Most insurers cover infusion treatments in the home. Medicare does not.
If you had to sit for an hour a day while you got an intravenous infusion of medication, would you rather be in the hospital — or at home? There's no argument among doctors that many intravenous medications can be safely infused at home. And at home, patients aren't exposed to hospital germs. So-called infusion therapy is cheaper when administered at home, and most health insurance policies pay for it. But not Medicare.
Now, however, several lawmakers are trying to change that with legislation that would require Medicare to pay for the at-home treatment.
Pushing For Less Costly, More Comfortable Treatment
Infusion therapy is used to treat conditions such as infections, gastrointestinal disorders, arthritis and some cancers. Administered drugs include antibiotics, painkillers and chemotherapy. Around 30 years ago, companies developed pumps, tubing and other equipment simple enough that intravenous treatments could be given in homes.
And insurance companies began paying. But Medicare has yet to come on board.
"Not only is this a hardship for patients and families," says Sen. Blanche Lincoln (D-AR), "but it adds to Medicare costs." Hospitalization costs $1,500 or more a day, while home-infusion therapy costs at most a few hundred dollars a day. Lincoln has two Republican co-sponsors behind a bill that would require Medicare to cover at-home treatment.
On the House side, Eliot Engel (D-NY) has also sponsored legislation. "Current Medicare coverage is illogical and incomplete," he says.
Making Do In The Meantime
Nancy Helms, 72, found herself caught last winter. She needed intravenous antibiotics for an infected toe. Medicare would pay only if she were in the hospital or went to the hospital as an outpatient. So every day for several weeks she and her husband went to the hospital, even though Helms was weak from heart failure, and her husband, who had emphysema, had to drag his oxygen tank around.
"For weeks I had to go," says Helms. "Every morning I dragged myself out of bed. I don't know exactly how I did that, to tell you the truth. Some mornings I would just as soon have died, I think."
No one from the Center for Medicare and Medicaid Services, which runs Medicare, would comment on the record, because of the pending legislation. Sean Tunis, former chief medical officer for Medicare, says, "It certainly seems if someone is ready to go home, and all they need is [home infusion], it would make way more sense for Medicare to pay."
The problem is, Medicare can't just add a benefit on its own. "Medicare doesn't have the legal authority," Tunis says.
Sponsors are waiting for an analysis by the Government Accountability Office that is expected to show the benefits of home infusion. Meanwhile, people like Helms will have to wait.