As I explained his options, my patient’s initial shock turned to disbelief. I told the 84-year-old man that Medicare would pay for treatment of his urinary tract infection if he received infusion therapy at a nursing home, but it would not be covered if he opted to receive the therapy at his own home.
We calculated that the four weeks of therapy at a skilled nursing facility would cost Medicare about $15,000. The same infusion treatments administered in his home by a nurse would cost $1200. The wheelchair-bound patient knew the daily commute to a nursing home would be a tremendous burden to his family and elderly spouse, so he had little choice but to stay home and pay out-of-pocket.
Like most of my patients facing this dilemma, the man asked “Why won’t Medicare cover at-home infusion when it’s ten times less expensive than going to a nursing home?”
The answer is a little known but glaring glitch in Medicare that forces patients who need intravenous medications to have these treatments in hospitals and nursing homes rather than in the safety and convenience of their own homes. Considering that almost every private insurance program covers home-infusion therapy, this gap in Medicare is a blatant case of age discrimination for anyone age 65 and over.
Not only is the at-home option far less costly, it’s far safer than typical medical-care settings. Requiring patients to receive treatment in hospitals and nursing facilities places them at increased risks of infection, particularly deadly infections like MRSA. The Centers for Disease Control and Prevention (CDC) estimates that two million Americans get hospital-acquired infections every year, and almost 100,000 of them die as a result.
Trying to understand why Medicare requires people to have infusion-therapy treatments in costlier and less-safe environments makes me as baffled as my patients. Medicare’s Part D program covers only the drugs administered intravenously, but not the supplies, equipment and pharmacy-related services that account for more than half the cost of home-infusion therapy. Most of my Medicare patients cannot afford to pay for the therapy out-of-pocket, so they are forced to undergo extended stays in hospitals, nursing homes and daily visits to outpatient clinics.
I have spoken several times with U.S. Sen. Pat Toomey’s (R-Pa.) office and other legislators about closing this gap in Medicare coverage. I’m advocating for the reintroduction and passage of the Medicare Home Infusion Therapy Coverage Act. The bill was supported by such prestigious groups as AARP, American Diabetes Association and American Association of People with Disabilities.
Medicare’s short-sighted policy conflicts my duty as a physician to “do no harm.” Ironically, Medicare is jeopardizing the wellbeing of the very people the program was established to protect. Until Congress and the Medicare program corrects this wrongheaded policy, my elderly and frail patients will continue to be placed in harm’s way.
Emma Singh is medical director, home infusion services, Healthcare Evolution.