Keep home infusion off bidding table

Thursday, August 25, 2011

ALEXANDRIA, Va. - CMS must continue to exclude home infusion therapy from competitive bidding, say infusion stakeholders.

In a July 15 letter to CMS Acting Administrator Donald Berwick, the National Home Infusion Association (NHIA) outlined reasons why the therapy should be excluded from Round 2. The category was not included in Round 1.

"With regular DME, it's basically a product with a small service component, but infusion therapy is largely a service with a small product component," said David Franklin, CEO of Advanced Care Consulting Services. "Anything with a large service component doesn't lend itself to competitive bidding."

CMS hasn't yet said which product categories will be included in Round 2, but at a meeting of the Program Advisory and Oversight Committee this spring, the agency listed the expenditures of product categories that they were looking at for potential inclusion in the competitive bidding program. That list included expenditures related to products within the home infusion pump benefit. 

Those numbers are misleading, says the NHIA. The home infusion market is highly segmented with several subcategories that should be excluded from CMS's savings estimates. For example, the list of contains expenditures certain limited distribution drugs paid for under Part B, which are offered by only a very few specialty pharmacies. 

"If you take those out of the equation, then the total Medicare allowed charges would be much, much less," said Bruce Rodman, vice president, health information policy for NHIA. "The potential savings to the government (under competitive bidding) would be much lower. There are bigger apples to pick off the tree."

Further complicating the issue: Medicare coverage of home infusion therapy is split between parts B and D. Subjecting just part of the benefit to competitive bidding would create a nightmare for coordinating patient care, said Rodman.