Necessary to report INR levels to Alere each time?

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Sherryl

Member
Joined
Oct 27, 2011
Messages
8
Location
Lafayette, LA
I'm fairly new to home testing. However, I've had Dr. Al Lodwick's book along with the dosing chart for quite a while. I feel comfortable with the process, so is it necessary for me to call Alere with INR results every single time? Medicare appears to be charged for this call. Am I correct about Medicare being charged for the calls?

I'd appreciate any input on this topic.
Susie Q
2005
ATS Aortic Valve
Mitral Annuloplastry Ring
 
Am I correct about Medicare being charged for the calls?
QUOTE]

Yes and No. I was in a similar(I think) program with Alere a couple years ago. They furnished me a meter and all supplies as long as I was in their program. I had to call in my results to them and they called the results to my doc....who called me if any dosage change was warranted. They then bill medicare for an amount that includes the use of the meter, supplies and their monitoring service. Medicare paid them 80% of the contract amount and I paid them 20%.
Frankly, I found it to be a pain in the A-- and have discontinued the program. I go to my PCP, usually once a month, and let his people do the finger stick. Saves both Medicare AND me money.

I also use the Al Ludwig INR chart and have found it to be as good, or better than most. Incidently, I don't believe Al was an MD. He was a pharmacist and acknowledged INR expert.
 
Thank you, Dick, for your reply. I'm sorry I'm just now getting around to acknowledging your response. I bought my meter outright in 2007 before I was on Medicare because my husband & I were going on a long vacation. When I initially went on Medicare, Alere tried to tell me I needed a new machine because mine was older & wouldn't work with the new test strips. I told them that was not the case because I had the exact same machine & test strips the Coumadin Clinic used. Therefore, Medicare can't charge me rent for my machine. I'm just buying the strips & supplies from them. As you said, Alere calls my cardiologist with the results & his office calls if adjustments need to be made. I'm going to try to skip the step involving the call to Alere with my test results. From my standpoint, this is a prime example of Medicare abuse.
 
.......As you said, Alere calls my cardiologist with the results & his office calls if adjustments need to be made. I'm going to try to skip the step involving the call to Alere with my test results. From my standpoint, this is a prime example of Medicare abuse.

I agree that this is Medicare abuse. For thirty years I had to go into my docs office and get a lab draw because the finger stick was not invented. For the past fifteen years I have had finger sticks at my docs office. A few years ago, after reading about "home testing", I thought it was a good idea.....so I "bought in" to the leasing program thru Alere. It was a "can of worms" from the beginning. After a year, or so, I changed to a PCP that insisted I come in to his office for testing and I cancelled the Alere program. Now, this PCP would like me to reconsider "home testing" because he knows I know how to manage INR. I won't do it because I now get a "visit" with my PCP along with the INR test on a monthly schedule for a $10 copay. I don't consider that an abuse of the system because he is going to charge Mecicare for an office visit anyway......and his office visit charge is about the same as Alere gets for their "program". I use that INR appointment to ask any questions I have about any medical issue I have.....from how to treat my seasonal allergies to how to treat a "tennis elbow" type problem. I currently have "golfers elbow" and I will ask him about it on my monthly INR finger stick in about a week. I have also asked him, a time or two, during my "visit", about some of the stuff I read on this forum....for his input.

That's my story.....and I'm sticking to it LOL.
 
I have a problem with the monthly testing. Personally, I think that it should be done more often - when I have enough strips, I test weekly. The few times I didn't test that often, the space between tests got me into INR trouble. Even with 'consistent' diet, medications, dosing, etc., it's not always correct to believe that the INR is ALWAYS in range.

The thing with Alere seems like something of a scam to me -- especially if you have your own meter. Okay, so most doctors won't CALL you and make sure you've reported your results to them -- but Alere DOES and charges plenty for that little nudge. If you have your own meter, and can keep to a schedule (I usually test mine every Friday -- that's not very hard to remember to do, is it?), you should be able to manage your own test scheduling. If you are afraid to manage your dosing (and you may not need to make changes for small changes in INR), you can probably still call your MD with your results. (I keep a spreadsheet for EVERY test - time, date, which meter I use (I have changed meters over the years), weekly dose, and any changes in diet, or activity, or illnesses, etc. I haven't had to show this to my doctors yet - but this record is very interesting (to me) and may be valuable to you, if you DO self test.

