EPO UTILIZATION EXPERIENCE AND BILLINGS - ONE METHOD OF AUDITING ACCOUNTABILITY

Next to physician and employee salaries, the largest single expenditur e for most dialysis facilities is the utilization of recombinant human erythropoietin (EPO) which, in some instances, can exceed 15% of tota l operating costs. The importance of this product in reducing the inci dence of anemia in dialysis patients is significant Under current guid elines, a patient whose hematocrit level is below 30 should be adminis tered an EPO regimen, the patient is removed om EPO once the hematocri t level exceeds 36, unless medical orders dictate otherwise. If the he matocrit level subsequently dips below 36, the regimen is reinstituted (appropriate to the requirements of the individual patient) in order to again stabilize the hematocrit at 36 or above. The amount of EPO to be administered and the procedures for its handling can generate sign ificant discussions. Appropriate methods to account for utilization an d billing to the responsible third-party payer are crucial in assuring that the dialysis program does not lose money on this product.