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Some Infusion Providers Now Taking Medicare Patients on a Case-by-Case basis

The recent passage of the 21st Century Cures Act has placed some very real constraints on home infusion providers caring for Medicare patients. The Act severely slashed reimbursement rates for certain therapies, prompting some infusion providers to stop taking Medicare patients, or do so on a limited basis. It is a very real issue and puts patients at risk.

Infusion Solutions has always done whatever we can to accept Medicare patients and provide them with exceptional care. Some are forced to pay out-of-pocket costs, but find that it is worth the money spent to be at home where they belong.  We will continue to service the Medicare population to the best of our ability, and offer them the lowest possible rates to help make home infusion a viable option.

Here is a link to a blogpost which flushes out the rationale of some providers to stop taking Medicare: .


The mandate of medical reform is clear: providers are tasked with providing better outcomes for patients at lower costs, all while maintaining a high degree of patient satisfaction. Home infusion companies are ideally suited to meet all three of these medical reform measures.

At Infusion Solutions, we proudly share our outcomes data and patient feedback with the public. We have been tracking our progress since our inception in 2010, and continually strive to improve our workflow to exceed our key benchmarks. The results printed below are not the only indicators that we track, but are the standardized indicators that are deemed most important by our industry, our referral partners, and the payers that we contract with to provide care. We are especially proud of our patient satisfaction data, as it is our mission to improve the lives of the patients we serve.

Sharing these outcomes is important for several reasons. First, it allows patients to make educated decisions related to the care that they receive. Second, it gives our referral partners the data they need to continue to trust in our ability to serve their population. And last, it allows the payers to see the value in home infusion, and thus continue to cover these services for their beneficiaries.

The onus is on each agency providing medical care to track and monitor standardized outcomes that matter across the entire spectrum of care. Infusion Solutions is committed to this task and will continue to make these data available for anyone who has an interest in our work. Collaboratively, we seek to do our part to improve patient care across the entire continuum.


Patient Satisfaction (n=175), based on willingness to refer Infusion Solutions to family or friends

Overall patient satisfaction of 97%

Overall Referral Source Satisfaction (n=66), based on our customer service rating scale from 0-5

Average score of 4.84 out of 5

Access Device Occlusions requiring alteplase or de-clotting therapy

Goal <5 – Met

per 1000 catheter days


Confirmed Access Device Related Blood Stream Infections

Goal <1 – Met

per 1000 catheter days


Unplanned Hospitalizations related to diagnosis or infusion therapy

Goal < 2 – Met

per 1000 census days





Today is Leap Day, which only comes upon us every 4 years. The odds of being born on Leap Day are 1 in 1,461, which is about 4 million people worldwide…a pretty small group, considering.

But today is also Rare Disease Day, which is celebrated on the last day of February each year. By definition, a disease is considered “rare” in the US if it effects less than 200,000 people, a much smaller group. There are over 6000 different rare diseases; 80% are genetic in nature, while others are the result of infections (bacterial or viral), allergies, or environmental factors. 50% of rare diseases touch children.

One such rare disease touched Shyloh, an infusion RN here at Infusion Solutions. When she was two years old, her father noticed a soft spot on her head that was concerning. They got it checked out, and Shyloh was subsequently diagnosed with Langerhans Cell Histiocytosis (LCH)–a 1 in 200,000 diagnosis.

LCH, like all histiocytic disorders, involves an abnormal increase in the number of immune cells called histiocytes. Normally these cells would help prevent and fight off infections, but in cases where there are too many, they turn against your body’s own tissues to form tumors or damage organs. In Shyloh’s case, her cells targeted the bones in her skull, ribs, jaw, and right shoulder.

Once diagnosed, Shyloh was treated by an oncologist at the Naval Hospital in San Diego. From the age of 2.5-5 years, she underwent two rounds of chemotherapy and radiation. She had two central lines placed, and had a plastic plate placed on the left side of her skull. She had to wear a bike helmet everyday to protect her head. She still has the helmet–it is decorated with stickers that she would get after her many doctor visits. Although her LCH did go into remission when she was 5, the damage to her facial bones later necessitated a great deal of oral surgery. She had complete reconstruction of her jaw when she was 13, and that process did not stop until she was 17. Braces, normally the biggest bane of high school youth, was just another of a long list of interventions that Shyloh had to endure.

