Anemia treatment varies between profits, nonprofits

A potential link between epoetin prescribing patterns and Medicare reimbursement levels attracts congressional attention.

By David Glendinning, AMNews staff. May 7, 2007.

Washington -- Physicians at for-profit dialysis centers consistently order higher doses of an expensive anemia drug for their Medicare patients when compared with nonprofit centers, according to a new study.

The report, which appeared in the April 18 Journal of the American Medical Association, compared the two types of dialysis centers based on how much epoetin therapy they prescribed to increase red blood cell levels in their kidney disease patients. When compared with nonprofit centers, for-profit facilities administered higher doses of epoetin, increased successive doses to a greater degree and achieved higher hematocrit levels in their patients -- in many cases well above recommended limits.

The results have potential patient safety implications. A pair of studies released last November found an increased risk of heart attacks, strokes and other adverse cardiovascular events in patients whose hematocrit levels were raised too high. The Food and Drug Administration responded in March by issuing a "black-box" warning for epoetin agents. It called on physicians to use the lowest dose needed to avoid blood transfusions.

For-profit dialysis centers might be prescribing higher levels of the drug because of how Medicare pays for the medication and determines the quality of a center's anemia care, according to the JAMA study.

"These findings suggest that reimbursement policy and clinical performance measures may provide incentives for dialysis facilities, in particular for-profit facilities, to target hematocrit levels exceeding those recommended by the clinical guidelines," the authors stated.