CMS SOM App. H, Tag V632

Anemia management.

Interpretive Guidance § 494.110(a)(2)(iv):

The intent of QAPI in addressing anemia management is to maximize the number of patients who

achieve the goals in this area. Refer to the Measures Assessment Tool (MAT) which lists the

current professionally-accepted clinical practice standards and CMS CPMs in this and other

areas.

For anemia management, factors that should be tracked monthly for the facility's patient

population as a whole include laboratory values for hemoglobin and hematocrit. If facility QAPI

goals for anemia management are not achieved over consecutive evaluation periods, the facility

IDT should conduct a review of: transferrin saturation (TSAT) levels, ferritin levels, and other

iron indices; erythropoietin stimulating agent (ESA) doses and response to those doses; and, any

evidence of blood loss, such as repeated episodes of insufficient rinseback of red blood cells or

prolonged bleeding post treatment.

If the facility uses a standardized anemia management guideline or algorithm, the IDT should

evaluate the efficacy of this tool if facility QAPI goals for anemia management are not achieved

over consecutive evaluation periods.

Home and in-center patient outcomes may need to be reviewed separately by the facility in this

area as the factors to be addressed may be different. For example, a home peritoneal patient

may be reluctant to inject himself/herself with an ESA, resulting in lower values for this measure

in the home population.