GAO study boosts association's message

Wednesday, June 16, 2010

WASHINGTON - A new report by the Government Accountability Office (GAO) backs up what the infusion industry has been saying all along: Therapy is cheaper if it's done in the home.

"We've been trying to tell this story for years," said Russell Bodoff, executive director of the National Home Infusion Association (NHIA). "It felt good that the GAO saw the same thing."

In the June 14 report, "Home Infusion Therapy: Differences Between Medicare and Private Insurers' Coverage," the GAO found that, in the private sector, it is less expensive to provide infusion therapy in the home than in a hospital or nursing facility.

Currently, Medicare may pay for certain infusion drugs under the Medicare Part D drug benefit, but not for services, equipment or supplies.

The GAO recommends that CMS conduct a study to determine if it can realize the same savings in its fee-for-service model.

"As we understand it, CMS is concerned that their reimbursement structure is much different than the private sector," said Bodoff. "Everybody is saying there are savings in the private sector, but CMS is having trouble understanding how the savings would apply in their system."

The NHIA would like to see CMS take it a step further. It envisions a demonstration project like this: A control group of Medicare beneficiaries receiving IV antibiotics--the most common infusion treatment--would receive treatment from one of several selected companies. The companies would include those that serve small, medium and large geographic areas, as well as rural communities, to provide a sense of what savings would be gained in different communities, said Bodoff.

"You actually run people through this system and through a (Medicare) payment and reimbursement process so CMS can see the savings exist," he said.

The NHIA has had meetings with CMS to discuss the benefits of setting up a demonstration project and, with the backing of the GAO study, it plans to continue reaching out to the agency.

"Our goal would be to work together and move this forward," said Bodoff. "We truly believe that a Medicare home infusion benefit will provide savings and benefit patients."

To view the GAO report, go to and click on Reports & Testimonies. Scroll to June 14 for a downloadable version.