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Ethanol Lock Therapy: How ContinuumRx Continues to Support Our Patients Despite Barriers

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Total parenteral nutrition (TPN) patients require central venous catheters to provide them with nutrition. While this care method has been instrumental in giving patients the nutrients they need, catheter line-associated bloodstream infection (CLABSI) is a serious risk associated with this treatment.

Ethanol lock therapy (ELT) has been proven effective in reducing the risk of CLABSI. Yet, recent supply shortages have forced patients to switch to less effective antimicrobial solutions to fight infection. So today, we’re diving into what ELT is, its benefits, and how ContinuumRx continues to provide ELT through this national healthcare issue.

What Is Ethanol Lock Therapy (ELT)?
To understand ELT, first, we have to take a look at CLABSI. When intravascular catheters are inserted, matrices called biofilms are created. Within these biofilms, microorganisms form and can detach from the biofilms and enter the bloodstream, thus causing a CLABSI. Unfortunately, due to the stubborn nature of the biofilm microorganisms, typical antibiotic therapy is not always effective in treating CLABSI, and generally, the infection is difficult to clear.

ELT is a method of care that aims to prevent CLABSI before it starts by injecting ethanol and allowing it to dwell in the central venous catheter to kill these harmful microorganisms. However, not all methods of ELT are successful in combating infection. The most effective method requires using a 70% ethanol solution for a dwelling period of four hours daily.

What Are the Benefits of ELT?
ELT can be a life-saving treatment for a TPN patient due to the severity of these types of infections. According to a study published by the American Society of Enteral and Parenteral Nutrition (ASPEN), CLABSI is the second most common cause of morbidity in TPN patients. Another ASPEN study stated, ‘ethanol lock use has been associated with significantly lower rates of central line-associated bloodstream infection (CLABSI) in children with intestinal failure.’ So, if the benefits of ELT are widely known, then why aren’t more patients utilizing it?

The initial rise in popularity around ELT stemmed from its affordability and accessibility. The price of ethanol was substantially lower than other antimicrobial solutions, and it was readily available to most medical professionals. For this reason, many physicians began prescribing ELT to their patients daily to help prevent CLABSI.

Recently, the US Food and Drug Administration (FDA) gave an orphan drug designation to Ablysinol, a dehydrated alcohol made by Belcher Pharmaceuticals, for treating a rare form of cardiomyopathy. This patent prohibited other manufacturers from producing dehydrated, sterile ethanol, resulting in a nationwide ethanol shortage and price increase. Care providers can no longer afford to administer ELT regularly, and since it is most effective when used daily, this has led to an increase in CLABSI nationwide.

How Is ContinuumRx Helping?

“Recently many providers began workarounds to avoid providing ELT to their patients due to the extreme price increase.”

Keith Hartman, Chief Executive Officer, ContinuumRx

As a result, many patients have been forced to use alternative, less effective methods such as heparin lock therapy (HLT) to avoid infection. However, even with the alternative methods, the rate of CLABSI has risen again to the historical level it was at before ELT became common practice, according to ASPEN.

Despite the shortage, ContinuumRx continues to provide ELT to its patients at a reasonable price point. We believe that no patient should have to settle for a less effective method of care because of inflated ethanol prices. Continuing to deliver quality care no matter the circumstances is just one of the many ways we help our patients through the healthcare continuum.

If you or your loved one is a TPN patient in need of ELT, we can work with your healthcare provider to deliver your treatment at home and restore your peace of mind. So don’t wait; call us today to onboard your therapy.

Call us!

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ContinuumRx Pediatric Infusion Services: Allowing Families to Get Back to Their Normal, Everyday Lives

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As a parent, you are always working to give your child a happy and normal childhood. However, medical factors can arise keeping your child from living the life you envisioned. No parent can foresee or prevent these changes, but infusion therapy can ease your child’s discomfort and restore a sense of normalcy to everyday life. Home infusion therapy is common for ailments that include, but are not limited to, juvenile arthritis, Crohn’s disease, metabolic disorders, bone diseases, cancer, multiple sclerosis, rheumatoid arthritis, immunodeficiencies, and others.

While infusion therapy is highly beneficial, infusion centers and hospitals are costly, isolating, and can disrupt a family’s schedule. Some infusion treatments can take hours, and the added travel time makes it impossible for kids to participate in extracurricular activities and sports.

Home Care Magazine estimates that roughly 60,000 patients undergo infusion treatments from home every day, and this number is expected to double in the next five years. Many patients realize the benefits home infusion therapy can offer and are making the switch – especially when it comes to a child that needs treatment. 

ContinuumRx delivers top-rated expertise in home infusion therapy, eliminating the need for treatment at a hospital or infusion center while granting peace of mind and an undisruptive infusion therapy schedule for children. Receiving treatments in the comfort of a patient’s home is not only safe and convenient but allows children to receive medication under the care of a registered nurse while watching TV or movies, playing games, and even finishing homework.