Shyloh still lives with the effects of LCH today. Her jaw is still troublesome, and she gets migraine headaches from time to time. Her right arm is shorter than her left. She periodically looks at her labs to make sure that nothing is out of whack and that the disease is still in remission. But perhaps the biggest effect is that LCH inspired Shyloh to go into nursing, which is now her life’s passion. Because of her personal experiences with disease, she has a great deal of empathy for those who are suffering–no matter how rare or common. It is this rare perspective that makes Shyloh such an outstanding nurse, and we are happy she is on our team!

Please take a look at the video and support Rare Disease Day!


Becky Burns is an Island person.

As a child she would spend the school year in Seattle, but the day it let out, she and her family would go to their summer place on Orcas Island. There they could run wild and enjoy the unique freedoms that only Orcas could provide.

Orcas would be the first of many islands that Becky would inhabit during her life. At one point in her early twenties, she lived on a 3.5 acre island just off the coast of Orcas. She had no running water, no electricity, and no neighbors. It was just her and her gardens, a clean simple lifestyle that she would pursue throughout her life.

But Becky does have an entrepreneurial spirit, and eventually she earned enough money selling cakes ($1 profit!) that she got a ticket to Hawaii, ultimately settling in the Anahola Valley on the island of Kauai. There she started baking granola, and some forty years later, that is what she continues to do. If you have been to Hawaii, you have probably run across her awesome product; Anahola Granola is widely distributed throughout the islands from their bakery in Anahola.

In June of this year, Becky took a trip to Africa, and upon return noticed a pain in her stomach. Thinking she had picked up a parasite while swimming, she consulted her local healthcare provider for confirmation. Unfortunately, her self-diagnosis was incorrect; Becky instead was feeling the first symptoms of Non-Hodgkins Lymphoma. She took swift and immediate action, and began a chemotherapy regiment at a well-known cancer center in Seattle. They came up with a plan for her to receive 6 R-CHOP chemotherapy sessions through a PICC line, each 21 days apart. Indicative of her spirit, Becky chose to embrace the chemotherapy entering her body, thinking of it like sunlight glinting off the surface of water. Quite island-esque.

She travels to Seattle to receive these R-CHOP infusions, and in between Becky was in need of weekly dressing changes on her PICC site. Since Becky is now 65 and a Medicare beneficiary, the only place she could go locally to get that done was the hospital. Unfortunately, after a couple of dressing changes, Becky noticed bumps and blisters on her skin, and her arm was itchy and raw which kept her up at night. The sutures that held the PICC line in place then began to pus, and Becky was admitted into the hospital to receive IV antibiotics to combat this newly acquired infection. This was literally the first time she had any sort of antibiotic therapy in her life.

The last thing that a person battling cancer needs is to be admitted to the hospital with an infection on their PICC site. Oncology patients are under heavy medical loads and as a result of chemotherapy their immune systems are often suppressed, making them quite vulnerable to other health-care acquired infections. Fortunately she avoided that further complication; they pulled the PICC line, put in a new one, and she was on her way.

After her discharge Becky decided to take a different course, so when the next dressing change was due she showed up at our facility to get it done. She came to Infusion Solutions despite having to pay 100% out of pocket due to Medicare’s lack of coverage for home infusion services. And it was here that a remarkable discovery was made by one of our infusion nurses—Becky was allergic to the chloraprep cleansing solution that is commonly used on PICC sites. We began using a simple iodine and alcohol-based option instead, and in time her issues with the PICC site resolved completely!
Our nurses took the time to figure out the one simple thing that had been overlooked by all of her other providers, and for that Becky is quite grateful. We shared what we discovered with her oncology team down in Seattle, so their dressing changes are now a non-issue as well. It is the small things that sometimes matter the most, and this small collaborative gesture went a long way towards a happier, healthier patient.

