HCFA needs to more closely monitor the number of laboratory tests administered to Medicare dialysis patients because some providers may be ordering too many tests and others not enough, according to a new government report.
The General Accounting Office's audit of 1994 and 1995 billing data from 766 freestanding dialysis facilities serving patients enrolled in Medicare's end-stage renal disease program found widely varying test rates for clinically similar patients.
Medicare paid $35.9 million for laboratory tests on those dialysis patients in 1994 and $40.6 million in 1995.
The 100 dialysis facilities providing the most tests did so at four times the rate of the median facility, while the 100 providing the least tests did so at a rate less than one-sixth the median, according to the GAO, Congress' investigative arm.
This year, Medicare will spend $8.4 billion to cover dialysis and related treatment for more than 243,000 people with kidney failure. That number includes thousands who are younger than 65, the standard eligibility age for Medicare.
Most patients receive three dialysis treatments a week. Medicare pays each facility a flat payment per dialysis treatment that averages about $126, which also covers a bundle of 16 laboratory tests. Tests not part of the bundle are billed separately.
The GAO's report, released late last month, said a test for calcium absorption in the bones, which has no value for dialysis patients, was provided to 20% of patients in 100 facilities with the highest test rates. Another test, one that indicates malnourishment and is rarely needed by dialysis patients, was administered to 96% of patients at one facility and 88% of patients at another.
A test to determine the effects of the drug heparin, which is used to prevent blood clotting, was provided nearly three times more often than necessary to 87% of patients at one facility.
The GAO report said the separate fees paid for those tests, as well as differences in medical practice, may have contributed to the heavy ordering of tests.
The GAO said Congress may want to make physicians pay back Medicare laboratory fees when they continue to order unnecessary tests.