The DOPPS Practice Monitor for US Dialysis Care: Update on Trends in Anemia Management 2 Years Into the Bundle

The DPM has examined trends in hemodialysis practices spanning the phase-in of the new bundled PPS, the ESA label update, changes to the CMS Quality Incentive Program, and more. Overall, changes in anemia management were substantial in 2011 but relatively stable by mid to late 2012. There was wide variation in response at the center level, with modest changes in anemia care in some centers, but dramatic decreases in ESA dose and/or increases in iron use in others. As a result, in December 2012, a sizeable proportion of centers (20%) had .10% of patients with Hb levels , 9 g/dL, and nearly half the centers had at least 50% of patients with ferritin levels . 800 ng/mL. Surveillance by CMS and their contractors indicate that transfusion rates among endstage renal disease patients with fee-for-service Medicare increased from 2010 to 2011.11,12 Additional study is needed to understand whether this burden fell on particular patient groups and the effects, if any, on other clinical outcomes.