I personally don't see a reason to report to Alere - especially if you OWN your meter and aren't required to report to them in order to keep THEIR meter.
 
For the moment, I'm reporting my weekly INR test results to Alere, who then forwards it on to my doctor. This year, I expect to have expenses beyond my health insurance deductible, so my incremental cost to pay Alere for the meter lease and the reporting is only my 10% co-pay (about $17/month).

However, in anticipation of future years where I will not exhaust my deductible, and the expense of reporting through Alere is not justified, I asked my doctor (the one who is actually prescribing the warfarin) if he cared whether I went through Alere or if it would be OK if I just reported my home-test INR results directly to him. I told him that I might just buy my own meter and test supplies if it became more cost effective. My doctor was fine with that, and said as long as he got the test results he did not care whether he got them directly from me or via Alere.

I've just passed my first year of ACT, and I plan to continue the home testing of my INR weekly, whether I go through Alere or not. Perhaps after a few years of experience I may go to longer intervals between tests. At about $5 per test strip after you have paid for your meter, it seems like false economy NOT to have the extra peace-of-mind with weekly tests. At least this is how I feel as a relative newcomer to ACT, whose INR is not all that stable yet.

So, my advice is to ask the doctor who is prescribing your warfarin if he/she cares whether you report the results directly or go through Alere. If your doctor is OK with it either way, then you can decide on the basis of your own insurance or out-of-pocket costs. If your doctor has specific reasons why he wants you to stick with the lease/reporting through Alere, then presumably he will share his reasons with you and you can decide to either live with it or find another doctor if you really want to cut Alere out of the loop.
 
Whether you call your results in to Alere or not, I strongly suggest that you keep a record of your INRs, dosage, and any factors that may be related to your INR (changes in diet, etc.). This will give you a history that ONLY you can maintain - and may also help to convince your doctor or insurance company that you actually keep on top of your INR and are a safe bet for renewals of your warfarin prescriptions.

As a one-time (and perhaps STILL) idiot who went for many months without testing (yeah, some of you suspected as much), I really don't see why people who have meters don't test weekly. (I can look at my years of records and if I try to break this into months, I can find some weeks where my INR was, perhaps, not as stable week to week as it could have been. A weekly finger-stick, and about $5 for a test strip, shouldn't be that big a deal, and can provide better state of mind to those who test weekly.

(FWIW: I am going to an anticoagulation clinic. After three visits, a week apart, I was told to have a blood draw monthly and see them in three months. Although my range is 2.5-3.5, my last INR tested on TWO InRatio meters, was 2.3. Of course, I didn't tell the clinic, and I didn't change my dosage. (I may test tomorrow or Tuesday - 3 or 4 days after my 'sub-range' INR.) This may be something that, perhaps the clinic should know about -- but they only want a snapshot of my INR once a month. I'll keep an eye on this INR (a 2.3 didn't distress me, and I made no dosing changes), but let the clinic continue to THINK that they're on top of my INR. I honestly do NOT believe that once a month - or even two months - testing makes sense when, as was noted, tests are only about five bucks or so.)
 
I honestly do NOT believe that once a month - or even two months - testing makes sense when, as was noted, tests are only about five bucks or so.)

Whatever floats your boat. You are assuming that everyone has a $1200 meter...."cause I personally would not buy a used meter off Ebay. I agree that "or even two months" is too long, but, for me, once a month is fine......been doing it for 45 years. I think you do some diservice to new people because you tend to blow this INR stuff way out of proportion. INR management is not "rocket science" and warfarin is not "scary" and only requires a little common sense. Personally, I think it is silly to invest in a $1200 meter (that is obsolete soon after purchase) IF you have good access to a PCP meter, which is updated often to the latest technology. But, like I said before, its a personal choice.
 
Dick:

I don't think I'm blowing the INR stuff out of proportion - I'm not saying that it's a fatal error to NOT get tested every week -- but with the availability of meters and the relatively low cost of strips, it doesn't make a whole lot of sense to NOT test more often than once month. I know from personal experience that, if I tested once a month, I've had periods where I was out of range. I also know, from personal experience, that going months without testing was probably not life threatening.

