The following statement can be attributed to Thomas Slama, MD, President-Elect of the Infectious Diseases Society of America (IDSA). Dr. Slama practices medicine in Indianapolis, IN, and has provided home infusion therapy to his privately insured patients for several years:
The bipartisan group of senators and representatives who reintroduced home infusion legislation in the new Congress have taken an important step toward delivering on a key promise that President Obama made on his inauguration—to raise health care’s quality and lower its cost.
As an infectious disease physician, I often prescribe home infusion drugs, such as antibiotics, antivirals, anti-fungals, immunologic therapies, and intravenous fluids, for patients who have serious infections, such as pneumonia, bone and joint infections, skin and soft tissue infections, blood stream infections, and urinary tract infections. Home infusion therapy allows my patients to be treated in a safe and cost-effective manner in the comfort of their own homes.
Unfortunately, today, we have two standards of care. Patients who have good private health insurance usually have this benefit covered. Most patients who have fee-for-service Medicare do not.
As a result, Medicare beneficiaries who need antimicrobial infusion services often must be admitted to an extended care facility where they are less comfortable and more likely to be exposed to hospital-acquired infections that increase the likelihood of treatment failure and avoidable readmission. Not only is this unnecessary, inconvenient and difficult for the patient, but it also is costly to the Medicare program.
A home infusion therapy benefit under Medicare would achieve what Dr. Donald Berwick of the Centers for Medicare and Medicaid Services refers to as the Triple Aim—improved care for individuals, improved population health, and lower per capital costs of health care—by reducing hospital stays, limiting complications, and decreasing costs. For many of my patients, who are already actively fighting infections, quality care in the home is the best way to go.
Editor’s Note: The Medicare Home Infusion Therapy Coverage Act of 2011 was introduced concurrently in the Senate (S. 1203) by Sen. Olympia J. Snowe (R-ME) and in the House (H.R. 2195) by Rep. Eliot L. Engel (D-NY). The legislation would give Medicare beneficiaries access to the same life-saving drug therapies in the home setting that are already enjoyed by most privately insured patients. Both bills also would require high quality standards to ensure the safe and effective provision of home infusion therapies.
When Congress passed the Medicare Modernization Act in 2003, lawmakers added coverage for home infusion drugs. Unfortunately, the Centers for Medicare and Medicaid Services (CMS) interpreted the law to cover only the drugs but not the services and supplies associated with home infusion therapy, including pharmacy and care coordination services, medical supplies and equipment, and when necessary nursing services. S. 1203 and H.R. 2195 would fix this problem.
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