Recent changes in Medicare reimbursement policy have led to the creation of a bundled payment for home infusion therapy (HIT). While the full benefit won’t start until January 1, 2021, a transitional payment is currently in effect. The creation of this bundled payment indicates that CMS recognizes the value of HIT and the need to streamline the varying reimbursement pathways that have been traditionally associated with the service.
Per CMS, HIT refers to the “intravenous or subcutaneous administration of drugs or biologicals to an individual at home.” HIT generally includes several elements: the drug, the equipment and the supplies. It also requires a nurse to educate the patient and their caregivers on how to safely administer the drug and recognize potential side effects. The intensity of nursing services typically depends on the drug being infused and the patient’s acuity level. Some drug administration is so complex that a nurse is needed to be present every day an infusion must occur whereas other drugs only require nurses to be in the home periodically assess the infusion site on the body.
In addition to the changing regulatory landscape, there are several reasons why growth in HIT continues.
First, the growing prevalence of chronic disease has increased demand for the service. People are living longer which has led to an increasing incidence of chronic disease. HIT allows people to avoid costly inpatient care and creates more room in outpatient centers for individuals that are not well-suited for HIT.
Second, receiving care at home improves patient experience. Allowing patients to receive care in the comfort of their home enables them to continue their daily lives with minimal disruption. This leads to better patient outcomes and improved patient satisfaction.
As the health care system continues to evolve away from fee-for-service, HIT is an opportunity to not only improve quality but also reduce costs. Perhaps most important, HIT allows the patient to be a more active member of their care team due to the rigorous patient education that occurs as part of this service. Lastly, it reduces one’s likelihood of developing a hospital-acquired infection which could lead to an avoidable readmission.
All these reasons lend support to health care’s triple aim: improving population health, improving patient experience and reducing per capita costs. It is for this reason that many are seeing promise in home infusion.
To learn more about URAC’s recently launched Medicare Home Infusion Therapy Supplier Accreditation, click here.