulating agents to reach satisfactory hemoglobin levels. Baseline hemoglobin levels and erythropoietin use were monitored and compared for the black and white patients. The study was undertaken in response to a proposed Centers for Medicare & Medicaid Services (CMS) reimbursement scheme that would bundle outpatient hemodialysis and injectable medications, such as erythropoietin, into a single fixed payment.

At baseline, black patients had lower hemoglobin levels values than white patients (9.9 ± 1.7 versus 10.3 ± 1.6 g/dl). To achieve satisfactory hemoglobin levels, the black patients needed 11 percent more erythropoietin than white patients. After baseline hemoglobin level was included in the calculation, this difference shrank to 6.8 percent.

"In conclusion, if CMS implements its proposed reimbursement scheme, facilities may have a financial disincentive to treat African Americans, potentially resulting in reduced access to outpatient dialysis therapy," the authors write.

Two co-authors report a financial relationship with Amgen.

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