For decades, home IV infusion has been known as a reliable and effective method of treatment for a wide variety of illnesses. While seniors are particularly at risk for illnesses that require infusion as treatment, Medicare coverage is notably lacking.
Over 43 million seniors are Medicare beneficiaries, many of whom will require infusion therapy at some point due to illness, dehydration, or infection (“Fast Facts about Medicare,” 2015). Astonishingly, home infusion isn’t fully covered by Medicare’s fee-for-service programs. While infusion medications are covered, home infusion doesn’t technically fall under inpatient or outpatient care and is therefore excluded from Medicare coverage. Consequently, Medicare recipients who prefer home infusion must pay for the required equipment and services out of pocket. Considering that around 69% of Medicare recipients are enrolled in a fee-for-service plan, home infusion is simply not an option for a majority of Medicare enrollees. Clearly, this is a considerable issue that requires amendment.
Last January, Senators Johnny Isakson and Mark Warner, along with Congresspeople Eliot Engel and Pat Tiberi, introduced the Medicare Home Infusion Site of Care Act: a bill that ensures full Medicare coverage of at-home infusion therapy (“Home Infusion Legislation Introduced by Senate and House Would Lower Medicare Spending; Enhance Patient Care,” 2015).
According to Kendall Van Pool, VP of Legislative Affairs for the NHIA, the bill is a long time coming. In the early 90s, the Clinton Administration attempted to push for provisions to cover home infusion with the Health Security Act. Unfortunately, that bill didn’t pass.
Medicare’s ongoing lack of home infusion coverage means that the out-of-pocket expense for home infusion equipment and services totals around $120 per day, says Van Pool. For those who require infusion therapy every day over the course of multiple weeks, the costs add up quickly. Thus, receiving infusion therapy is a lose-lose situation for many Medicare recipients. On one hand, home infusion is too expensive to even be a viable option. On the other hand, travelling to a hospital or physician’s office in order to receive treatment can be a huge inconvenience, especially if the patient needs multiple rounds of infusion per day. Imagine how disruptive it would be to have to travel to and from the hospital multiple times a day while trying to balance a job at the same time. What if you were too sick to drive yourself to the hospital? The Medicare Home Infusion Site of Care Act would remove the cost barrier, making home infusion a far more accessible treatment option for Medicare beneficiaries.
By opening up the opportunity for Medicare recipients to receive infusion therapy in the comfort of their own homes, the bill would also reduce stress on infusion patients and lessen their chances of acquiring a secondary illness. According to the NHIA, patients who receive at-home infusion are less likely to develop health-care acquired infections which can be life threatening to those who are aging and immune-compromised (2015).
Even the fear of health complications alone is enough to affect patient well being. Richard Rubin, an infusion patient featured in NHIA’s Medicare and Home Infusion white paper (2015), expressed concerns regarding inpatient care. “Being in the hospital and away from home takes an emotional toll on your mental health, not to mention the fear it instills knowing that you are in a hospital full of drug-resistant bacteria and your immune system is at its lowest point,” said Rubin, who needed infusion therapy to treat a serious skin and bone infection. For Rubin, receiving infusion in his own home felt safer and allowed him peace of mind in an already stressful time.
Medicare coverage of home infusion would also reduce the costs of hospital stays, saving patients, hospitals, and Medicare a great deal of money in the long run. A study by Avalere, a U.S.-based healthcare consulting firm, estimated that about 23% of Medicare patients receiving infusion would choose home therapy if they had the option to do so (Avalere Health et al., 2104). This movement to at-home infusion would translate to $80 million or more in Medicare savings over the next 10 years (Avalere Health et al., 2104).The Medicare Home Infusion Site of Care Act would help mitigate the current Medicare spending crisis, allowing taxpayer dollars to be allocated to other areas in need of funding.
The Medicare Home Infusion Site of Care Act is a revolutionary bill that would benefit infusion patients, taxpayers, and healthcare providers. If you’re interested in helping advocate for this exciting legislation, take action now and contact your Member of Congress!