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Cost Deterrent to Treat African-American Patients?


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NEW YORK (Reuters Health) Apr 30 - The Centers for Medicare and Medicaid Services (CMS) has proposed changes to its dialysis reimbursement policy, making one lump payment to cover both dialysis and injectable medications, which were previously reimbursed separately. Researchers at the University of Minnesota caution that, because African-American patients require higher doses of costly erythropoietin than Caucasians, facilities may be biased against treating them.

The Minneapolis-based team, headed by Dr. Areef Ishani, constructed a mathematical model for a cohort of 12,002 patients who started hemodialysis, with no previous history of erythropoietin therapy, in 2006 when they 67 years old or older. They describe their findings in the April 23 online issue of the Journal of the American Society of Nephrology.

Baseline characteristics, which were drawn from the CMS End Stage Renal Disease Medical Evidence Report, showed that African Americans had lower initial hemoglobin values than did Caucasians (9.9 vs 10.3 g/dL, p < 0.001). Moreover, Blacks required higher erythropoietin doses than Whites to achieve similar hemoglobin concentrations.

As a result, African Americans required on average 11.0% (p < 0.001) more erythropoietin per month than Caucasians during the first 2 months on dialysis, after controlling for age, sex, BMI, vascular access type, comorbidities, and kidney function.

Currently, the proposed CMS changes do not consider race in determining "case mix," Dr. Ishani and associates note.

They conclude: "Costs of providing dialysis care could be higher than reimbursement rates, possibly creating a disincentive to treat African Americans, and thus difficulties gaining access to care."

J Am Soc Nephrol 2009.