Fighting cancer is obviously a big deal. Getting a routine dressing change should not be. Medicare should cover the cost of our services for Becky, but they don’t. Instead, Medicare forced Becky to the hospital, which is the most expensive place to go. Medicare covered those unsuccessful dressing changes, the resulting hospital stay, and the placement of a new PICC line, passing that bill onto the taxpayers who support the Medicare program.

Becky is now on her last round of chemotherapy, and with any luck, she will be discharged from our service in a couple of weeks. Her prognosis is good, with an 80% survival rate. If all goes well, Becky will be cancer-free and back to her Hawaiian Island before Thanksgiving. I can’t think of anything an island girl would appreciate more.

We at Infusion Solutions are grateful to have played this small role in Becky’s recovery and we wish her the best of luck as she returns to full health. We can’t wait to see her again at her Anahola bakery next time we are on her island. Aloha!

Infusion Solutions now contracted with United Healthcare

As of June 15th, 2015 Infusion Solutions is now contracted with United Healthcare and all its affiliates!

This is outstanding news, as it opens up our home infusion services to a large bank of patients who were previously out-of-network. They were thus exposed to higher co-pays, or were denied coverage altogether. Having access to the cost savings associated with home infusion is a great win-win-win for patients, providers, and insurers alike!

United Healthcare was the last of the major insurance companies to contract with Infusion Solutions. We are now up and running with virtually all private and public health insurers, so there are virtually no gaps in coverage for our services, no matter what insurance the patient may have.

We look forward to serving patients with United Healthcare–please call us if we can be of any help!


What is TPN?

TPN stands for Total Parenteral Nutrition.  What does that mean?  Healthy individuals get their nutrition via the digestive tract, or the “enteral” route.  Thus, “parenteral” means that a route other than the digestive tract is used to obtain nutrition.  TPN is ordered for patients who, for whatever reason, cannot obtain adequate nutrition through their digestive tract.  This could be because of a blockage or a leak in the digestive tract.  Some patients have absorption issues as well, perhaps due to short bowel syndrome.  In short, when the digestive tract is not functional, TPN is necessary for patients to maintain adequate nutrition.

TPN is administered into a vein, generally through a PICC (peripherally inserted central catheter) line, but can also be administered through a central line or port-a-cath.  Patients may be on TPN for many weeks or months until their issues resolve.  Throughout the course of therapy, patients may or may not be able to ingest anything orally; whatever the case, they will not get any substantive nutrition via the oral route.


Because patients are not getting any other true form of nutrition, the TPN formula needs to contain all of the essential nutrients a body needs to be healthy.  This includes proteins, carbohydrates, fats, electrolytes, vitamins, and minerals.  There are standard formulations that are available, and these are often what are used by large hospital systems.  Infusion Solutions, however, batches each TPN formula to meet the individual dietary needs of the patient.  This leads to optimal nutrition and a better chance of restoring health.

TPN bag

The TPN formula is monitored by the Infusion Solutions team, including pharmacists, nurses, and dieticians.  The formula can be adjusted as necessary based on lab markers and the progress of the disease state.  The rate of TPN administration can also be changed under some circumstances.  Generally, patients are initially started on a continuous cycle and are given their TPN over a 24 hour period.  As patients progress, it may be possible to move to an 18, 15, or even a 12-hour infusion cycle.  This can certainly improve the quality of life for those patients managing this infusion at home.

The TPN itself comes in a 2-3 liter bag, and most patients infuse one bag per day.  The bag itself is connected to a portable infusion pump that has been pre-programmed by the pharmacy team to deliver the TPN over a specified amount of time.  The whole system fits nicely into a small backpack that can be worn by the patient or hung nearby throughout the infusion.  As with all home infusion therapies, the intent is for the patient to be as mobile as he or she would like to accommodate their lifestyle.

tpn backpack

All therapies come with some inherent risk, and TPN is no different.  Caution must be taken to ensure that the PICC line and insertion site remain clean and free of infection.  Glucose abnormalities (hyper- or hypoglycemia) and liver dysfunction can also be a concern.  Patients on long-term TPN may be at risk for gall bladder inflammation and refeeding syndrome.  Essentially, there are issues that can arise when the digestive tract is not being used for prolonged periods of time, and so care is taken to mitigate or avoid these known complications.