Your assumption that, apparently, ALL meters cost $1200, and that ALL meters get obsolete quickly is just plain wrong. The InRatio meter may have been updated a few years ago, but the strips used for testing are the same for both meters. I don't expect this to change any time soon -- and even if it does, I am confident that the strips will still be available. The ProTime meters still use the same cuvettes they've been using for more than a decade, and I was told by the manufacturer that there's no plan to stop selling the meters or the cuvettes. The CoaguChek XS came out many years ago - replacing the CoaguChek S, and it took something like 6 or 7 years until Roche stopped supporting the CoaguChek S meter. I don't think the fear of obsolescence is valid.

Also -- with the exception of an InRatio 2 that I got from Alere, I've had CoaguChek S (when they still supported the meter), new in box for less than $50. I've gotten ProTime and ProTime 3 meters relatively inexpensively, and my original InRatio was also fairly inexpensive. These were all bought on eBay, and lab tests compared very closely to the meter results. Hell, the meters that came from clinics were retired for financial reasons - not because of inaccuracies. One meter came from the family of a user whose INR was being monitored. Most meters on eBay come with a return privilege, and many are New In Box. I personally am no concerned about buying a meter on eBay - if a person reading this is concerned, check the seller's feedback, ask the seller about return policies, etc. I wouldn't let fear of ALL eBay purchases keep me from getting a meter - probably more affordably than retail and certainly well below $1200.

Yes, INR management is pretty easy - and most of us are capable of managing our own dosing (and make few changes, most of the time), but I still think that weekly testing helps to detect any anomalies that otherwise may not be detected with monthly tests.
 
Protimenow...

When you make statements such as...."it doesn't make a whole lot of sense to NOT test more often than once per month", and you present yourself as an "authority" on INR management for everyone, you are wrong. Many who come here are new and frightened and this BS concerning the effort needed for INR management serves little value. If it works for you...OK, I find that once per month works OK for me.

INR meters, like computer, cell phones, TVs, etc., etc. are obsolete soon after production because of the ongoing technical advances in all electronic products. I prefer to get tested on my docs meter, who is more likely than me, to have the "latest and greatest" meters....and I don't have to incur a significant $1200 expense.....or the risk of buying a cheapy off Ebay.

Your comment that clinic machines are "retired for financial reasons and not inaccuracies" is not accurate. On 10/19/11 I had a finger stick and the result was 8+. This was either a significant medical problem or a malfuntioning meter......since my INR have stayed between 2.5 and 3.5 for years, a confirming lab draw was done and showed an INR of 2.5 which made a lot more sense. The docs meter proved to be malfunctioning and was replaced with a new meter....and my INRs have returned to my 2.5-3.5 range. Any meter can malfunction at any time for a lot of reasons.
 
I don't want to start a debate about meters, etc., but I don't agree with you about many of your statements. Both Alere and another manufacturer suggest weekly testing -- and it's not just to sell more strips or charge Insurance companies more often. As I said, I've had spikes and drops when testing weekly that would not have shown up on monthly tests.

Meters aren't cell phones or television sets -- although the manufacturers may be making some advances in technology, their meters don't go 'obsolete' for quite a few years. As I said earlier, Protime meters have been using the same strips for many years (by my count, probably fifteen years) and I was told that the strips should be available for at least five or six more. The InRatio strips work with both InRatio machines -- and I wouldn't imagine the strips or the machines becoming obsolete for quite some time. It took Roche roughly a decade to phase out the CoaguChek S. If labs and hospitals make investments in these meters, ongoing, long term support is required.

As far as $1200 meters are concerned -- you should check your numbers again. And your fear of eBay is your own personal bias -- I'm sure that a LOT of people buy their meters on eBay or Amazon and have had NO problems.

I'm not saying that meters don't fail. A small percentage (like the one that your doctor used) fail -- but such a spectacular failure (an INR of 8.0???) calls immediate attention to the failure, and calls for a blood draw. This kind of failure would be obvious and require confirmation. But labeling ALL meters as instantly obsolete, painting them all as failures waiting to happen, and suggesting that any meter bought on eBay is likely to be inaccurate or not work - is, in my way of thinking, just plain incorrect.

Again - I STILL think that weekly testing is preferred over monthly testing. It's not because INRs are hard to manage or warfarin is a particularly dangerous medication -- it's because there may be times - between monthly tests - where changes in INR deserve detection (and. occasionally,correction). I choose to trust the 'experts' like Alere and other meter makers who advocate weekly testing over the 'clinics' that are comfortable with monthly tests.
 
