When it finalizes its proposed rule, CMS should listen to Medicare experts and especially to the concerns of patient and physician groups who say that reinstating the lower-level hemoglobin trigger point of 10 will guard against under-treatment of anemia for dialysis patients.
Now CMS is proposing a rule that gives dialysis centers an extra incentive to under-treat patients by saying that the lower-level trigger point of 10 to administer ESAs should be eliminated.
The technology exists for lower-cost home dialysis for kidney patients, but the companies selling dialysis machines and services are incented under reimbursement schedules to keep patients at inpatient renal centers.