Reading Time: 4 minutes By Jerry Dennany, Chief Technology Officer at Brightree As an HME or pharmacy home infusion provider, your patients place their trust in you to get
The vast majority of Americans want and deserve the flexibility to seek medical treatment from the comfort of their own homes. The Preserving Patient Access to Home Infusion Act will provide increased access to care for Medicare patients with immune diseases, serious infections, cancer, heart failure and other conditions that might otherwise force them to receive their care in a more expensive and less convenient hospital or ambulatory setting.
With the passing of this bill, millions of Americans will enjoy more peace of mind as they seek lifesaving treatments in their own homes. The bill, introduced in August 2021, is scheduled to be up for vote this December. For those of us who strongly believe patients deserve more access to home infusion drugs, it’s a big deal.
First, some background
Home infusion pharmacies have been effectively and safely supplying a wide range of IV medications to patients in their homes for over four decades. Research shows that 95% of patients* who are dependent on IV medications prefer to be treated at home, and nearly 98% of patients** are highly satisfied with their home infusion services.
In the 21st Century Cures Act, signed into law in 2016, Congress created a professional services benefit for Medicare Part B home infusion drugs. The intent was to maintain patient access to home infusion. Unfortunately, the Centers for Medicare and Medicaid Services (CMS) improperly interpreted the benefit by requiring a nurse to be physically present in the patient’s home in order for providers to be reimbursed. As a result, provider participation in Medicare’s home infusion benefit has dropped significantly.
Next, some benefits
The home infusion bill, which has received bi-partisan support, will accomplish the following if passed:
- Require CMS to pay home infusion providers for professional services each day the drug is administered
- Remove the requirement that a skilled professional be present in the home for billing to occur
- Explicitly acknowledge pharmacy professional services
- Invite patients to share their stories with NHIA how home infusion has positively impacted their lives
Some preliminary analysis from the Moran company suggests the new measure will create savings for both patients and taxpayers by moving care into more cost-effective home settings. Their model estimates on balance that the legislation would produce more savings than costs – with an estimated savings of $93 million over 10 years.
Advocacy is the answer
Getting this bill passed is the right thing to do because it will put infusion pharmacies back in a better place. Home infusion pharmacies need to be reimbursed for what they do every day – not just getting reimbursed when there’s a nurse that visits the house.
Correcting wrongs and getting them right, however, isn’t as easy as it sounds. Especially in Washington, DC. It takes many people, including an impressive number at Brightree, to drum up awareness and get buy-ins from senators and men and women in congress to understand and co-join in support for the bill.
In the end, it’s all about the patient
We’re all in the business of delivering a world-class patient experience. But patients, as we know, need access to what comforts them most. As it stands now, infusion pharmacies don’t want to pick up Medicare patients because they’re not going to get paid for them. So patients don’t have access to those infusion pharmacies. They are left with going to an ambulatory infusion center or back to the hospital or hospital infusion centers. Whoever made the decision or changed the code on it, didn’t fully understand home infusion, how it works and what the benefits are for home infusion.
Going beyond to get involved
Software solution providers need to provide more than software. They need to stand up and go beyond the expected by getting involved.
That’s what I did. And I’m proud of the team here at Brightree for joining me in correcting this wrong. We’ve actively worked side by side with the NHIA to help the industry. And there is still work to be done. Local infusion providers are encouraged to remain involved, knocking on doors and getting appointments with their representatives and senators.
In just a few weeks, we hope to be Preserving Patient Access to Home Infusion by celebrating the passage of this act.
More than a software solutions vender, Brightree is here to support our providers and do what is right for the industry. To learn more about our long-term commitment to home infusion and other services, contact us to speak with a team member or to schedule a demo.
Senior Director, Strategic Initiatives, Brightree
Paul O’Toole has worked in the healthcare technology market for over 25 years. He has developed, sold, and operated software applications over these years for post-acute care providers, acute care hospitals, and software applications to support many different areas within a healthcare operation. Most recently Paul has worked in the infusion pharmacy market where he develops strategic partnerships with infusion pharmacy-related entities. Part of Paul’s responsibility is to support associations like NHIA for the overall industry providers.
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