NHIA Provider Membership
NHIA Key Accomplishments
Since the 2008 Reorganization
The reorganization of NHIA in 2008 from a professional society to a trade association allowed NHIA to significantly increase its level of service and program activity on behalf of its company members—and all of their employees. Below is a list of accomplishments that have taken place in the last three-plus years.
- Transformed from a financially struggling professional society to a successful trade association, that distinguishes itself through its commitment to enhancing and developing the alternate-site infusion field—inclusive of better representing all stakeholders in the field, both publicly and politically. Moving to a trade association model assured all member companies’ employees full access to NHIA membership benefits.
- Expanded the size and composition of the NHIA Board of Directors to fully represent the diversity of the alternate-site infusion field and the Association’s membership.
- Revamped entire NHIA website to provide members and all alternate-site infusion stakeholders with a richer, more user-friendly online experience. Traffic to NHIA’s website dramatically increased, as users took advantage of more robust content.
- Lobbied the Centers for Medicare & Medicaid Services (CMS) successfully to continue improvement of requirements for Medicare Part D plans inclusion of home infusion drugs in their formularies.
- Petitioned CMS effectively to permit professionally-licensed contractors (e.g. pharmacists and others) to provide services for home infusion providers where state licensing regulations permit (this was included in supplier standards issued in 2010).
- Petitioned CMS successfully to allow Medicare Advantage plans to accept single, consolidated claims for home infusion drugs, services, supplies and equipment, leading to claiming efficiency for home infusion providers.
- Developed web-based grassroots section on the NHIA website to help members more proactively engage in direct outreach at the local level, and to increase the industry’s voice in Washington.
- Engaged in strategic public relations efforts, leading to a feature article published in The Wall Street Journal that highlighted how home infusion therapy is safe, high-quality and cost-effective, while also emphasizing the need for legislation that would provide Medicare beneficiaries meaningful access to infusion therapies at home, denied to them under the current program.
- Established the Future of Infusion Advisory Council (FIAC) to engage leading manufacturing and service member companies in helping to address the critical issues and challenges facing the industry. The FIAC’s significant financial support, leadership and collaborative partnership with the NHIA Board, staff and provider members has been instrumental in developing and advancing the strategic goals of the Association.
- Conducted the first-ever major, industry-wide educational event on Capitol Hill to generate awareness among Members of Congress about home infusion therapy—including the lack of meaningful Medicare coverage. Implemented in conjunction with hundreds of visits to elected representatives, the Hill event was held in the largest meeting room on Capitol Hill, attracted over 350 attendees, included patient testimonials, and featured keynote addresses by two Senators and a member of the House of Representatives.
- Developed award-winning patient video that dramatizes the detrimental trials and tribulations of our nation’s elderly and disabled when faced with a lack of Medicare coverage of home infusion therapy.
- Worked in collaboration with provider members to capture a dozen patient stories to highlight the personal experiences of Medicare beneficiaries denied home infusion therapy—these touching, real life stories offer the best opportunity to gain congressional support and media awareness of the need to gain full coverage of home infusion therapy.
- Raised awareness for the need of a Medicare home infusion fix via National Public Radio (NPR) print and aired radio stories, which brought to life the hardship one elderly patient faced when denied safe, cost-effective infusion therapy at home and was forced to undergo twice-daily treatments at a health care facility far from home.
- Increased, through unyielding NHIA outreach, the number of organizations supporting the proposed Medicare legislation to thirty-two varied groups—representing physicians, dieticians, disease-specific national organizations, aging services, patient advocacy groups, and industry trade groups. This support has expanded and diversified the alternate-site infusion industry’s voice in Washington.
- Published new, helpful reimbursement educational product—NHIA’s Medicare Billing for Denial Commercial Claim Crosswalk Tool.
- Petitioned TRICARE’s military insurance program successfully to write its first policy on coverage for home infusion therapies that resolved significant payment denial situations.
- Informed and guided alternate-site infusion providers on meeting Medicare requirements for accreditation and obtaining surety bonds, which included proactive NHIA collaboration with accreditation providers and the National Supplier Clearinghouse (NSC).
- Established a forum for communicating with the Blue Cross and Blue Shield Association in order to facilitate resolution of reimbursement challenges for claims handled through the BlueCard® system. One result was a decision in 2011 by a Blue plan to conform to the drug coding conventions of most other Blue plans.
