Home Infusion Is Booming – But Payers May Be Getting It Wrong

A new set of recommendations from the National Home Infusion Association (NHIA) hopes to remove barriers and reduce the administrative burden for payers aiming to access home-based infusion services.

The NHIA is the trade association for providers of infusion services in the home or alternate settings. Its members are either providers or suppliers of items that are used to facilitate those services.

The set of recommendations is the first of its kind. They are directly targeted to commercial, Medicaid and Medicare Advantage (MA) payers.


“This is the first time we have put out recommendations for commercial payers,” NHIA President Connie Sullivan told Home Health Care News. “It’s a new endeavor for us. We’ve always been very focused on advocacy in the Medicare space with policies that impact home infusion services, but of late, we’ve recognized that there are ways that we could be better partners for our commercial payers and help them achieve their goals of lowering the total cost of care.”

Infusion therapies are among the many services that have begun to quickly make their way to the home.

By administering these services – which are typically delivered in a brick-and-mortar facility – in the home, payers have gained an opportunity at cost saving. That comes through avoiding hospital stays, emergency room visits and hospital outpatient department usage.


One of the main goals was to elevate the conversation between payers, NHIA members and home infusion providers at large.

“The ability for a home infusion nurse to go out and resolve a catheter occlusion is a really good example of where a payer just may not realize that their policy is actually driving patients to the ER, rather than allowing the home infusion nurse to go out and simply resolve that,” Sullivan said.

Payers should understand the capabilities of the providers when home infusion is on the table.

One of the recommendations the NHIA included was to address the lack of coverage for resolving catheter occlusions.

“If the patient has to pay out of pocket for that service if a home infusion nurse comes out, but it’s free if they go to the ER, which do you think they’re going to choose?” Sullivan said. “We wanted to raise these types of issues with the providers and to our members to say, ‘You need to be bringing these things up when you have your conversations with payers.’ That way they’re maximizing their capabilities to help them prevent patients going into the emergency room or being hospitalized unnecessarily.”

Another point of emphasis made by the NHIA was to allow accredited home infusion organizations to provide nursing for managed Medicaid patients without a home health certification.

This, the NHIA argues, will greatly increase the safety and availability of home infusion services for this patient population.

A recent study done by the American Journal of Infection Control suggested that home infusion is running the risk of higher central line-associated bloodstream infections (CLASBIs). However, Sullivan said some of the methods behind that study were flawed.

“There’s a 40-year history of safety and efficacy demonstrated by home infusion,” Sullivan said. “That is a very flawed study, in our opinion, and was a small research study that was qualitative and only looked at one very small sample size of providers. A qualitative study like that doesn’t tell you really much of anything about an industry.”

In fact, Sullivan said that home infusion catheter infections are always significantly lower than they are in a hospital setting. A recent study found that over 98% of home infusion patients said they had a strong understanding of how to wash hands, self-administer medications and care for the IV catheter.

Looking ahead, Sullivan said that it will be key to keep home infusion services as local as possible.

“Home infusion is all a local service,” Sullivan said. “What’s concerning to us is that there’s been some recent activity with companies who are trying to centralize all infusion drugs and all specialty drugs to one pharmacy. That’s not how home infusion services work.”

Providers are responsible, not just for preparing the product and dispensing it, but also for making sure a patient has all the supplies needed. In addition, they’re responsible for making sure the nurse understands the administration plan and has all the appropriate equipment.

“What we’re saying is, if you want to have a network to try to manage some of these very expensive drugs, fine, but have a network of infusion providers who can provide the full wraparound of services and understand how you coordinate the care for these types of products,” Sullivan said. “Because there’s a lot on the line from a cost standpoint. The amount of money that they will pay for in waste will absolutely negate any savings they might think they’re gaining by centralizing that contract.”