Recently, we received a referral from Peace Health hospital to provide intravenous antibiotics to a patient living in Blaine. This gentleman was admitted to the hospital for endocarditis, which is an infection of the heart valves. The standard treatment protocol includes 6-8 weeks of antibiotics delivered through an IV line. Since the patient cannot stay in a hospital for that long (without racking up a huge bill), home IV services such as ours are asked to provide care for these patients in their homes. It is safe, efficient and cost-effective for the medical system. Patients love it because they get to heal in the comfort of their own home environment.
Sadly, the patient in Blaine was covered by Medicare. This means that he would not have access to home infusion services, because Medicare does not pay for a majority of the costs associated with the care. Medicare Part D will help cover the costs of the drugs involved, but not the supplies, equipment and pharmacy-related services that make up more than half the cost of the therapy. This patient now had three choices: travel to and from the hospital out-patient facility every day for his medicine; check into a skilled-nursing home for 6-8 weeks; or pay us out-of-pocket for our services.
Since the patient lived in Blaine, driving to the hospital daily was not an option due to his health and the travel time involved. And although our cash rates are fair, the patient did not have the funds to pay us for our services. His one remaining option was to go to a skilled-nursing facility, even though his wish was to be at home with a supportive family.
Why does Medicare put patients in this position? Why would they cover the services at the hospital, at nursing homes and at outpatient clinics, but not at home? Virtually all national private insurance companies, state Medicaid programs and managed care organizations (such as Group Health) provide coverage for home infusion, but Medicare itself does not.
For most insurance companies, the decision to cover is obvious. First, the cost of home infusion is far less than the same therapy delivered at a hospital or a skilled-nursing home. Second, the data is clear that patients suffering from infection are far better off at home, as they are much less likely to experience secondary infections that may result in unnecessary re-admissions to the hospital. And last, most patients who are able certainly prefer to be at home, which offers a psychological boost and can further expedite the healing process.
Medicare could save money, protect patients from the risk of re-infections, potentially shorten the duration of therapy and vastly improve the quality of life for patients. Instead, time and money is wasted, patients are put at risk and the U.S. taxpayer continues to foot the ever-increasing bill.
The Centers for Medicare and Medicaid Services is the governmental agency that oversees Medicare. They do not have the authority to change the coverage criteria for Medicare beneficiaries. Instead, it is up to Congress to enact this change. Given the current economic climate and the need to control health care spending, you would think that your representatives would be eager to cast a vote that closes this egregious coverage gap for our seniors and disabled Americans. It is a rare win-win for all sides, a great opportunity to maintain Medicare solvency and do what is best for patients.
It is always effective to contact your local, state and national representatives to let them know about this issue. Urge them to become a co-sponsor of the House (H.R. 2195) and Senate (S. 1203) bills already introduced by their colleagues in Congress.
And if you or anyone you know has been put in a similar situation due to the lack of Medicare coverage, please reach out to us at Infusion Solutions. We would be grateful for the opportunity to share your story with elected officials and industry leaders to further the argument to enact change now.
When it comes to healing and health, there is truly no place like home.
Rowena Birnel is president and CEO and Chuck Loos is account manager at Infusion Solutions in Bellingham. Reach him at 360-933-4892.