Under the new policy, the Centers for Medicare & Medicaid Services (CMS) will make a single payment to dialysis units to cover both dialysis and injectable medications, which were previously reimbursed separately. African American dialysis patients have more problems with anaemia (low haemoglobin) than white patients and thus may require more treatment with costly erythropoiesis stimulating agents (ESAs) to raise haemoglobin levels.
On analysis of 12,000 patients starting dialysis during 2006, the researchers confirmed that African Americans had lower initial haemoglobin levels when starting haemodialysis compared to white patients. Also, the average required dose of ESAs over the first two months on dialysis was eleven percent higher in African American patients.
Thus, "The change in payment policy may disadvantage a substantial group of dialysis patients," comments Areef Ishani of the University of Minnesota. Since dialysis centres will no longer be reimbursed for the higher ESA doses, the researchers are concerned that the new policy could create a "financial disincentive" to accept African Americans. "The CMS has suggested that the new reimbursement scheme will adjust for a variety of factors," according to Ishani. "If race is not included as a payment adjuster, African American patients could be disadvantaged by this policy change."
The study is limited in that it included only patients who were over age 67 at the start of dialysis and had Medicare as their primary insurance source. Also, it only looked at ESA use during the first two months on dialysis.
MEDICA.de; Source: American Society of Nephrology (ASN)