WASHINGTON — The drive to gain full Medicare coverage of home infusion therapy got a shot in the arm last week when the General Accountability Office issued a report supporting the industry's long-held assertion that home infusion therapy is both effective and cost efficient.
The report, issued June 14, also calls for a follow-up demonstration project to look at potential costs and savings associated with a comprehensive benefit.
The National Home Infusion Association applauded the findings.
"It confirms what we have been saying all along: Home infusion is quality, cost-effective health care," said John Magnuson, NHIA vice president of legislative affairs.
Medicare currently provides limited coverage of home infusion, generally for patients who are receiving the home health benefit. Some drugs are covered under Part D, but the program does not pay for the equipment or services that go with them, forcing many patients to get treatment in a hospital or other institution.
Rep. Frank Pallone Jr., D-N.J., and Rep. Eliot Engel, D-N.Y., commissioned the GAO report to compare Medicare's fee-for-service benefit with that of private health plans, including Medicare Advantage. Last year, Engel introduced The Medicare Home Infusion Therapy Coverage At of 2009 (H.R. 574) to close the program's coverage gap. Sens. Blanche Lincoln, D-Ark., and Olympia Snow, R-Maine, introduced a companion bill (S. 254) in the Senate. The bill currently has 103 cosponsors in the House and 31 in the Senate.
"Medicare is the only major payer that does not cover all the essential components of home infusion therapy," Engel said in a statement about the report, adding that a demonstration "would bring to light real-world applications of home infusion therapy and confirm the benefits of comprehensive access."
For its 15-month study, the GAO garnered information from five of the top MA insurers in the nation, a home infusion provider, the NHIA and the Infectious Diseases Society of America.
"Health insurers contend that the benefit has been cost effective, that is, proving infusion therapy at home generally costs less than treatment in other settings," the report concluded. "They also contend that the benefit is largely free from inappropriate utilization and problems in quality of care. Given the long and positive experience health insurers reported having with home infusion therapy coverage, further study of potential costs, savings and vulnerabilities for the Medicare program is warranted."
Magnuson said the NHIA is also urging a demonstration project. "It will show the same savings that have been provided for decades in other sectors," he said, noting that it is past time to move the benefits of home infusion along to Medicare patients. "Not only is the doctor directing this, but it's where the patient would prefer to be and it's a very cost-effective site. This is a rare win-win-win for everyone."
Providing a comprehensive home infusion benefit could generate cost savings for the beleaguered Medicare program, supporters say, and the GAO largely supported that assertion.
"Health insurer officials we talked to asserted that infusion therapy at home generally costs less than treatment in other settings," the report said. "Hospital inpatient care was recognized as the most costly setting. One insurer estimated that infusion therapy in a hospital could cost up to three times as much as the same therapy provided in the home."
Magnuson said there are crucial cost efficiencies to be had — and Medicare can use those savings. "Why are we not allowing this efficient and cost-effective care [to be given to Medicare patients]?" he asked.
A demonstration project, he said, would be "a baby step toward the continuing delivery system reforms that are going to be crucial to solving the larger health care issues. If we can't move forward on these simpler baby steps, how do we ever attack the larger issues of health reform? The time is now, and the need is now."
Read the full GAO report.