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home infusion therapy

Hospital at Home or (HaH) is a term that will quickly be added to the vocabulary of Americans due to the current pandemic. As reported by Fox Business on August 20th, “Across the U.S., “hospital at home” programs are taking off amid the pandemic, thanks to communications technology, portable medical equipment, teams of doctors, nurses, X-ray techs and paramedics.”1 Excitingly enough, the home infusion industry has been operating under the care-at-home mentality for decades. This affords patients that have both acute and chronic illnesses, and cannot be treated with oral medications, the ability to be treated safely and effectively from the comfort of their own homes.

Think about it, how many people do you know that have a chronic illness like rheumatoid arthritis, cancer, congestive heart failure, Crohn’s disease, multiple sclerosis, or ALS to name a few? Do they spend a multitude of time traveling to and from a healthcare facility to receive hours of treatment? Now layer on COVID-19, a virus that has proven to impact individuals with weakened immune systems, and you have a recipe for disaster.

If you had the option, would you choose for your loved ones to have a treatment option that would increase the quality of their care AND deliver some sense of normalcy in their life?

Prior to COVID-19, the home infusion industry was predominantly a B2B industry where a physician, nurse practitioner, and/or case manager kick-started the process. This is understandable, as there are many moving parts and seamless coordination that required between patients, physicians, hospital discharge planners, health plans, and of course, a home infusion pharmacy. Home infusion companies, like ContinuumRx, make the process seamless by coordinating all the pieces, including insurance approvals and payment plans to get patients into the right setting of care at the right time. But there is a recent shift as patients are learning about treatments online and are seeking out care on their own. Joe Malatesta, Executive Vice President of Sales at ContinuumRx stated, “We are seeing a significant increase in customers reaching out to us directly to learn more about our IVIG, cardiac, parenteral, enteral, and antibiotic therapies. This is giving us a greater opportunity to engage with our prospective patients and educate them about the benefits of home infusion therapy.”

Hence, here are three key benefits of selecting home infusion therapy:

  1. Risk Reduction and Improved Safety
    Less is more. Home-based treatment in a controlled environment with one-on-one treatment with a certified nurse has proven that home infusion therapy prevents unnecessary hospital admissions, shortens the length of a hospital stay, and avoids unnecessary readmissions. The key learning is to have the professionals come to you.
  2. Cost, Time + Quality of Care
    As they say, home is where the heart is. Well, the truth is that it’s where healing occurs too. A pilot study at Brigham and Women’s Hospital in Boston around the concept of Hospital at Home (HaH), concluded that care can be improved while reducing costs. According to the study, those patients that received at-home care had fewer lab orders, less imaging (like X-ray and MRI), had fewer consultations, and were more mobile, which resulted in a 70 percent lower readmission rate. The findings also indicated that at-home care patients had total costs that were almost 40 percent lower than for patients treated conventionally. Aside from the time, cost savings for travel, and wear and tear on a patient’s vehicle (and psyche), a home infusion patient benefits from being at home in a controlled environment that saves money and keeps them healthier.
  3. Medical Coverage
    The Centers for Medicare Medicaid Service (CMS) issued a proposed rule: CY 2021 Home Health Prospective Payment System Rate Update; Home Health Quality Reporting Requirements; and Home Infusion Therapy Service Requirements” (Proposed Rule). The NHIA has been working with stakeholders and legislators to advocate for Congress’ intended implementation of the 21st Century Cures Act.

    Find comfort in the numbers. According to the National Home Infusion Association, 3.2 million patients receive home infusion annually with 98% of patients reporting that they are very satisfied with their treatment. Connie Sullivan, President and CEO, National Home Infusion Association, commented that the role of the home infusion industry is, “Helping patients get back to normal life. They can take care of the medication, take care of their health, without having to focus on it and make their entire world revolve around it. It really allows us to bring those solutions to the patient, literally where they live.”3

Do you know someone that could benefit from home infusion therapy? Please contact ContinuumRx for more information @ info@continuumrx.com.

References:

1(2002, August 20). Coronavirus pandemic pushes expansion of ‘hospital at home’ treatment. At-home care aims to reduce strains on medical centers and ease patients’ fears. Retrieved from FoxBusiness.com HERE.

2(2019, December 17). Being Treated at Home Can Help People Save Money and Heal Faster. Retrieved from HealthLine.com HERE.

3(2020, August 12). NHIA: Representing Home and Specialty Infusion. Retrieved from YouTube HERE.

