Infusion industry tries again

Tuesday, July 26, 2011

WASHINGTON - Home infusion stakeholders are back with another bill that seeks to close a payment gap in how Medicare pays for the therapy.

"We'll continue to knock on the doors of Congress until this legislation is passed," said John Magnuson, vice president of legislative affairs for the National Home Infusion Association (NHIA). "It's needed, it fixes the problem and it's good for Medicare and Medicare patients."

Sponsored by Sens. Olympia Snow, R-Maine, and John Kerry, D-Mass., and Reps. Eliot Engel, D-N.Y. and Tim Murphy, R-Pa., the Medicare Home Infusion Therapy Coverage Act of 2011 would require Medicare to pay for infusion-related services, supplies and equipment under Part B. Payment for the drugs--which Medicare already pays for--would remain under Part D.

With the average cost to provide infusion therapy per day about $200 in the home; $300 in a skilled nursing facility; and $1,200 in a hospital, the bill makes good financial sense for Medicare, say stakeholders.

"We take Medicare patients and we put them into institutional settings at higher costs (for services) that can easily be provided at home," said Russ Bodoff, NHIA president and CEO. "The physician and the patient prefer it at home, and more and more, it is apparent to members of Congress and other folks that this is something that just makes sense." 

Similar legislation was introduced in the past in the House and Senate, most recently in the 111th Congress, where it was co-sponsored by 32 senators and 105 representatives. What's different this time around: A study from the Government Accountability Office, published in June 2010, found that in the private sector, it is less expensive to provide infusion therapy in the home. The report also recommended that CMS conduct a study to determine if it can realize the same savings in its fee-for-service model.

"This is Congress's own research arm and one of the most respected government agencies there are," said Bodoff. "It's saying we can lower costs and provide quality care and that's a winning combination any way you look at it."