Congress urged to cover home infusion therapy for Medicare beneficiaries

Jun 8 2007

The Infectious Diseases Society of America (IDSA) is urging Congress to support the Medicare Home Infusion Therapy Coverage Act of 2007 (H.R. 2567), bipartisan legislation introduced yesterday by Reps.

Eliot Engel (D-NY), Kay Granger (R-TX), Tammy Baldwin (D-WI), Charles Pickering (R-MS), Randy Kuhl (R-NY), and John Tierney (D-MA). The long-awaited bill would extend coverage for home infusion services to Medicare beneficiaries a benefit enjoyed by most patients in the private sector.

When Congress passed the Medicare Modernization Act in 2003, lawmakers added coverage for home infusion drugs including antibiotics, antivirals, and antifungal drugs, which are prescribed for patients with serious infections, such as bone and skin infections, heart infections, pneumonia, and urinary tract infections.

"Congress correctly understood what many private payers have realized for decades that a home infusion therapy benefit under Medicare would reduce hospital stays and decrease costs. For my patients, who are already actively fighting infections, quality care in the home is preferred because it reduces their exposure to other infections in the hospital," says IDSA President-Elect Donald M. Poretz, MD, who has provided such therapy to his privately insured patients for years.

Unfortunately, the Centers for Medicare and Medicaid Services (CMS) interpreted the law to cover only the drugs but not the services and supplies associated with home infusion therapy, including pharmacy and care coordination services, medical supplies and equipment, and when necessary nursing services.

"As a result, my Medicare patients must come to my office, stay in the hospital, or live in a nursing home to receive antimicrobial infusion services," Dr. Poretz says.

Not only is this inconvenient or difficult for Medicare patients particularly those in rural areas and elderly and infirm Medicare patients, including those with Alzheimer's and dementia but it also may result in higher costs for the Medicare program.

In addition to potential cost savings, home infusion therapy can be safer for patients because they are less likely to be exposed to hospital-acquired, drug-resistant infections. Annually, nearly 2 million U.S. patients acquire infections in the hospital and nearly one in 10 die from them.

H.R. 2567 would give Medicare beneficiaries access to the same life saving drug therapies in the home setting that are already enjoyed by most privately insured patients. It would ensure that the highest quality standards are employed to ensure safety and effectiveness of home infusions. And, it would enable Medicare to realize the efficiencies and positive outcomes that home infusion therapy has brought to the private sector.