Bidding ‘needlessly complicates’ home infusion benefit

Friday, May 4, 2012

ALEXANDRIA, Va. – Home infusion stakeholders have asked CMS to rethink its plan to include the therapy in the Round 1 re-compete of competitive bidding. 

"It's one of the most service intensive and invasive therapies under the Part B program and we are just extremely disappointed," said John Magnuson, vice president of legislative affairs for the National Home Infusion Association (NHIA). "Subjecting it to the bidding process needlessly complicates Medicare reimbursement for an area that has complex and unresolved issues."

In its April 16 announcement, CMS called for bidding on infusion pumps and related supplies.

Stakeholders, who have worked for several years to create a more coordinated and comprehensive Medicare benefit for the therapy, say subjecting home infusion to competitive bidding will needlessly disrupt patient care.

"Pharmacies need to be monitoring the patients very closely in close partnership with the ordering physician," said Bruce Rodman, vice president of health information policy for NHIA. "The pharmacies have established good relationships—that's very important to ensure effective care—and act in a consultative manner interpreting lab results and advising on the best type of treatment in the home."

Stakeholders worry that out-of-state companies could submit low-ball bids. Safe, effective home infusion therapy requires a local presence, they say.

"There's a high risk of infection so these patients have got to be monitored in the home setting,'" said Bob Simmons, vice president and owner of Dedham, Mass.-based Boston Home Infusion. "If someone wins a bid, at a ridiculous price, that is based across the country, how will that patient receive adequate service?"

When infusion patients don’t receive proper care, they wind up back in hospitals or skilled nursing facilities at a much higher cost, stakeholders say. The NHIA has estimated that it costs about $200 per day to provide infusion therapy in the home vs. $1,200 in a hospital.

Complicating matters: Medicare pays for about two dozen infusion drugs under Medicare Part B; the rest are paid for under Part D. It is not unusual for patients to require both. Under competitive bidding, that could mean a patient would need to use more than one infusion pharmacy, something that infusion pharmacies typically frown on.

"Care needs to be carefully coordinated and the more hands on you get into that, the more opportunities there are for it to be messed up," said David Franklin, president of Advanced Care Consulting Services in Shelby Township, Mich.