- Worked successfully with CMS to indefinitely delay planned claim rejections when ordering physicians are not enrolled in its Provider Enrollment, Chain and Ownership System (PECOS) enrollment database.
- Established the NHIA Consultant Network database to match knowledgeable industry consultants with the needs of NHIA members and industry stakeholders.
- Responded to the draft CDC Guidelines for the Prevention of Intravascular Catheter-Related Infections, final copy released in April of 2011, as a guide to health care providers who insert catheters and are responsible for surveillance and control of infections in hospital, outpatient, and home health-care settings.
- Reacted swiftly to White House website statement that incorrectly listed home infusion as part of the Medicare fraud problem—through aggressive outreach had the statement removed within 48 hours.
- Communicated to Health and Human Services (HHS) Secretary Kathleen Sebelius, the Association’s concern that CMS, in press statements, often was confusing home infusion with the fraudulent HIV infusion clinics that were being investigated by CMS and the Justice Department. Determined outreach by NHIA secured a written clarification that the infusion fraud being investigated pertained only to clinics and solo practitioners and not home infusion providers.
- Through our work with Congressional sponsors, the Patient Protection and Affordable Care Act of 2010 included the requirement for the Medicare Payment Advisory Commission (MedPAC) to conduct a comprehensive study of the home infusion field, with a report due in June 2012.
- Launched Phase I of a comprehensive, multi-year, industry-wide effort to collect data to better define the alternate-site infusion industry and its value proposition—the NHIA Industry-Wide Data Initiative is a strategic response to addressing the field’s lack of standardized data and core measures vital to effecting change in public policy and to strengthening providers’ clinical and operational effectiveness in the care and service of patients.
- Collaborated in a comprehensive manner with industry stakeholders in the submission of comments to the Food and Drug Administration (FDA) following the launch of the agency’s Pump Safety Initiative that called for a more restrictive and complex approach to the infusion device approval (510-K submission) process. The request to reconsider the approach, so as not to limit infusion pump innovation or improvement as a result of an overly complex process, was one of several dozen received that led to a study by the Institute of Medicine, just finalized in July of 2011.
- Filed complaint against Medicare for not accepting HIPAA-standard Healthcare Common Procedure Coding System (HCPCS) per diem “S” codes for submitting billings for denial to Medicare (awaiting corrective action in 2011).
- Obtained clarification from CMS that accredited home infusion providers are deemed as meeting fraud, waste and abuse training requirements for Medicare Part D and Medicare Advantage Plans.
- Via NHIA’s work with Congressional leaders, a formal study by Congress’ research arm, the General Accountability Office (GAO), was conducted—and the exciting results from the study demonstrated that home infusion provides costs savings, quality care and no over utilization. The GAO recommended that the Secretary of HHS should conduct a study of home infusion therapy to inform Congress regarding potential program costs and savings, payment options, quality issues, and program integrity associated with a comprehensive benefit under Medicare.
- Launched online version of INFUSION Magazine—the virtual edition provides readers with enhanced capabilities for viewing and navigating through each issue and the ability to share articles electronically.
- Facilitated the successful completion of Phase I of the NHIA Industry-Wide Data Initiative—the first-ever comprehensive, field-specific collection of standardized data pertaining to the alternate-site infusion industry. With surveys received from 283 licensed pharmacies that represented 74 member organizations, results from the study can be extrapolated to the NHIA membership with a 90% level of confidence.
- Developed and released Central Vascular Access Device (CVAD) Guidelines for the Home-Based Adult Patient—a concise tool created by industry nursing experts that represents a standardized approach to CVAD care for the alternate-site infusion patient.
- Took productive action that prompted CMS to issue clarification to end denials of claims to Medicare for dialysis patients also needing non-dialysis-related home infusion therapies.
- CMS accepted NHIA recommendations for improvement of coverage for home infusion drugs in the 2012 Medicare Part D program operations.
- Recommended to CMS that it should assure providers of home infusion therapy the ability to participate in Accountable Care Organizations (ACOs).
- Commented to CMS that state Medicaid programs should be required to analyze provider costs for setting rates, rather than making arbitrary reductions.
- Petitioned CMS successfully to delay implementation of, and to relook at, new Medicare billing requirements for drugs refilled into implanted pumps in physician offices.