....... I choose to trust the 'experts' like Alere and other meter makers who advocate weekly testing over the 'clinics' that are comfortable with monthly tests.

Hmmmm, you don't suppose Alere would rather bill for four tests per month, rather than one? When I was in the Alere(QAS) program in 2009, Alere was charging insurance $70/test. Simple math tells me that one test/month=$70 billing and four tests/month=$280 billing. Which program would you push? I may be nieve, but I would rather bill $280.

I don't want to get in a pissing contest either. You, as I am, are entitled to our "opinion". But we should make sure that our posts are "our opinion only". There are very few experts on this forum.....and you and I ain't one of them.
 
Dick: I thought I pointed out that the vendors would, of course, prefer to bill for weekly tests. When I had a cardiologist - years ago - he wanted tests every two weeks. The manufacturer of a meter that I'm researching - and hope to have soon (and we haven't seen anything written about it yet) - also recommends weekly testing. In the days when it was inconvenient and expensive to get blood draws, perhaps a monthly test was a decent tradeoff, but with the cost of home testing running about $5-8 per test, to me it hardly makes sense not to test more often than once a month.

I thought I stated all of the above as my personal opinion -- or 'what I would do' -- rather than saying this is what YOU should do. No, I'm not an expert, but I HAVE read up on the topic, I've reviewed books and journals on the subject, and DO believe that I've got pretty decent knowledge of the subject. But, again, I try to be pretty careful to make it clear that these are my opinions, and if possible state references or facts (such as the reality about obsolescence of meters, and my personal experience with meters on e-Bay)
 
Hey Protimenow, I don't know jack, since I've only been at warfarin therapy for 8 weeks. However, per Dick's comment "I think you do some diservice to new people because you tend to blow this INR stuff way out of proportion. INR management is not "rocket science" and warfarin is not "scary" and only requires a little common sense. "

I agree totally. I'm an analytical chemist by trade and you scared me with a number of things you've said over the past weeks. That ended, when I analyzed what you were saying, vetted it against logic and facts, and concluded that you were incorrect.
 
Tom:

I appreciate your comment, but still believe that weekly testing is the appropriate way to manage warfarin therapy. I don't believe that a monthly test is adequate to REALLY know what goes on DURING the month. Even though my dosing and diet have been consistent, I've seen periods when my INR HAS moved from week to week - and these moves would NOT be detected if testing was only done monthly.

It's never been my goal to make it seem as if warfarin management was a black art, or particularly difficult - or even that warfarin is 'scary.' To me 'a little common sense,' as Dick said it, would dictate WEEKLY testing, just to be sure that the INR continues to be in range. That's it. Nothing should be scary about this.

I've based my statements on past personal experience -- including problems that I've encountered (including a stroke) when I stretched my testing out to too many weeks. If I had tested more frequently (weekly), this incident may have been avoided. Warfarin management doesn't have to be scary -- but it CAN BE if it's not managed properly (and I don't believe that monthly testing is PROPER testing).

FWIW - I've taken graduate courses in Biostatistics and Epidemiology, so I think that my perspective on this stuff also has a bit of merit.
 
Not to "beat a dead horse"....but I had my INR this morning at my docs office. I learned that their office protocol is to run a test on their Coaguchec machine EACH morning(sometimes during the day as well, depending on how many INRs are being run that day). This is a chemical test and is not sticking a non-coagulated nurse LOL. When I home tested, I did not validate my machines functioning each time I tested......although I did stick my non-coagulated wife, a time or two, to check my machine. My docs protocol made me comfortable that my test today was accurate.
 
There are 'standardized' test solutions for the CoaguChek machines, and these are used to verify the accuracy of the machines. The anticoagulation clinic that I go to has its Hemochron 'calibrated' every six months.

The machines at your doctor's office - and at my clinic - probably run a large number of tests each day. It probably wouldn't be wrong to think that your doctor (not knowing your doctor, this is a pretty broad assumption) and most clinics run more tests on their meters in a day or week than most home testers would run in a year or two - or perhaps even a decade.

