Free Money for Amgen

The language buried in Section 632 of the [American Taxpayer Relief] law delays a set of Medicare price restraints on a class of drugs that includes Sensipar, a lucrative Amgen pill used by kidney dialysis patients. The provision gives Amgen an additional two years to sell Sensipar without government controls. The news was so welcome…

Timeline: Medicare Payment for Dialysis

Medicare spending for outpatient dialysis and injectable drugs administered during dialysis was about $9.2 billion in 2009 and is a predominant share of revenues for dialysis facilities. According to MedPAC, “Medicare covers two methods of dialysis—hemodialysis and peritoneal dialysis. In hemodialysis, a patient’s blood is cycled through a dialysis machine, which filters out body waste.…

Measuring Patient Case Mix in Medicare

How does Medicare measure patient case mix?  For the most part, Medicare uses the Hierarchical Condition Category (HCC) model.  A recent CMS presentation describes the HCC model in more detail.  Today I review where CMS applies the HCC model, provide an overview of the HCC methodology, briefly describe its performance, and give some background on…

Medicare payments for outpatient dialysis

Today I will review how Medicare treats patients with end-stage renal disease (ESRD), relying largely on data from MedPAC’s 2011 Report to Congress. In 2009, about 340,000 dialysis beneficiaries were covered by fee-for-service (FFS) Medicare. Compared with all Medicare beneficiaries, dialysis FFS beneficiaries are disproportionately younger and African American. Ninety two percent of there beneficiaries…