For IV Meds, Medicare Forces Costlier Hospital Trip



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If you had to sit for an hour a day while you got an intravenous infusion of medication, would you rather be in the hospital — or at home? There's no argument among doctors that many intravenous medications can be safely infused at home. And at home, patients aren't exposed to hospital germs. So-called infusion therapy is cheaper when administered at home, and most health insurance policies pay for it. But not Medicare.

Now, however, several lawmakers are trying to change that with legislation that would require Medicare to pay for the at-home treatment.

Pushing For Less Costly, More Comfortable Treatment

Infusion therapy is used to treat conditions such as infections, gastrointestinal disorders, arthritis and some cancers. Administered drugs include antibiotics, painkillers and chemotherapy. Around 30 years ago, companies developed pumps, tubing and other equipment simple enough that intravenous treatments could be given in homes.

And insurance companies began paying. But Medicare has yet to come on board.

"Not only is this a hardship for patients and families," says Sen. Blanche Lincoln (D-AR), "but it adds to Medicare costs." Hospitalization costs $1,500 or more a day, while home-infusion therapy costs at most a few hundred dollars a day. Lincoln has two Republican co-sponsors behind a bill that would require Medicare to cover at-home treatment.

On the House side, Eliot Engel (D-NY) has also sponsored legislation. "Current Medicare coverage is illogical and incomplete," he says.

Making Do In The Meantime

Nancy Helms, 72, found herself caught last winter. She needed intravenous antibiotics for an infected toe. Medicare would pay only if she were in the hospital or went to the hospital as an outpatient. So every day for several weeks she and her husband went to the hospital, even though Helms was weak from heart failure, and her husband, who had emphysema, had to drag his oxygen tank around.

"For weeks I had to go," says Helms. "Every morning I dragged myself out of bed. I don't know exactly how I did that, to tell you the truth. Some mornings I would just as soon have died, I think."

No one from the Center for Medicare and Medicaid Services, which runs Medicare, would comment on the record, because of the pending legislation. Sean Tunis, former chief medical officer for Medicare, says, "It certainly seems if someone is ready to go home, and all they need is [home infusion], it would make way more sense for Medicare to pay."

The problem is, Medicare can't just add a benefit on its own. "Medicare doesn't have the legal authority," Tunis says.

Sponsors are waiting for an analysis by the Government Accountability Office that is expected to show the benefits of home infusion. Meanwhile, people like Helms will have to wait.

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As legislators begin weighing big changes to the nation's health care system, some people are trying to change smaller parts of it right now. Supporters of something called Home Infusion Therapy rallied recently on Capitol Hill.

NPR's Joanne Silberner was there and reports on a glitch in Medicare that is making life harder for many of the people it's meant to help.

JOANNE SILBERNER: If you had to sit for an hour a day while you got an intravenous infusion of medication, would you rather be in the hospital or at home? There's no argument among doctors that many intravenous medications can be safely infused at home.

At home you wouldn't be exposed to all those bad germs in the hospital. It's cheaper. Most health insurance policies pay for it, but Medicare, the federal program for the elderly and disabled does not. And that irked 72-year-old Nancy Helms enough to get a friend to bring her in wheelchair from her home in Yorktown, Virginia to a rally on Capitol Hill.

(Soundbite of applause)

SILBERNER: Last winter, Helms needed daily IV infusions.

Ms. NANCY HELMS: I'm a diabetic, have been for about 43 years. I had infection on my toe, and I had to start taking antibiotic IV therapy.

SILBERNER: Besides her toe, Helms was okay. She didn't want or need to stay in the hospital. So every day for weeks, she and her husband got into their truck and headed to the hospital because Medicare won't pay for home infusion.

Ms. HELMS: Looking back on it, it was just a really hard situation for the two of us. He didn't feel like taking me, and I didn't feel like going.

SILBERNER: She had a bad heart. He had emphysema and had to take his oxygen tank with him.

Ms. HELMS: He would go and take me and sit in the parking lot and just wait for me to get through. It would take about an hour each day to get the infusion and then go home.

SILBERNER: Her husband died in June. If Helms needs IV therapy again…

Ms. HELMS: I don't know who would take me to the hospital this time because he died, and I have two sons, but they have to work. You know, you don't have people who just can take you to the hospital every day. But then, especially, when you need help getting up, getting dressed.

SILBERNER: People started getting home infusions about 30 years ago for infections, cancer, arthritis, gastrointestinal diseases and more. Some people can hook themselves up to the IV, others require a health worker to stop by. It makes financial sense. It costs a couple of hundred dollars a day, rather than $1,500 or more to be in the hospital.

With Medicare, the prescription drug program part D, will cover the antibiotics and other drugs used, but the home services and equipment needed for home infusion falls between the cracks. It's not covered by any part of Medicare. Letting people like Nancy Helms get infusion at home would be a lot easier on patients, says Sean Tunis, former chief medical officer for Medicare. The problem is Medicare doesn't have the legal authority to pay for it.

Dr. SEAN TUNIS (Former Chief Medical Officer, Medicare): Even if they think it would be a smart thing to do, even if they think it would, you know, save them tons of money, even if it's better for patient care, if Congress didn't give them the authority to pay for that, they can't do it.

SILBERNER: To change the situation, legislators have introduced bills in the last Congress and this one. Democratic Eliot Engel of New York is an author of the House version.

Representative ELIOT ENGEL (Democratic, New York): It's just common sense. I mean, it's just a matter of if we can show people. It saves the government money. It's better for people in the home. It's a win-win. I can think of no negatives for this bill.

SILBERNER: But there is one negative, an accounting problem. If you just look at the equipment and services costs and don't look at the hospital savings, it looks like it could cost the government more money. But there's an analysis being done now that is very likely to show that home infusion is a good deal.

What the bill's sponsors are hoping is that this analysis will convince fellow legislators that it's okay to vote for the bill and that folks like Nancy Helms will be able to get their infusion treatments at home.

Joanne Silberner, NPR News, Washington. Transcript provided by NPR, Copyright NPR.