Morality and metrics in dialysis

By Michael Fraase

Sunday, 04 May 2008 01:09PM CST

Section: ESRD

Medical moneyAfter the Epogen overuse dust up last year, you just knew the US government would stumble over itself trying to remedy the problem and end up making it worse. Well, here come the unintended consequences.

Earlier this year the Centers for Medicare & Medicaid Services (CMS) submitted a report to Congress, “A Design for a Bundled End Stage Renal Disease Prospective Payment System.” The crux of the proposal is to “bundle” payments for dialysis medications and medical treatment into a single payment of US$234.66 (in 2006 dollars) per treatment with up to 13 treatments per month. The intent of the proposal, presumably, is simple: reduce Epogen overuse by capping and combining payment for it with medical services.

A secondary purpose behind the proposal is probably to reduce the Medicare expense for dialysis. Almost all dialysis patients are covered under Medicare, regardless of age. The CMS report indicates that as of 2006 there were roughly 4,700 outpatient dialysis facilities serving 315,000 Medicare dialysis patients to the tune of US$8.1 billion.

If the goal is to stop the overuse of Epogen, there are far better ways to reach that goal: have Medicare negotiate the medication prices directly, thereby removing dialysis providers from the drug business is one that comes immediately to mind. Paying providers based on patient outcomes is another.

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