Medicare OKs hematocrit treatment reimbursement
Political pressure used on HCFA
Effective March 10, HCFA approved partial reimbursement for use of EPOGEN with end-stage renal disease patients whose hematocrit levels exceed 36%. Current FDA-approved labeling for EPOGEN recommends target hematocrit levels of 30%-36%. Under the new payment policy, Medicare contractors are allowed to take into consideration physician justifications for reimbursement for EPOGEN provided to patients with higher than the allowed hematocrit levels.
HCFA already had planned to make this change on April 1, but subcommittee chairman Arlen Specter (R-PA) has been pushing HCFA to act faster. HCFA has come under congressional criticism for its hematocrit threshold payment policy. A March 9 letter from House Ways and Means Committee chairman Bill Archer (R-TX), Health Subcommittee chairman Bill Thomas (R-CA), and subcommittee ranking Democrat Pete Stark (D-CA) to Specter says, "We thought you might be interested to learn that over a dozen members of the House from both sides of the aisle have expressed their concerns to [HHS] Secretary Donna Shalala and to . . . [HCFA Chief Nancy Min] DeParle expressing our concerns with HCFA's mishandling of this important issue. In particular, we are concerned that HCFA has set an unreasonable hematocrit level cut-off point above which EPOGEN will no longer be reimbursable. This rigid rule fails to take into account the well being of the patient."
According to Specter, this is another example of HCFA interfering with the physician/patient relationship, particularly its failure to consider physician justification for using higher hematocrit levels for specific patients.
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