In the past 20 years, Americans have become used to the efficiency and cost savings of receiving all manner of services at home that we used to have to travel for.
That extends well beyond consumer goods and streaming videos, to life-saving medical treatments: Today, vulnerable medical patients receive life-sustaining continuous intravenous drug therapy at home that two decades ago was routinely administered in hospital.
That has huge benefits, for those waiting for a heart transplant in such places as Houston, Cheyenne and New Orleans. It’s a clinical advance that restrains soaring healthcare costs, lowers the risk of hospital-acquired infections and increases patient satisfaction. Thanks to last year’s CURES Act, these patients have a hope for treatment, but not until 2021. Unfortunately, many congestive heart failure patients living all over the United States can’t wait that long in line for heart transplants.
These vulnerable patients are too sick to travel to Washington to implore lawmakers to fix the inadvertent delay in CURES, so I will set out their case here. Home infusion gives continuous intravenous drug therapy to patients with severe congestive heart failure. It alleviates symptoms, keeping them alive and comfortable at home. The treatment is palliative for some patients and is also used as a bridge to a heart transplant. Without home treatment, many patients are admitted to the hospital for care, others have to enter hospice care, and some must undergo invasive surgery to implant a ventricular assist device to help their heart pump blood.
Beyond severely impairing quality of life, it’s a disaster for healthcare costs. Centers for Medicare and Medicaid Services (CMS) data reveals that the average hospital stay for a heart failure patient is 5.6 days at an average daily cost per patient of $2,798. Under the Medicare reimbursement for home infusion that current law won’t allow to begin until 2021, the average cost per day was about $350, including the cost of the drug and associated services. And, heartbreakingly, by removing home treatment as an option, even those patients that had wanted the opportunity to die peacefully at home now have to end their days in a hospice, away from their loved ones and home comforts.
Home infusion has been around for decades, and is covered by every sector of the health care ecosystem other than Medicare. Given the better outcomes and tremendous cost savings, it has been growing rapidly in the United States and is expected to more than double between now and 2024, according to a report by Grand View Research, that notes, “the growing requirement to contain healthcare costs has led to a higher preference for homecare therapies amongst patients, especially the elderly, requiring long-term care.”
However, Medicare patients no longer can receive home infusion because of an unintended consequence of a law passed last year — the 21st Century Cures Act (CURES,) which enjoyed strong bipartisan support for its ambitions of promoting medical research and funding the so-called “moon shot” to cure cancer. The law unfortunately also cut reimbursement for many infusion drugs, reducing monthly Medicare payments by 95% infusion patients. The law did create a new benefit to reimburse home-infusion providers, but that measure does not take effect until 2021 — creating a funding gap for patients. Private insurance, Medicaid, Tricare (for veterans) and Medicare Advantage, all still pay for home infusion, but it is not viable under Medicare after the passage of CURES. It is imperative that Congress now pass a law to pull that benefit forward to 2019 for Medicare patients. CMS says it can implement the home infusion benefit in 2019, if the Senate acts.
Making that change will be a huge boost for the roughly 4,000 Medicare patients in the United States that are waiting for a heart transplant. Every lawmaker I have spoken to agrees if it were their mother or father waiting up to one year or more for a transplant, they’d want them receiving care at home.
Fixing this mess can be surprisingly easy. U.S. senators must pass the Medicare Home Infusion Therapy Access Act of 2017 to restore home infusion therapy payments for patients on Medicare. The bill was introduced by Democrat Mark Warner and Republican Johnny Isakson and has broad, bipartisan backing. The U.S. House of Representatives has already passed legislation to address this issue, but the U.S. Senate must approve its version. In my discussions in Washington, I’ve yet to meet a lawmaker that opposes this sensible fix that’s right morally and economically. Hopefully, that will translate into congressional action soon.
(Daniel E. Greenleaf is president and chief executive officer of BioScrip Inc., a provider of infusion and home healthcare management solutions.)