Connie Sullivan in a screen capture from the Jan. 8 subcommittee meeting.
The bottom-line message from Connie Sullivan to members of Congress gathered for a Jan. 8 Energy and Commerce health subcommittee was simple: Reforming Medicare’s home infusion coverage is a logical move to benefit all stakeholders.
Sullivan — president/CEO of the National Home Infusion Association (NHIA) — was on Capitol Hill to testify as part of a three-hour hearing on several durable medical equipment (DME)-related bills, including H.R. 2172, the Preserving Patient Access to Home Infusion Act.
“NHIA represents pharmacies that coordinate and deliver home infusion care to patients across the country,” Sullivan said in her opening statement to the Energy and Commerce health subcommittee. “Home infusion is a mainstream part of modern health care delivery. Every year, over a million patients rely on home infusion to treat serious infections, immune disorders, cancer, heart failure and other complex conditions.”
She noted that receiving infusion treatments at home “is strongly preferred by patients because it helps them get the IV medications they need with the least disruption to their daily lives, allows earlier discharge from the hospital, and lowers the risk for complications such as drug-resistant infections.”
But despite all the upside, “Home infusion has largely been out of reach for patients with traditional Medicare,” Sullivan said. “The Medicare home infusion benefit only covers a handful of available drugs, and is limited to a set of professional services that occur face to face in the home.”
‘A car without an engine’
Because of Medicare’s different coverage policies, Sullivan said beneficiaries “remain significantly underserved compared to those insured under commercial or other government plans” — an assessment “confirmed in a 2010 study conducted by the Government Accountability Office.”
Rep. Buddy Carter (R-Ga.), a licensed pharmacist, told colleagues on the subcommittee, “I always try to pull the conversation back to what patients deal with after they leave the hospital because treatment doesn’t end at discharge. We all know that. Many still need infusion treatments. And the question is, where do they finish them and how hard is it on the patient and the family?
“Home infusion is about safe care at home, not just drug delivery. But Medicare patients often struggle to access it, pushing them back into hospitals or facilities. And that’s not what we want, options that are tougher on seniors and families and use more resources than needed.”
Carter asked Sullivan to describe the role that home infusion pharmacists play.
“The Medicare benefit today has an unusual restriction that does not exist in the commercial market, which has a robust home infusion benefit,” Sullivan replied. “Medicare restricts the services payments only to those that take place face to face in the home, which essentially is nursing.
“But without the essential pharmacy services that occur in the background in the pharmacy, home infusion is just simply not available. I like to describe it as the Medicare benefit for home infusion is kind of like a car without an engine. The pharmacy is what makes home infusion a functioning benefit.”
Sullivan noted that it’s the pharmacy that designs a care plan that the patient and caregivers can follow on their own, “with support of nurses when it’s needed. But they also provide that continuous support and 24/7 availability to answer questions, serve as a point of contact for physicians, and ultimately prevent patients from returning to the hospital or needing to visit the emergency room for support.”
Carter then asked Sullivan how home infusion reform could impact Medicare beneficiaries.
“It will change patients’ lives dramatically,” Sullivan said. “They simply do not have the same benefit that everyone else in the country essentially enjoys and has access to when they might need a home IV therapy unexpectedly.”
Rep. Nick Langworthy (R-N.Y.) told Sullivan that his district “covers a large stretch of rural communities, where a simple infusion appointment can easily turn into an all-day ordeal for patients and caregivers — and in the winter, especially. Weather and road conditions can make repeated trips to a hospital outpatient department unrealistic. And missing doses isn’t just inconvenient; it can derail the treatment plan of a patient.”
To avoid treatment lapses, Langworthy added, “the system too often defaults patients into a more inconvenient setting, simply because it’s the only workable way to complete their treatment.”
“Home infusion operates on a model that is incredibly efficient,” Sullivan replied. “And we rely on the pharmacy to provide that support, the continuity of care for patients so that they can independently infuse their medications at home. They don’t rely on a nurse regularly. The nurse visits periodically to make sure things are on track, to lay eyes on the patient. But the support really comes from the pharmacy on a daily basis and largely happens behind the scenes.”
Even health systems providing acute care do not want “almost a million beneficiaries under the Medicare program being sent to hospital outpatient departments for these infusions,” Sullivan added. “Most health systems have signed letters of support of this particular legislation because they recognize these are not patients that need to be there.”
A common-sense solution
Langworthy said when it comes to reforming Medicare’s home infusion benefit, the “key word is common sense.”
And under questioning from Rep. Dan Crenshaw (R-Texas), Sullivan said, “The range of medications available to patients in the home, if you have commercial insurance, reaches above 300 different individual medications. Unfortunately for Medicare beneficiaries, they’re limited to a handful of drugs that use an item of DME or an infusion pump to be administered. So they live with much more restricted access under the Medicare program.”
Crenshaw then asked if the proposed reform would remain budget neutral or save Medicare money.
“Historically, the Congressional Budget Office has scored home infusion legislation as something that would generate savings,” Sullivan said. “We’re still waiting for an updated score on the provisions in this bill. However, when we look at care in settings such as hospital admission or outpatient departments or urgent cares, generally we feel confident that home would be a more efficient model for those patients.”
Sullivan told Rep. Erin Houchin (R-Ind.) that fewer than 70 providers currently provide home infusion services to Medicare patients, “which essentially means that patients in most areas are not accessing this benefit. And in some states, there are no patients accessing this benefit and no providers offering the benefit.”
When Houchin asked if that lack of access resulted in treatment delays, Sullivan said, “I think it’s probably closer to no treatment versus a delayed treatment.”
Rep. Diana Harshbarger, PharmD (R-Tenn.), vice chairman of the health subcommittee, submitted into the record a letter from a constituent “who stands to benefit from this legislation.” Harshbarger noted this constituent lives in a rural area, uses a wheelchair, and “relies on these [infusion] services for life-saving treatment.” Sullivan agreed that in this constituent’s case, getting to a medical facility to receive treatments “would be several hours [worth of driving] through the mountains in inclement weather, which is a very difficult thing for a lot of patients to do, particularly our seniors and those with disabilities.”
After the meeting, the NHIA sent out a Jan. 8 bulletin to members.
“Congress is increasingly recognizing that Medicare’s home infusion benefit is incomplete and, as a result, too many beneficiaries are pushed into facilities even when receiving therapy at home is safe and workable,” Sullivan said. “Today’s hearing is an important step forward — and it underscores that the case for fixing Medicare’s home infusion benefit resonates on both sides of the aisle. NHIA looks forward to working with committee leaders and bill sponsors to keep moving this legislation toward enactment.”
