Lets Take a Look at This
Joined: 13 Nov 2003
Posts: 1
Posted: Thu Nov 13, 2003 12:22 pm Post subject: The Management or Mismanagement of Tx Medications?
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How can we know if the meds commonly given on tx are managed properly? These medications are big money makers. Am I correct to say that they could easily be mismanaged in order to increase profits? What entity is responsible to see to it that this doesn't happen? <
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>Let's begin with a discussion of EPO. Are all dialysis patients anemic, or is it possible to improve nutrition and the efficiency of the tx, therefor reducing, or eliminating the need for EPO? If this is possible, it would eliminate the huge profits for EPO.
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FYI
Joined: 15 Feb 2003
Posts: 72
Posted: Thu Nov 13, 2003 12:59 pm Post subject: Shocking
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Epogen is protected by congressional act, wonder why. Epogen is the major benefactor of the clinics.,up to 60%profit, and protected by congressional act!<
>Amigen owns this industry and who would of guessed they feel they are protected by congress? Hmmm! <
>It pays the clinics to keep the epo going up.
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leadsag
Joined: 31 Oct 2002
Posts: 263
Posted: Thu Nov 13, 2003 1:21 pm Post subject: EPO
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I heard one of the nurses going over the short term care plan for a new patient. Said he had hemocrit of 11.5 so that did not meet goal. <
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>Made me wonder just who these short term care plans goals are for. The facility or the patient
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ridgerunner
Joined: 11 Jan 2003
Posts: 101
Posted: Thu Nov 13, 2003 2:38 pm Post subject: tx meds
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as far i can determine there are no standards for giving meds.
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BE
Joined: 23 Jun 2003
Posts: 25
Posted: Fri Nov 14, 2003 7:12 am Post subject: Meds
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There are standards for EPO. For one, the government will only reimburse up to a specific hematocrit. Also, there are NKF DOQI guidelines that most of the industry follows. All meds have specific prescribing guidelines. You can also look in the PDF. There is no congressional act for EPO. It was at one time considered an orphan drug. Do you think Dr's just give out meds haphazardly?
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jfwag
Joined: 11 Jan 2003
Posts: 140
Posted: Fri Nov 14, 2003 8:58 am Post subject: Around here...
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Around here in Mass. Medicaid does not pay for EPO so Amgen gets only 80% of cost, through Medicare. To "BE" you are absolutely correct in your statement. A hemoglobun level of 12 is about the highest they want you to be at. Real healthy blood though is around 14. A 'crit of I believe 36 is the highest that they will pay for. 12 X 3= 36. So I've been told, this.
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gamcoff
Joined: 14 Nov 2003
Posts: 1
Posted: Fri Nov 14, 2003 9:14 am Post subject: To BE
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So are these prescribing guideines followed, or are there ways to milk the system? And why does the govt want hcts and hgb below normal?
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EFFICIENT DIALYSIS
Joined: 24 Jun 2003
Posts: 5
Posted: Fri Nov 14, 2003 10:30 am Post subject: Arresting Anemia
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A machine that delivers an efficient tx, eating nutritious meals on tx, eating nutritious meals the rest of the time, flushing the dialyzer, exercise and oxygenation can restore the blood and greatly reduce or even elimnate the need for EPO. Doctors have said that the liver can make EPO and it is possible it is made in other tissues.<
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>For those who do nocturnal what is your hct and hgb? How much EPO do you take as compared with in-center?
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FRN
Joined: 24 Feb 2003
Posts: 25
Posted: Fri Nov 14, 2003 5:11 pm Post subject: Milking the System
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Yes, there are ways to milk the EPO system. EPO needs adequate levels of iron in your blood to work effectively. When iron studies are only drawn every 3 months, the iron level can drop severely. Then they give you more EPO in an effort to keep your hct up in the target range. For those companies who make most of their profit from reselling EPO, this is one way they have done it. Iron studies need to be drawn monthly as each patient utilizes iron differently. Some just eat it up, others only need one series of IV iron a year. <
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>And if you have a patient with a constant, adequate level of iron in their blood, the amount of EPO can be significantly reduced. I've done it my patients when I worked in an outpatient unit.
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Lin
Joined: 28 Oct 2002
Posts: 337
Posted: Fri Nov 14, 2003 11:52 pm Post subject: Yes
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the unit I go to draws labs for iron every month. Prior to dialysis and when I first started I was going through 10,000 units of epo a week, but now I'm only getting 1,500 and have a hgb. of 11.5. Just had a series of iron after not needing any for over a year. The unit keeps changing protocol on how to draw the epo; I swear if they could squeeze the glass viles would do it!
