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Study Finds Medicare Part D Hampers Home Infusion Therapy Access for Dual-Eligible Patients

(Updated June 7, 2007; Original Post November 15, 2006)

Hospital discharge planners experience more difficulty arranging for home infusion therapy for Medicare-Medicaid dual-eligible patients under Medicare Part D than under their previous Medicaid coverage, according to a survey released by by the National Home Infusion Association (NHIA) in November 2006.

Part D limits patient access to home infusion therapy because the program does not cover the pharmacy and nursing services, supplies, and equipment needed to safely and effectively administer the therapy. In most states Medicaid covers at least some of these essential services and supplies. NHIA has worked with the Centers for Medicare & Medicaid Services (CMS) and applauded steps taken by CMS in 2006 year intended to restore the same safe access to home infusion that dual eligible patients had before Part D. However, the survey indicates the Medicare Part D benefit creates problems for treating dual-eligible patients needing home infusion therapy.

“The retail drug dispensing model of the Part D benefit prevents a logical and effective fit for home infusion therapy within Part D, impeding access to safe, quality, and cost-effective infusion therapy for Part D enrollees,” notes NHIA Executive Director Russell Bodoff.

The survey found more than two-thirds (68 percent) of respondents reported delays in hospital discharges for dual-eligible patients due to complications in arranging access for home infusion therapy under Part D, with similar complications for all Part D-covered patients.

Hospital discharge planners also reported:

  • Delays in Hospital Discharges are Lengthy and Costly: Among planners reporting discharge delays for dual eligibles, 86 percent said the delays last one or more days, at an average cost of $1,645 per occurrence to the hospitals. NHIA estimates the annual cost of such delays for all Part D-covered patients may exceed $4.5 billion, based on survey data and information from the “American Hospital Association/Lewin Group Trendwatch 2006.”
  • Patients Forced to Rely on More Costly Nursing Homes: Sixty-three percent of hospital discharge planners said they place more dual-eligible patients in nursing homes or hospital outpatient settings for infusion treatment than before Part D. Care in nursing homes is more expensive than home-based treatment.
  • Access Problems Extend to All Part D Patients: Sixty-seven percent of hospital discharge planners reported complications in arranging access to home infusion for Part D patients who are not dually eligible. This indicates that the structure of the home infusion therapy benefit in the Medicare prescription drug program is problematic for all Part D enrollees.

 

"With costly hospital discharge delays and steering to nursing homes, clearly Medicare's gap in home infusion coverage is both expensive and depriving seniors of their choice to be treated in the comfort of their own homes," adds NHIA Vice President of Health Information Policy Bruce E Rodman.

The internet-based survey, conducted with assistance by the Case Management Society of America (CMSA), polled 246 individuals with hospital discharge responsibilities in 39 states. Hospital discharge planners ensure patients receive appropriate care after their discharge from hospitals. Medicare is the federal health insurance program for seniors and disabled Americans. Medicaid is a federal-state program that provides health coverage for indigent and near-indigent individuals and families. Dual eligibles are persons qualifying for both Medicare and Medicaid health coverage.

NHIA urges Congress to pass legislation to address the significant gaps in Medicare Part D by establishing meaningful coverage of all aspects of home infusion therapy, including the drugs, supplies, equipment, and professional services, as would be addressed in H.R. 2567, a bipartisan bill introduced by Representatives Eliot Engel (D-NY), Kay Granger (R-TX), Tammy Baldwin (D-WI), Chip Pickering (R-MS), Randy Kuhl (R-NY) and John Tierney (D-MA).

  • Click here to view all survey questions and answers from hospital discharge planners.
  • Click here for a one page summary for policymakers.
  • Click here to read a November 30, 2006, Inside CMS article on the survey. It is reprinted here with permission of the publisher, Inside Washington Publishers. Copyright 2006. No further distribution is permitted.
  • Click here to read a December 2006 article on the survey by Specialty Pharmacy News.