Medicare Home Infusion Site of Care Act Report
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Why a Study Was Necessary
For decades, the private sector has recognized that home infusion therapy is a cost-effective, clinically effective treatment option. Nonetheless, the Medicare fee-for-service program does not have a comprehensive home infusion therapy benefit. Substantive changes to Medicare coverage policies will require credible evidence that similar savings are possible in the provision of home infusion therapy to Medicare beneficiaries. For that reason, NHIA commissioned Avalere Health to conduct a study of the potential savings to the Medicare program that could result from Medicare coverage of infusion therapy for anti-infective drugs in the home. Anti-infective infusion therapy constitutes approximately 50 percent of the treatments provided by home infusion providers. Thus, savings to the Medicare program from home infusion of this therapy will likely drive the savings that would result from providing a wider range of therapies in patients’ homes.
What NHIA Asked Avalere to Study:
NHIA asked Avalere to analyze the impact on Medicare program expenditures from a portion of patients receiving anti-infective infusion therapy from skilled nursing facilities (SNFs), hospital outpatient departments (HOPDs), and physicians’ offices shifting their infusion treatment setting to the home. The numbers of patients who were assumed to shift anti-infective infusion settings to the home varied by their current setting, but averaged approximately 23 percent of patients receiving anti-infective infusion therapy in these settings.
What Avalere Found:
Under these migration assumptions, there would be an estimated savings to the Medicare program for the 10-year period from 2015 to 2024 of 12.6 percent, or $80 million, of the overall cost of infusion services that migrate from HOPDs, physician offices, and SNFs to home. The first-year savings, assuming implementation in 2015, would be approximately 17.7 percent, or $8.5 million. These calculations take into account the new Medicare Part B program expenditures that would result from new Medicare Part B coverage for infusion-related services, supplies and equipment in the home (the volume of all Medicare-covered anti-infective infusion services—in all settings, not just in the home— would need to substantially rise by at least 7.4 percent, for the expanded coverage to result in net increase Medicare program expenditures). Importantly, Avalere did not calculate the potential additional savings that could result from the avoidance of hospital stays, and hospital-acquired infections, which could be considerable.
Read the Medicare Home Infusion Site of Care Act As Introduced in the Senate and House of Representatives