Washington, D.C.--Rep. Frank Pallone, Jr. (D-NJ), and Rep. Eliot Engel (D-NY) announce the release of a Government Accountability Office study on insurance coverage of infusion services for patients at home, an alternative that could potentially save money by allowing more infusion procedures to be done outside of costly hospital or nursing home settings. The new study from the GAO compared coverage of the treatments under traditional Medicare fee-for-service (FFS) and private health plans, including Medicare Advantage plans.
The report found that health insurers have long touted the benefits of home infusion therapies—evidence that a distinct, comprehensive home infusion benefit may support Medicare’s cost containment efforts. According to GAO, ways to structure such a benefit to achieve Medicare savings and maintain quality require further investigation. GAO concluded that, “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.”
GAO recommended the secretary of Health and Human Services conduct a study of the potential savings and other issues associated with establishing a comprehensive home infusion benefit under Medicare.
"Providing these therapies at home where patients are most comfortable may improve their recovery and prove to be more cost-effective," said Rep. Pallone, Chairman of the House Energy and Commerce Committee's Subcommittee on Health. "I urge HHS to follow through with GAO's recommendations for a study which will help us determine whether improvements to home infusion therapy coverage under Medicare would be in the best interest of both patients and the program."
"I am very pleased that the GAO has called for further study on this very important issue. I would like for this study to be in the form of a demonstration so we can better understand the real-world applications of home infusion therapy and how it will not only save money, but save lives," said Rep. Engel, a longtime advocate of home infusion therapy and author of the Medicare Home Infusion Therapy Coverage Act of 2009. "Both patients and the Medicare program itself would reap the benefits of broader access to home infusion therapy. It would also provide a much-needed relief to taxpayers by reducing costs from fewer hospital visits. It would ease the burden on home infusion patients living in rural areas, or who rely on public transportation. On the heels of our historic health care insurance reform legislation, further savings to the system should be continually sought out."
The report found that the extent of Medicare FFS coverage of home infusion therapy was dependant on whether Medicare beneficiaries met certain criteria. For example, certain homebound patients with Medicare Part D receive comprehensive coverage, including nursing services, supplies, and drugs. However, in 2008 only seven percent of Medicare patients were eligible for this coverage. Patients who are not homebound face more limited coverage that may only pay for supplies and some drugs. GAO found that the range of coverage offered under traditional Medicare contrasted with the more comprehensive coverage for home infusion therapy that was available from several of the largest Medicare Advantage plans and commercial health plans.
“The GAO report illustrates what private payers have known for years - that home infusion therapy can be dramatically cost-effective when provided appropriately,” said Russ Bodoff, President of NHIA. "We urge Congress and HHS to act so that Medicare beneficiaries can enjoy the same access to infusion therapy that non-Medicare patients have had for many years. We commend the leadership of Chairman Pallone and Congressman Engel in obtaining this important analysis.”
Pallone and Engel have also requested that the Medicare Payment Advisory Commission perform a study to determine if legislative changes to Medicare coverage for home infusion therapy are warranted, and if so, what the appropriate payment mechanisms would be for these services. The study is expected to be completed by 2012.
For a full text of the report – go to http://engel.house.gov/uploads/Home%20Infusion%20Therapy%20-%20Differences%20Between%20Medicare%20and%20Private%20Insurers%27%20Coverage.pdf
