Medicare should cover infusion services at patients’ homes

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.

Comments are moderated before they are published. Please read the comment policy.

  • Dr. Drake Ramoray

    Medicare doesn’t cover most infusion medications appropriately. We can no longer give infusion medications for osteoporosis because to do so would be at a financial loss. So are patients go to the hospital to have them. Same meds. Still outpatient. But with a big fat facility fee charged to Medicare.

  • Patient Kit

    This legislation sounds like common sense. Good for patients and their families, good for lowering costs for Medicare. Plus there is a precedent of every other major payor, including Medicaid in many states, covering home infusion. It even has bipartisan leadership support. So, I’m almost afraid to ask because I know has to be purely political — who is opposed and what is the rationale of the opposition to this legislation?

  • http://hautuconsulting.com/ Shane Irving

    Yes, the are many situations with infusions where Medicare patients are forced into much more expensive options. If you follow the money and see who benefits from this gap it’s certainly not the patients….(If it looks like a duck, qwacks likes a duck there was probably a good lobbyist around)

  • Steven Reznick

    Clearly antibiotic and medication infusion at home would be far more cost effective and convenient for patients and families than the current situation.

  • GAP

    More physicians and the public at large must speak up on this issue. The only way to effect change is to get tax payers aware of this complete waste and oversight on the part of Medicare. We must contact our legislators to pass this bill. As it stands, patients are suffering and our country’s money is being wasted. The change we need is simple!

  • Tim Redline

    I am a pharmacist and home infusion pharmacy owner in a rural area of Nebraska and I can tell you that we get calls every week from hospitals trying to get Medicare patients home with IV antibiotic treatments. Unfortunately the story is always the same…no coverage for it by Medicare or their supplement. Then the choices are:

    1) stay in the hospital…much more expensive to Medicare than home infusion

    2) go to a nursing home…quite a bit more expensive to Medicare than home

    3) drive up to 2 or 3 times daily sometimes an hour each way to a hospital outpatient clinic for their infusion…more expensive to Medicare than home infusion and a hardship on most Medicare patients and their families

    4) Pay out of pocket for home infusion supplies and services…no cost to Medicare but hard for many patients to afford AND home nursing services may not be covered by Medicare since they are not technically “homebound.”

    All other federal, state and private insurance plans cover home infusion services including state Medicaid programs, Tricare and state and federal employee plans.

    I am hopeful that Congress will see the glaring omission of this coverage gap for Medicare patients and pass legislation to allow them to receive safe and cost-effective quality home infusion care at home.

  • disqus_qJEMXTKtR1

    Congresspeople have their own healthcare plan, and therefore have no vested interested in changing something that doesn’t effect them.

    When they have to live under the laws they legislate, we will all be on an equal footing.

    Gene Uzawa Dorio, M.D.
    Santa Clarita, CA