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Patient Example #1:
Patient is a 78 year old male on Medicare who before entering the hospital, was living independently with his wife of 50 years. His treatment calls for two antibiotics, each infused over one hour (total 2 hour infusion) three times daily for 5 weeks (35 days). The discharge planner was having difficulty discharging him from the hospital to return to his wife, due to the Medicare coverage which would have him paying out of pocket for his treatment. Due to his fixed pension, a down economy, he is unable to afford the out of packet treatment costs. His final outcome was being forced into a nursing home (SNF) for his treatments, at a significantly higher cost to Medicare.

Patient Example #2:
Patient and spouse reside together in an assisted living facility. Both reportedly suffer from early-stage senile dementia/Alzheimer’s disease and, according to family members, are marginally capable of self-care with each relying on the other for support. Following visit to patient’s physician office, patient was diagnosed with bone infection and prescribed a 5 week course of IV antibiotic therapy. Patient has traditional Medicare Part A and B and no part D plan. Because the patient was referred directly from the physician office rather than discharged from a hospital, coverage under Medicare for this therapy required admission to a hospital and then discharge to a skilled nursing facility. Patient’s family was also concerned that admission of the patient to a SNF would necessitate transferring patient’s spouse to a nursing home.

Patient Example #3:
Seventy-three year old male patient with Parkinson’s. Needs Rocephin IV treatment for 70 days to treat infection acquired while in hospital. Was quoted an out of pocket cost of $12,000 for home infusion vs. Medicare paying $27,000 for hospital outpatient treatment. Due to limited income, will need to be treated in the hospital outpatient. 63 year old wife is very concerned that he already acquired an infection while in the hospital, and fears additional infections, as he is also undergoing wound care treatments. In addition, they live a considerable distance from the hospital outpatient, and to support her husband during treatments, she is forced to stay in a hotel room or make three daily trips back and fourth to the hospital.

Patient Example #4:
Mrs. Smith is a 75 year old widow who lives alone and enjoys an active life. She has three children who live nearby, but all work full time and are only available to assist her with any needs she may have in the evening or on weekends. Mrs. Smith volunteers at the local food pantry, and delivers meals-on-wheels to 10 senior citizens three days per week.  During a recent trip to the grocery, she slipped on ice getting out of her car, and broke her right hip. While in the hospital for hip replacement surgery, she developed an MRSA infection in the femur/surgical site, and has been prescribed a 6 week course of IV vancomycin. She was planning a one-week stay in the hospital’s rehabilitation suite, and then a return home with skilled care visits for nursing (wound care), physical therapy and occupational therapy. Her children were able to coordinate assistance for their mom’s twice-daily doses of Vancomycin. However, her out-of-pocket expenses for IV Vancomycin therapy under a Medicare Part D plan were expected to be approximately $7,000.00 and she is unable to pay this amount on her fixed income. Her only alternative is to enter a Skilled Nursing Facility (SNF) for a 5-week stay at a cost to Medicare.

If you have questions or need additional assistance, please contact NHIA: Kendall Van Pool, VP Legislative Affairs at Kendall.VanPool@nhia.org or 703-838-2664.