As parents we know how difficult it can be to have a child needing medical care. We aim to take the confusion and fear out of that for the entire family. Patience and empathy are guiding principles for our entire team. Keeping the family comfortable in their home or in one of our infusion suites helps make the process more pleasant.

Keith Hartman, President, ContinuumRx

Our team is dedicated to the care and recovery of your child through all stages of their journey. Keep reading to learn more about the pediatric infusion therapies we offer at ContinuumRx.

Intravenous Immune Globulin (IVIG) for PANDAS/ PANS
Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS/PANS) is a disease that predominantly affects children. With PANDAS, a child is usually diagnosed following a streptococcal (strep) infection, like strep throat or scarlet fever. They will develop mannerisms associated with Obsessive-Compulsive Disorder (OCD) seemingly overnight. PANS is similar where there is a sudden onset of OCD behaviors, but it does not follow an infection.

Intravenous immune globulin (IVIG) therapy has been proven effective in treating PANDAS/ PANS. According to the PANDAS Network, the treatment has been shown to alleviate symptoms and improve a child’s condition in as little as 3-4 weeks. 

ContinuumRx works closely with the PANDAS Network to raise awareness around the condition and encourage plasma donation to help with the IVIG supply. We also travel to patient’s homes to deliver IVIG therapy so they can remain comfortable in a familiar setting.

Subcutaneous Immunoglobulin Therapy (SGIg)
When a child (or adult) cannot make their own antibodies to fight off infection, they usually have an immunodeficiency disorder. Some examples of these conditions are X-linked agammaglobulinemia (XLA), common variable immunodeficiency (CVID), and severe combined immunodeficiency (SCID).

One form of treatment shown to help patients with immunodeficiencies is subcutaneous immunoglobulin therapy (SGIg). With this treatment, defective antibodies are replaced with healthy ones provided by a donor. 

While this procedure is ordinarily well-tolerated and safe, it can still be a daunting experience for a child. Undergoing SCIg therapy at home can help make patients both young and old feel more at ease. 

Inotropic Therapies for Heart Failure Patient
Inotropes are drugs typically administered to heart failure patients and can be instrumental in keeping patients comfortable or stabilizing their condition while they await transplant. Recently, many patients undergoing inotropic therapy have opted to receive treatment from home. This is primarily attributed to the fact that home infusion is proven to be a clinically safe, cost-effective, and patient-preferred method of care.
A 2007 study published by the National Library of Medicine set out to explore the effects of home inotropic therapy in children with advanced congestive heart failure (CHF). The study found that receiving inotropic therapy from home was significantly beneficial for children stating, “continuous home inotropic therapy in children with CHF is safe with few complications. Home inotropic therapy may result in substantial cost-savings and improve family dynamics by avoiding prolonged hospitalization.”

Parenteral Nutrition and Enteral Nutrition 
Parenteral and enteral nutrition are two types of tube feedings prescribed when a child cannot eat normally. Parenteral nutrition delivers nutrients through a vein, while enteral nutrition is done through the gastrointestinal tract. 

Receiving either parenteral or enteral nutrition is a massive lifestyle change for any individual; however, children and adolescents may need more support from loved ones during this transitional time. 

ContinuumRx realizes how important it is for your child to still maintain a sense of normalcy and independence. That’s why we deliver expert parenteral and enteral nutrition services right from your living room, so treatment can fit into a patient’s day rather than centering around it.

Specialty Medications
Antibiotic, antimicrobial, antiviral, and antifungal medications are examples of infusion treatments a child may need regularly. A child may require this type of treatment if they have conditions like cystic fibrosis, Crohn’s disease, cellulitis, cancer, dehydration issues, prolonged pain, and many others. 

Having one or more of these types of medical ailments can add up to lengthy hospital stays, medical bills, and constant traveling to and from the medical facility. All of these factors can take a toll on a family in more ways than one.

Hospitals are not always the only answer when your child requires specialty infusion medications. At ContinuumRx, we help patients save time and money by bringing the treatment to them. Worried about the cost? Our specialists work with you to vet your insurance and payment options for treatment.
If your family feels overwhelmed by the infusion site or hospital setting, you’re not alone. Your child’s infusion therapy should be a fraction of their daily life, not their whole day. Ready to switch to a more convenient method of care? ContinuumRx can help. We grant families the freedom to heal together in the comfort of their own homes when they need it most.

Contact us today to onboard your child’s therapy.

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Rusty Daily

CRX Welcomes Rusty Daily, New Regional Sales Manager based in Nashville, Tennessee!

As a registered nurse for the last seventeen years, Rusty has dedicated ten years of his career to the home infusion industry. His clinical background, in addition to sales and operations, has enabled him to gain extensive experience and unique industry knowledge.

Rusty is PICC/midline-certified and has worked in pharmacy branch operations, sales, and ambulatory infusion suites. He has used strategic partnerships to help facilities decrease the length of stay (LOS) while transitioning patients home for optimal outcomes.

Working collaboratively with his internal and external partners, he has exceeded corporate goals and objectives with proven growth in his markets year after year. As a result, he has received multiple recognitions and awards from corporate management.

