The cost of healthcare continues to be a hotly debated topic. In this current climate of reform and cost-containment, it may come as a surprise to you that there’s an easy fix within Medicare that will help save precious healthcare dollars and improve care. It is called the Home Infusion Site of Care Act, and it is awaiting action from your Congress.
While physicians and patients generally prefer that intravenous medications be delivered at home, a glitch in Medicare is forcing patients to get their treatments in a hospital or nursing home setting. This means, for example, that a Medicare patient being treated for an infection with an IV drip must get that therapy in a far more expensive institutional setting rather than the comfort and safety of his or her own home. Even more concerning is the fact that because infusion therapy dispenses medication through a needle or catheter, patients treated in hospitals run an increased risk of attaining life-threatening infections such as MRSA that are acquired more readily in institutional settings. While studies show that hospitals and skilled nursing homes do everything possible to prevent infections, patients at home are clearly at far less risk.
The Medicare fee-for-service program stands virtually alone among insurers in the United States in not fully recognizing the clinical and cost benefits of providing infusion drug therapy to patients in their homes. While Medicare covers infusion therapy in hospitals, skilled nursing facilities, hospital outpatient departments, and physician offices, it does not adequately cover infusion therapy furnished in patients’ homes.
Lack of Medicare home infusion coverage is not good for anybody–not Medicare, not the patient, and not the taxpayer. For over 30 years, home infusion therapy has been the standard of care within the private sector. Patients prescribed IV therapy and covered by private health plans have full access to infusion therapy delivered at their home. Ironically, these same patients lose this coverage when they enroll in Medicare. Medicare supplement plans are also of no value to infusion patients, as they use Medicare guidelines to determine what out-of-pocket costs they will cover. If Medicare says no, supplemental plans simply follow suit.
Although Medicare pays for certain infusion drugs provided in the home, most Medicare beneficiaries do not have true access to home infusion therapy due to gaps in coverage for the medically necessary services, supplies, and equipment used to actually provide the therapy. Closing the gaps in coverage would align the Medicare program with virtually all private payers, most Medicare Advantage plans, Tricare, and most state Medicaid programs.
So long as the Centers for Medicare & Medicaid Services and Congress allow this waste to continue, American taxpayers will continue to foot the bill for Medicare patients to endure often lengthy, and more costly, stays in hospitals or skilled-nursing facilities. Avalere, a respected health care policy firm, recently released a report that found providing anti-infective therapy in the home setting could result in a Medicare savings of approximately 17% when compared with furnishing the same therapy in skilled nursing facilities, hospital outpatient departments, and physician offices. This equates to millions of dollars annually of unnecessary spending, and these savings, if anything, are underestimated.
For Medicare to truly abide by its mission to serve our elderly and disabled, Congress should enact the Medicare Home Infusion Site of Care Act, which would give physicians and Medicare beneficiaries the option to prescribe and receive infusion therapy in the most cost-effective setting at a savings to Medicare.
Why should Medicare continue to deny beneficiaries access to safe, high quality, cost-effective infusion therapy at the home? The value of home infusion therapy is undeniable, and when it comes to healing, the age-old adage rings true: “There’s no place like home.”
Click on the bill to contact your members of Congress to show your support for home infusion benefits for Medicare patients! It is the right thing to do!