Baucus admits infusion gap

Thursday, October 22, 2009

WASHINGTON – Congress needs to figure out how to pay for home infusion coverage, said Sen. Max Baucus, D-Mont., chairman of the Senate Finance Committee, during a health care reform bill markup session Sept. 25.

“There is certainly a gap in benefits,” he said.

Currently, Medicare pays for home infusion drugs under Part D, along with a small dispensing fee for services and supplies. Bills introduced inn the House and Senate in January, known as the Medicare Home Infusion Therapy Coverage Act of 2009, would require Medicare to pay for services, supplies and equipment related to home infusion therapy under Part B.

A healthcare reform amendment introduced Sept. 25 by Sen. Blanche Lincoln, D-Ark., described the gap in Medicare coverage and told committee members that Medicare is basically the only payer who does not reimburse for home infusion treatments. Lincoln is one of the home infusion bill’s sponsors.

“Offering people the choice of infusion treatment at home for a lower cost will be a win-win for patients, families and the Medicare program,” she said.

The average cost to provide infusion therapy per day: $200 in the home; $300 in a skilled nursing facility (SNF); and $1,200 in a hospital, according to the National Home Infusion Association (NHIA), which has lobbied for several years to get home infusion covered by Medicare.

“It’s definitely penetrated the consciousness of the Hill,” said John Magnuson, vice president of clinical affairs for NHIA. “Unlike previous years, when you meet with staff (and lawmakers) there is now a significant knowledge of home infusion and the benefit of it.”

Lincoln withdrew her amendment after Baucus promised to work with her on the issue and include it in the final healthcare reform bill. She also sought Baucus’ help on getting a Congressional Budget Office (CBO) score for the legislation. Obtaining an accurate  score is crucial to demonstrating the cost-effectiveness of providing home infusion therapy, said Russell Bodoff, NHIA executive director.

“We strongly believe that instead of cost neutral, this is a cost savings,” he said. “By moving the cost out of hospitals and SNFs we save money.”