Infusion Solutions has built a well-deserved reputation as this region’s foremost provider of TPN and other nutritional therapies.  If you have additional questions related to TPN or any other home infusion, please call our Bellingham office at 360-933-4892.  Additional resources can be found on our website:


Help the Home Infusion Site of Care Act become a LAW!

Help the Home Infusion Site of Care Act become a LAW!

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!

Help the Home Infusion Site of Care Act become a LAW!

Help the Home Infusion Site of Care Act become a LAW!



This is one of the most common questions that patients have when they are told that they need home infusions. PICC is an acronym for a Peripherally Inserted Central Catheter, and it is, in essence, a long IV line. It is usually inserted in a smaller vein in the upper arm (peripheral), and terminates in a larger vein in the chest near the heart (central). “Catheter” is just another name for “tube” in the medical lexicon.

picc in arm

PICC lines are inserted by certified PICC specialists, who use ultrasound and X-ray images to ensure that the line is in the correct spot. PICC lines can have 1-3 lumens, which allow medications to be attached and flow through the line.  Additionally, blood draws for lab purposes can also be extracted from the line.  The one pictured has two lumens, which have orange “caps” to help keep the line sterile.  Sometimes these caps are blue as well.

A PICC line is a safe, stable, and effective way to deliver IV medications. They can stay in the body for weeks or months, alleviating the need to subject your veins to the numerous needle sticks necessary if the PICC was not there. Additionally, some medications are caustic to the vasculature; PICC lines allow these medications to be delivered to larger vessels that are less likely to be damaged.  PICC lines are thus a very versitile choice for patients requiring long-term venous access for conditions such as nutritional deficiencies or IV antibiotics.

Infection is always a risk with intravenous access, but reported rates of PICC line infections are low if proper maintenance protocols are followed.  Our team of skilled nurses teach and train patients the basics of sterile technique and how to properly care for the line.  The lines need to be flushed at regular intervals, and the dressing needs to be changed weekly by our team. 

Please take a look at our videos for more information on PICC lines and their care.



There will come a time in your life–whether you work in the medical profession or not–that you will be in a situation where someone you know is going through a difficult time.  How do you react to those that are grieving?  How can you best help them cope and get through? 

The latest meeting of the Skagit Senior Network focused on this topic.  It was held at the Hawthorne Funeral Home, and featured speakers from Hospice, Skagit Widow Support Services, and Hawthorne.  David Lukov, the Family Services Director there, has created a great guide to help those that are grieiving.  With his permission, I have posted it here.

Ways to help Grieving

If you find it useful, please print it out and share with others.



Intrathecal pump

When a competing home infusion company abruptly stopped servicing intrathecal pump patients in our service territory, Infusion Solutions stepped up to provide this care. We completed the training and are now ready to lend a hand to those that can benefit. 

If you or anyone you know has such a pump, please reach out to us for assistance with managing the refills in the comfort of your own home.  Our nurses will come to your home and complete a patient assessment.  They can then access, interrogate, refill, and/or reprogram the pump according to physician orders.

If you are unaware of intracthecal pumps and would like to learn more, please read on.  We are happy to be able to provide this service to this group of patients!


The fluid filled space around your spinal cord is called the intrathecal space. Cerebrospinal fluid (CSF) flows through this area, bathing and protecting your brain and spinal cord. An intrathecal drug pump works much more efficiently than oral medication because it delivers medicine directly into the CSF, bypassing the path that oral medication takes through your body. You generally need about 1/300 the amount of medication with a pump than when taken orally.

The pump is a round metal device about the size of a hockey puck that is surgically implanted beneath the skin of your abdomen. A small plastic tube, called a catheter, is surgically placed in the intrathecal space of the spine and is connected to the pump. A space inside the pump called the reservoir holds the medication. Some of the commom medications utilized are morphine, ziconitide, and baclofen.

In general, these pumps are used to better control either pain or muscle spasticity. Patients with cancer, failed back surgeries, cerebral palsy, and muscular dystrophy (among other conditions) may benefit from these intrathecal pumps. They can experience a great improvement in their quality of life, and be better able to function in their daily activities.