Infusion report: No matter how you spin it, access has gone down

WASHINGTON – A new report from CMS is an “indictment” of the agency’s current home infusion benefit, say stakeholders. 

The “HIT Monitoring Report, February 2023” shows utilization has remained basically flat over a 26-month study period, despite growing Medicare enrollment, with only 1,250 beneficiaries, on average, receiving Part B home infusion services per quarter.  

“We do feel like this is more evidence that CMS’s flawed policy is causing beneficiaries to lose access,” says Connie Sullivan, president and CEO of the National Home Infusion Association. 

Stakeholders have long argued that the home infusion benefit, which was implemented Jan. 1, 2021, is unattractive to many providers because it does not include payment for professional pharmacy services. 

While the report shows an increase for patients receiving category 2 drug therapies, it shows decreases for categories 1 and 3. No matter how you spin it, access has gone down, says provider Greg LoPresti. 

“There’s some incremental increases, but access has gone down,” said LoPresti, CEO of Syracuse, N.Y.-based Upstate HomeCare. “It’s precarious and it’s not serving Medicare well.” 

Forcing patients who are receiving everything from antibiotics to intensive chemotherapy to be treated outside of the home just shifts – and increases – health care costs, says provider Drew Walk. 

“Patients who cannot receive home infusion therapy services will instead receive care in higher-cost settings, such as hospitals,” said Walk, CEO of Frisco, Texas-based Soleo Health, a national provider of home infusion services. “Hospital-acquired conditions and high costs for patients, as well as the Medicare program, can be avoided if patients have access to home infusion therapy services.” 

The report should boost efforts by stakeholders to pass legislation that would, among other things, require CMS to pay for professional services each day an infusion drug is administered. With a new Congress in place, NHIA is developing its strategy for getting such a bill reintroduced, says Sullivan. 

“We’re hoping to pick up where we left off from last year,” she said. “We do hope this (report) inspires our champions this year.”