Please reach out to Rusty @ rusty.daily@continuumrx.com.

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What’s Cookin’ (or not) at ContinuumRx During National Nutrition Month?

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Enteral & Parenteral Nutrition Services are Available In-Home

Enteral and parenteral nutrition can be given from the comfort of home.

Author Joseph Raynauld Raymond once said, “diet is the essential key to all successful healing.” The importance of nutrition goes without question, but what happens when a patient cannot eat normally? In this case, experts turn to enteral and parenteral nutrition services. 

Enteral and parenteral nutrition can be done effectively at home, eliminating the need for an extended hospital stay. And our team of licensed professionals here at ContinuumRx is trained to deliver the highest quality of nutritional care necessary for its patients.

What is the difference between enteral and parenteral nutrition, and who requires either?

Enteral and parenteral nutrition are two types of tube feedings that some patients need when their regular nutritional intake is hindered. Enteral nutrition refers to tube feeding through the gastrointestinal (GI) tract, while the parenteral method delivers nutrition through a vein.

Of the two, enteral nutrition is preferred by physicians because it is closer to everyday eating habits, making it easier on the immune system and the patient themselves. Patients are generally recommended to receive enteral nutrition when they have trouble swallowing or chewing. Yet, there are a variety of reasons why a patient may require enteral nutrition, including:

  • Cancer
  • Cardiovascular Disease
  • Cystic fibrosis
  • Diabetes
  • Gastrointestinal disorder
  • High-risk pregnancy
  • HIV/AIDS
  • Pre and post organ transplant
  • Renal disease

Parenteral nutrition is reserved for patients who cannot or will not eat and cannot maintain proper nutrition through the enteral method. In this case, the onset will most likely need to happen in a hospital but can be moved to home care once the patient has adjusted. Those who usually require parenteral nutrition most likely have any of these inflictions:

  • Stomach and intestines that are not working or have been removed
  • Severe nausea, diarrhea, or vomiting 
  • Severe sores in the mouth or esophagus
  • A fistula (hole) in the stomach or esophagus
  • Loss of body weight and muscle with normal enteral nutrition

Both enteral and parenteral nutrition can be done in-home by licensed clinical dietitians, like our team at ContinuumRx.

What benefits does home infusion offer for those needing enteral and parenteral nutrition?

Receiving enteral or parenteral nutrition is an adjustment for many, but you don’t need to undergo that process in an unfamiliar place. Home infusion offers patients a chance to be surrounded by family, friends, and comfortable surroundings. 

In a 2017 study published by the National Library of Medicine, home infusion results were found to be immensely beneficial. It states, “patients overwhelmingly preferred home infusion, reporting significantly better physical and mental well being and less disruption of family and personal responsibilities.”

The cost of enteral and parenteral nutrition can weigh heavily on a family as well. However, the study also found that home infusion was more cost-effective and states, “Home infusion costs were significantly lower than medical setting infusion costs, with savings between $1,928 and $2,974 per treatment course.”

Are enteral and parenteral nutrition through home infusion therapy growing in popularity?

Home infusion therapy has grown substantially in recent years. And the enteral and parenteral nutrition science community is also recognizing it as a primary care method.

In fact, the annual Association of Parenteral and Enteral Nutrition (ASPEN) 2021 Conference is dedicating an entire section forum titled “Home & Alternate Site Care.” The section will discuss the growing popularity of home infusion and alternate site care due to the pandemic.

Why choose enteral and parenteral nutrition services with ContinuumRx?

At ContinuumRx, our team of registered clinical dietitians is trained extensively on enteral and parenteral nutrition services. The care and dedication they have for their patients is the foundation that ContinuumRx was built on.

Living a full and happy life is the goal between patient and physician, and ContinuumRx is here to support and help restore a sense of comfort while achieving that goal. We work with your physician to provide you the best possible care.

Receiving treatment from home provides a chance to be closer to family and friends when you need them the most. So, don’t wait to begin treatment with ContinuumRx; onboard your treatment today!

Contact ContinuumRx Today!

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Felicia Schaps of ContinuumRx is one of NHIA’s 16 Home Infusion Fellows in Program’s Inaugural Year

ContinuumRx is pleased to announce that Felicia Schaps MSN-Ed, RN and Vice President of Nursing and Clinical Compliance, is one of 16 members of the inaugural 2021 Fellow Program (FNHIA) cohort, made up of highly accomplished home and specialty infusion professionals.

The NHIA Fellow Program aims to advance the home and specialty infusion profession by recognizing the contributions and achievements of highly accomplished individuals. NHIA Fellow status is awarded to members who have successfully demonstrated a commitment to the field of home infusion for at least 7 years, have a record of sustained involvement and leadership within NHIA, and have been actively involved in educating practitioners and others.

Learn more about becoming a Fellow!

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home infusion therapy

Humanizing Home Infusion Therapy: 3 Reasons Why You or A Loved One Should Consider It

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.

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Parenteral Nutrition: Medicare Coverage for Home Infusion Therapy

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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.

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