In January 2011, Medicare’s prospective payment system for dialysis services (“bundling”) went into effect. Dialysis centers are reimbursed a flat amount to cover almost all the costs of providing care to dialysis patients. 

A number of recent studies have looked at the effect of bundling on anemia management and found that since the debut of bundling, average hemoglobin levels have decreased, the use of erythropoiesis-stimulating agents has decreased, the use of intravenous iron has increased, and the transfusion rate has increased. 

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