- NHIA legislative team briefed MedPAC research team on key issues impacting the alternate-site infusion field. MedPAC followed with interviews with dozens of NHIA provider members of various sizes and locations.
- Launched NHIA Standards for Ethical Practice to reflect the alternate-site infusion industry’s longtime commitment to ethical practices, while delivering safe, high quality infusion therapy. The Standards reaffirm providers’ pledge to conduct business operations with the highest level of integrity and represent an excellent opportunity to advance the field by promoting its sound reputation among key stakeholders and the general public.
- Realigned NHIA member committees to ensure that all committee activities support NHIA’s strategic initiatives and address the latest industry developments, while offering excellent learning, networking and collaboration opportunities for Association members.
- Urged CMS to exclude home infusion therapies from Round Two of the Medicare competitive bidding program, similar to NHIA's success in excluding home infusion from Round One.
- Initiated various meetings with the senior leadership of CMS’s new Center for Medicare & Medicaid Innovation to enhance the Center’s understanding of the issues surrounding the lack of Medicare coverage of home infusion therapy—and to work towards a potential demonstration project.
- The Medicare Home Infusion Therapy Coverage Act of 2011 was introduced concurrently in the Senate (S.1203) and House (H.R 2195) to provide Medicare beneficiaries with meaningful access to home infusion therapy. Additionally, the re-introduction of the House bill also includes highlights of the positive findings that emerged from the 2010 GAO study that demonstrated home infusion therapy provides costs savings, quality care and no over unusual utilization.
- Met with AARP to seek support regarding the lack of meaningful Medicare coverage for home infusion therapy—as a result of this collaborative NHIA outreach, AARP endorsed H.R. 2195 and S. 1203 through letters to House and Senate bill sponsors.
- Implemented a successful, strategic-driven financial management system to reduce and eliminate the Association’s massive, longtime debt—resulting in the avoidance of bankruptcy in 2008 and the stabilization and optimization of the Association’s limited resources. The solid plan eliminated past due rent and service payments in 2008, paid off a very large bank line of credit loan in 2009, and moved NHIA back on the correct payment schedule (preventing default) with the Association’s long-term start-up loan payments to the National Community Pharmacists Association (NCPA).
- Advocated on behalf of members, and provided updates on Medicare changes related to the Medicare claims processing contractors and NSC, through NHIA’s active participation in the Durable Medical Equipment Medicare Administrative Contractors (DME MAC) Advisory Councils.
- Produced four very successful and highly rated NHIA Annual Conferences, each receiving impressive evaluations scores across the board, as well as the highest ratings ever in many of the key education, conference and exposition areas of measurement—including an Overall Conference Customer Satisfaction & Value rating of over 98% for each of the years 2008 through 2011.
- Continued to update and release annual versions of the NHIA National Coding Standard for Home Infusion Claims under HIPAA, which presents the Healthcare Common Procedure Coding System (HCPCS) per diem "S-codes" as a comprehensive coding system—that is widely used by payers and providers (since its original introduction in 2002) to encourage standardization and payment for all industry services provided.
- Facilitated the introduction of legislation in the Senate and House to provide meaningful coverage of home infusion therapy for older and disabled Medicare beneficiaries—access presently denied to them under the current program. The proposed legislation enjoyed the strongest support yet by Senators and Representatives of any Bill in the history of the Association, with NHIA attaining over 130 co-sponsors for the legislation.
- Initiated collaborative discussions in 2009 and achieved resolution in early 2010 among provider and business firm stakeholders with the New York Board of Nursing that enabled patients to receive complex Monoclonal Antibody (MAB) therapies from well-trained infusion providers, in the comfort and safety of their own homes. This overturned a July 2009 Board of Nursing Opinion that prevented home infusion providers from delivering these therapies in New York State.
- Introduced, in 2009, free Continuing Education (CE) articles for Association members in every issue of INFUSION Magazine—representing at least six free contact hours of pharmacy and nursing CE credits each year since then.
- Instituted the NHIA Talk Infusion Membership Forum—a service of free educational and informational teleconferences for NHIA members, that take place two to four times a year.
- Engaged in an in-depth strategic planning process comprised of the NHIA Board of Directors, FIAC, and the NHIA management team to develop a future roadmap for the Association, including the launch and implementation of a comprehensive three-year strategic plan for 2009-2011.