Home Health & Hospice Week

Paying only when clinician is present is a mistake.

The advent of a home infusion benefit under Medicare has lots of promise — but a new proposal isn’t living up to it.

The Centers for Medicare & Medicaid Services touts the home infusion proposal that it includes in the 2020 Home Health Prospective Payment System proposed rule. “We are proud to announce the new permanent home infusion therapy benefit that will give patients the freedom to safely access critical treatments, such as chemotherapy, at home instead of traveling to the hospital or doctor’s office, improving their quality of life,” CMS Administrator Seema Verma says in a release. The benefit would take effect in 2021, a year after the transitional benefit taking effect in 2020.

“Home infusion therapy is the adminis­tration of certain types of medication utilizing a durable medical equipment pump in the beneficiary’s home, and includes professional services, patient education, and training and monitoring of patient care,” CMS explains in the release. “This benefit will give beneficiaries the option to receive critical infusion drug therapies at home, like anti-infectives, chemotherapy or treatment for immune deficiencies, instead of in a hospital or doctor’s office.”

CMS is proposing to group home infusion drugs into three payment categories, each with a single unit of payment, the agency explains in a fact sheet about the rule. Additionally, CMS is proposing to adjust this single unit of payment by the Geographic Adjustment Factor (GAF) — a weighted composite of the three geographic practice cost indices used for the physician fee schedule.

Plus: CMS is proposing higher payment amounts for the first home infusion therapy visit, “and in order to make these payment adjustments budget neutral, CMS is proposing a small decrease in the payment amounts for each subsequent visit,” the fact sheet says.

The benefit was required by the 21st Century Cures Act.

The National Association for Home Care & Hospice “continues to consider this reform as falling far short of what is needed to provide needed home infusion therapy to Medicare patients, comparable to what is available to privately insured individuals,” NAHC says in a rule summary.

“Home infusion is a vital patient-centric service that has proven to lower healthcare costs and improve patient outcomes,” stresses an official with Premier Inc., a “healthcare improvement company” based in Charlotte, North Carolina. “Premier has long advocated for comprehensive home infusion reform to provide high-quality patient care in the most clinically appropriate and cost-effective care settings,” says Premier spokesperson Blair Childs.

“However, CMS continues to misconstrue how home infusion services are provided by restricting payment to when a skilled professional is in the patient’s home,” Childs criticizes in a statement. “CMS’ policy runs counter to Congres­sional intent clearly articulated in the 21st Century Cures Act and Bipartisan Budget Act of 2018 and is contrary to the Administration’s goals of decreasing health care spending,” he contends.

Premier vows to work CMS and Congress on the “misguided policy.” NAHC will appeal to Congress for intervention, it says.

If the kinks can be worked out, watch for a “mad rush” to provide home infusion therapy, suggests Lynn Olson with billing company Astrid Medical Services in Corpus Christi, Texas.