Myths vs. Reality: The True Story of Medicare ESRD Reimbursement

[Black]

Check out the link I provided in the thread to which I referred.

http://www.hdcn.com/symp/06rpasat/per/flash/flash_perp.htm

Error 401
Reader not authorized to read this file
This means one of two things: If the file you requested is in the FREE ZONE of HDCN, then you tried to access it without first registering with HDCN. To register, go to the the registration link on the home page of HDCN and register, and get a free zone loginID and password.

Yeah, you have to register, but registration is free.

[BigSky]

...and remember Dr. Evil Medicare will only reimburse for EPO up to a certain Hemoglobin value, I want to say it is 12 but that may need correction.  When patients hit that magic number EPO is held until they drop to a certain point. Even with optimal EPO levels as defined by Medicare a patient will always be somewhat anemic.

CMS released a statment that so long as the dose is reduced by 25% once the target level is reached they will continue to pay for it.

[Rerun]

...and remember Dr. Evil Medicare will only reimburse for EPO up to a certain Hemoglobin value, I want to say it is 12 but that may need correction.  When patients hit that magic number EPO is held until they drop to a certain point. Even with optimal EPO levels as defined by Medicare a patient will always be somewhat anemic.

If you have too much thick blood you will have fistula clotting problems.  I'd rather be a bit anemic.

[Zach]

These links help explain the Medicare End Stage Renal Disease Program.

http://www.cms.hhs.gov/ESRDGeneralInformation/

http://www.cms.hhs.gov/faca/downloads/tab_H.pdf

Lets keep informed, as best we can, on some of the issues we patients are facing.

[Black]

These links help explain the Medicare End Stage Renal Disease Program.

http://www.cms.hhs.gov/ESRDGeneralInformation/

http://www.cms.hhs.gov/faca/downloads/tab_H.pdf

Lets keep informed, as best we can, on some of the issues we patients are facing.

Thanks, Zack, appreciate the links.

[BigSky]

If you have too much thick blood you will have fistula clotting problems.  I'd rather be a bit anemic.

Had problems with that without thick blood.     Was recommended aspirin.  Haven't had a problem since even now that my blood levels have improved.

[Zach]

Here's a little history of the Medicare ESRD program:

http://198.104.149.102/public-policy/Public-Policy-Articles/Medicare-ESRD-Program/

It's always good to put things in perspective.     

[Zach]

Here's more news on EPO and Medicare reimbursement:

http://www.boston.com/business/technology/biotechnology/articles/2006/11/08/doctor_hits_fda_on_epogen_oversight/

[Bill Peckham]

I have an opinion piece up online here:
Opinion - How is Dialysis Paid For in the US?
http://www.kidneytimes.com/article.php?id=20070626173734

It talks about current reimbursement and then gets into bundling.

Remember: the care experienced by an individual dialysis patient is the same no matter what their payment method. Everyone's care is based on the average rate of reimbursement. This is why each of us should care what Medicaid pays for dialysis even if we are covered by Medicare or private insurance. If Medicaid pays too little, it will drag down the average reimbursement rate, and everyone's care will have to be adjusted to cost less than the lower average reimbursement rate. And, if there is no annual update to the Medicare CR to allow for higher labor and supply costs or improved technology, inflation will continue to diminish the value of Medicare reimbursement and the average payment rate. Again, the care experienced by an individual dialysis patient is the same no matter what their payment method is. Even if you have private insurance, Medicare reimbursement impacts the care you receive.

The article turned out pretty good it is a complicated topic. It's never perfect. Here is one edit I asked for along with a citation:
(As of April 1, 2007, the monthly base rate established by the Centers for Medicare & Medicaid Services was $132.49 for free-standing dialysis facilities and $136.68 for hospital-based units. This base rate is then increased by a so called "drug add on", decreased by a "budget neutrality factor" (these adjustments are the same across the country; they are the result of previous legislation) this adjusted base rate is then further refined through case mix adjustment and a geographic wage index. These last two adjustments are why reimbursement varies among patients and between units. In 2005 the case mix adjusted per treatment reimbursement for a 75-year-old, 173-cm, 78-kg patient (BMI 26.1 kg/m2, BSA 1.917 m2) dialyzed in Cleveland, Ohio was $158.36.) 1

1. Blood Purification 2007;25:7–11; Finances of the Independent Dialysis Facility, DeOreo, Peter B.; Table 1

The article is online here as a pdf:
http://content.karger.com/ProdukteDB/produkte.asp?Aktion=ShowPDF&ArtikelNr=96390&Ausgabe=232307&ProduktNr=223997&filename=96390.pdf

[Zach]

 

For Hurlock.
See, some of us care.

[paris]

Thanks Zach     Good 

[Rerun]

For Hurlock.
See, some of us care.

YEH!