Talking Points for Congressional Meetings

I. Introductions

  • [Establish constituent connection: describe your facility, service area, number of employees, etc. Remember the patient always – speak as their advocate.]

II. State purpose of meeting

  • To alert the Congressman/Senator to a serious, unintended gap in Medicare’s possible sites of care for infusion services that affects the sickest patients
  • To propose a common-sense solution that will improve the quality of care for Medicare beneficiaries while lowering treatment costs

III. Briefly describe home infusion

  • [Describe the types of conditions that often require infusion]
  • [Describe the elements – sterile mixing, delivery of drugs, patient/caregiver education, supplies, equipment, monitoring, etc.]
  • [Emphasize that private health plans, Medicare Advantage, Tricare, Medicaid, and the VA have all been using home infusion for decades to keep people out of hospitals and nursing homes.]
  • [Highlight patient satisfaction rates and avoidance of hospital stays and hospital-acquired infections]

IV. Describe the problem

  • The Medicare drug benefit (Part D) covers infusion drugs, but does not allow for reimbursement in the home site of care for services, equipment, and supplies that are necessary to safely provide home infusion. These elements often amount to well over half the cost of home infusion therapy. Patients can’t afford to pay these costs out of pocket.
  • As a result, patients are forced into hospitals, nursing homes, and hospital outpatient departments for treatment, at greater cost to the program, higher risk, and significant inconvenience to the patient. Patients in rural areas face added hardships in trying to access hospital-based care.
  • So, while the drugs are covered, the lack of coverage for the services, supplies and equipment make the drug coverage virtually meaningless for most beneficiaries.
  • [Discuss how a physician’s clinical decisions are restricted because the home is not an option to patients in Medicare.]
  • [If possible, use a personal anecdote to illustrate the problem]

V. Propose the solution

  • The [NEW BILL TITLE] will provide for the home to be site of care for infusion services under Medicare.

VI. Make the request

  • Please cosponsor the [NEW BILL TITLE] and urge that the bill is included in any broader Medicare bill that will be considered.

 

NHIA Contact: Kendall Van Pool, Vice President Legislative Affairs,
703-838-2664
Kendall.vanpool@nhia.org