Although it may not actually be necessary to run so many tests against standard solutions (it would be interesting to find out how many of these standard tests your doctor's meters actually DON'T pass), it's certainly not a bad thing to test to make sure that the meter provides the right result. From a liability standpoint, it's probably good business to go overboard on these tests against standards -- if a patient has a clotting problem, the doctor can say 'it can't be my meter - we check it daily.'

Remember, too, that all three leading meters (CoaguChek, InRatio, ProTime) have quality controls built in to the strips. Although meter results may not match up to the lab results, in general, these meters are pretty accurate. (In another thread I write about a possible inaccuracy that I suspect in my meters).

(From a statistician's point of view - all that the doctor's tests are doing is confirming that the meter's results are 'reliable.' What this means is that, when the test is run against a standard solution, the meter provides the result expected. This still isn't saying that the results are RIGHT - they're just reproducible. It's also just saying that the standard solutions -- probably a 1.0 and perhaps a 2.0 or something similar - gets an expected result. I'm not sure if it's a guarantee that results of tests run on actual patient blood samples will accurately match lab results.)
 
Protimenow...For every argument I present, you have a counter argument......and for every argument you present I have a counter argument. This could go on for a long time with no "end in sight". Obviously I can not convice you, nor can you convince me. I have INR tested a long time and you have done it for multiple years as well, so we both know what works best for us. Lets agree to disagree and stop this line of posting before we totally confuse any newbie that may try to read our conflicting posts. Who knows....someday, if home testing ever makes sense to me, I may try it again. Currently it is convenient for me to use my docs machine. I was in his office this AM @ 8:30 and out at 8:45.....and I had him look at my elbow and confirm that I have tendanitus(?) while I was there. Like I have posted, I use my INR appointment to get answers to other problems......and as you get older, you get a lot of "other" problems
 
Dick: This is probably it for me on this particular thread. (In answer to the original posting -- I still believe that it's useful to test every week -- but I don't see that Alere is providing much of a service -- you could get your own meter and call the doctor on your own, if you don't trust your ability to use the available dosage charts to decide if any change is necessary. You can probably jettison Alere and do it on your own - or with your doctor's help).

Dick: I wasn't arguing with your testing at the doctor's office -- that's a good idea. Having a doctor who is concerned enough to test the meter's accuracy EVERY DAY is also probably a good thing. And having a doctor who will give you a quick look for other problems is also good. I'm glad that it works for you.

Having a regular doctor and, as you do, being on Medicare so it doesn't matter as much how often you see a doctor, is also a good thing.

For me, the idea of having a doctor who I can see regularly, and who I can see affordably, is a distant memory. I make do with what I have.

For me, testing once a week is appropriate. Although I now have access to a public clinic, I really don't like having my taxes (and the taxes that others pay) paying for these services.

Finally, if the argument that monthly testing works well, as long as everything that you do is consistent - dosage, diet, wine consumption, etc., etc., etc. - and that monthly tests are all within range - then why not test every two months? Every four or six months? Hell, how about annual blood tests? If you're consistent from year to year, then it's easy to assume that for the ENTIRE YEAR, your INR was ALWAYS in range.

Personally, I am most comfortable with weekly self-testing. In my experience, I've caught changes that I wouldn't have caught with monthly testing. Perhaps if it required a visit to a doctor or lab to get an INR test, stretching the interval beyond once a week is usually safe -- but for those of us with meters, I think the likelihood that we'll be in range more of the time increases - as recently published papers report -with weekly testing.

I appreciate the opportunity to check the results of my meter against a monthly blood draw, but I still have faith in my meter for the weekly tests. (And even though, for the time being, I have access to monthly blood draws, I'm still committed to weekly self-testing, in addition to the lab tests).

Warfarin is not to be feared. I don't want anyone to get the impression that it's scary. Hell, gasoline is a lot scarier, but people are using it all the time. With warfarin, it's a matter of understanding how it works - how the effects aren't fully expressed for a few days - and how other things can effect your INR. For many of us, we trust the management of our anticoagulation to doctors or clinics. For others - many at this site - we trust ourselves to test (weekly? twice a month? monthly?), and to adjust our dosing (or ask for advice) when we get out of range. Without warfarin, there would probably be no mechanical heart valves in use; people with a-fib or DVT would be at more risk than they are now, and life for many of us would probably just not be possible. Warfarin is a good drug - not to be feared, but certainly afforded due respect.
 
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