Opinion

Medicare Must Adapt to Keep Coronavirus Patients at Home

The recent passage of an emergency funding package to supercharge the nation’s efforts to fight COVID-19 is a welcome and appropriate step, but policymakers must quickly take additional action to close gaps in the nation’s health care system and prevent further spread of the disease. 

Yes, access to testing and vaccine development are critical, but curtailing unnecessary exposure — especially among seniors and other vulnerable patient populations — is paramount to slowing the spread of this novel virus and minimizing its impact on the country. 

Specifically, Congress needs to expand access by funding a wider range of home-based health care services for Medicare beneficiaries. Currently, the Medicare program considers home-based care a last resort rather than a beneficial alternative to inpatient and office-based services. But through the lens of a public health emergency, delivering services at home can be an essential tool in reducing exposure to infections and allowing hospital-based health care providers to prioritize sicker patients.

The Centers for Disease Control and Prevention is recommending people with mild symptoms self-isolate at home and engage local public health, home health services and community organizations to assist with support services. The challenge with this advice is that Medicare doesn’t pay for all the services that patients need in order to follow the CDC’s recommendation.

For example, home infusion allows patients who are stable and don’t require around-the-clock care to receive an intravenous antibiotic at home, avoiding unnecessary hospital stays or admission to a skilled nursing facility. Yet, Medicare requires seniors who rely on infusions of immunomodulating agents (i.e. monoclonal antibodies) for chronic conditions to receive them in hospital clinics and doctor’s offices rather than at home where they can avoid exposure to pathogens. This is despite the fact that these treatments make seniors inherently more susceptible to infections.

Medicare’s policy is counterintuitive under normal circumstances and just plain dangerous as we expect an influx of patients seeking treatment for infection arriving to these sites of care. If you are a patient at high risk for serious complications, the best way to avoid COVID-19 is to stay at home and limit the chances of exposure to others who might be infected.

But what do you do if you need to visit the hospital or doctor’s office to receive an IV treatment? Millions of patients will be faced with this dilemma as the COVID-19 outbreak grows.

For almost four decades, younger patients with commercial insurance have had the option to receive IV treatments at home where they can avoid exposure to infection. Commercial insurance plans have embraced home infusion primarily due to the savings it generates from avoiding lengthy stays in the hospitals and nursing homes. As a report from the Government Accountability Office concluded, “providing infusion therapy at home generally costs less than treatment in other settings … ” and the benefit is largely free from inappropriate utilization and problems in quality of care.

Further, patients overwhelmingly prefer to be at home when given the option. In fact, research shows that up to 95 percent of patients prefer receiving their infusions at home, and nearly 98 percent of patients surveyed last year indicated they are highly satisfied with their home infusion services. Avoiding exposure to resistant bacteria and common seasonal viruses is considered an added benefit.

Home infusion providers have the ability to serve more Medicare patients who wish to remain at home, but unfortunately Medicare is the only major payer of health care services in the United States to have severe limitations on this benefit. That means patients who want to avoid exposure to COVID-19 by receiving an IV infusion at home would have to pay out of pocket. Passing legislation to close the coverage gaps for home infusion could help millions of seniors, particularly those at high risk for serious infection.

Further, by failing to take advantage of the site of care optimization that has become increasingly prevalent in the private market, Medicare is missing out on a considerable windfall from potential savings. For context, the Congressional Budget Office has estimated hundreds of millions of dollars in savings by prioritizing home infusion based on the recognition that home-based care redirects patients away from more expensive care settings.

Unfortunately, sometimes it takes a crisis to expose the weak links in a system. As a rational, cost-saving step, the Medicare program needs a comprehensive home infusion benefit that provides seniors the ability to reduce their risk of exposure to infectious diseases. Otherwise, this weak link (and our most vulnerable seniors) are destined to be exposed. 

 

Connie Sullivan is president and CEO of the National Home Infusion Association.

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