On average, approximately 34,000 patients in the United States receive parenteral nutrition (PN) each year1 for critical ailments. For patients 65+ who are on Medicare, the worst news that a physician or case manager has to deliver is, “I’m sorry, you don’t meet the Medicare criteria for home parenteral nutrition.”

For over 20 years, parenteral nutrition has fallen under the prosthetic device benefit under Medicare Part B. There are seven gastrointestinal conditions (GI) that are considered by Medicare before providing coverage. And when it can be proven that a patient permanently (beyond three months) cannot absorb nutrients that are needed to maintain their weight and strength, is when Medicare may cover the accessories or supplies that are needed for long-term home infusion therapy. Patients with short bowel syndrome, GI fistulas, bowel obstructions, acute pancreatitis, and/or nutritional complications from cancer are typical candidates. It goes without saying that the nutritional mix of protein, carbohydrate, fat, minerals and electrolytes, vitamins and other trace elements and are received through parenteral nutrition can reduce complications, and even more so, reduce the risk of rehospitalization. As a result, regardless of insurance coverage or not, if there is any possibility that a patient may require parenteral nutrition (PN) at home after being discharged, the planning and documentation process needs to start immediately. By starting right away, it ensures that the physician, case manager, infusion provider, as well as the patient, are aware of what is required to attempt to secure coverage.

Understanding what Medicare covers and does not cover will ensure speed, efficiency, and uninterrupted quality of care on behalf of the patient. Utilize and implement the guidelines and quick-reference chart below to maximize effectiveness.

Medicare Does Not Cover Parenteral Nutrition For

Patients with a functioning gastrointestinal tract whose need for parenteral nutrition is only due to any of the following conditions:

  • Swallowing disorder
  • Temporary defect in gastric emptying such as a metabolic or electrolyte disorder
  • Psychological disorder impairing food intake such as depression
  • Metabolic disorder inducing anorexia such as cancer
  • Physical disorder impairing food intake such as the dyspnea of severe pulmonary or cardiac disease
  • Side effect of a medication
  • Renal failure or dialysis

Medicare DOES Cover Parenteral Nutrition

(Parenteral Nutrition is approved on an individual, case-by-case basis initially and at periodic intervals of no more than three months by a Medicare Administrative Contractor (A/B MAC (B)) medical consultant or specially trained staff. It is expected that the patient’s medical records will reflect the need for the care provided. These records are not routinely submitted but must be available upon request.)

7 Gastrointestinal Conditions for Medicare Consideration

  1. Severe Short Bowel Resection: Surgery within the past three months, leaving less than 5 feet of small bowel beyond the ligament of the Treitz.
  2. Severe Short Bowel Syndrome: The patient has a short bowel syndrome that is severe enough that the patient has significant gastrointestinal fluid and electrolyte malabsorption.
  3. Bowel Rest for at Least 3 Months: The patient requires bowel rest for at least three months for treatment of:
    1. Symptomatic pancreatitis with/without pancreatic pseudocyst
    2. Severe exacerbation of regional enteritis
    3. A proximal enterocutaneous fistula where tube feeding distal to the fistula isn’t possible.
  4. Complete Mechanical Small Bowel Obstruction: The patient has complete mechanical small bowel obstruction where surgery is not an option.
  5. Malabsorption and Malnutrition: The patient is significantly malnourished (10% weight loss over three months or less and serum albumin less than or equal to 3.4 gm/dl) and has severe fat malabsorption.
  6. Motility Disturbance and Malnutrition: The patient is significantly malnourished (10% weight loss over 3 months or less and serum albumin less than or equal to 3.4 gm/dl) and has severe motility disturbance of the small intestine or stomach which is unresponsive to prokinetic medication.
  7. Malnourished and Proven Condition: The patient is malnourished (10% weight loss over three months or less serum albumin less than or equal to 3.4 gm/dl) and disease and the clinical condition has been documented as being present and it has not responded to altering the manner of delivery of appropriate nutrients (e.g., slow infusion of nutrients through a tube with the tip located in the stomach or jejunum).

The information provided is meant to be a guide for your information only. Each health care provider’s office is responsible for providing accurate information to ContinuumRx for verifying codes, coverage and payment policies used for individual patients to ensure that they are exact and appropriate for the services and items provided.

Contact a ContinuumRx Medicare qualifying expert or trained clinician to assess your patient’s eligibility.

1 Trends in Parenteral Nutrition, By Kristi L. King, MPH, RDN, CNSC, LD, Today’s Dietitian Vol. 21, No. 1, P. 36, January 2019.