While Home Infusion Is The Next Big Thing In Home-Based Care, Barriers Remain  

The home infusion industry is experiencing significant growth due to the increasing number of aging patients wanting to remain in their homes. However, like many areas of home-based care, reimbursement isn’t keeping up with the cost of care.

Driven by an emphasis on cost-effectiveness, containment and the desire for patients to remain at home while recovering from illness, home infusion is cited as a $19 billion industry made up of more than 900 providers serving 3.2 million patients annually, according to the National Home Infusion Association (NHIA). Home infusion’s overall contribution to the health care system is significant, as the system cost of infusion therapy administered in the home is usually less than the cost of inpatient treatment.

“The home infusion industry has experienced significant growth in the past decade spurred by the aging population, payer initiatives to promote lower-cost sites of care and high patient satisfaction,” NHIA President and CEO Connie Sullivan told Home Health Care News. “We believe the industry will continue to grow for these same reasons, and due to the robust pipeline of new therapies requiring infusion.”

Under fee-for-service (FFS) Medicare, home infusion therapy (HIT) involves the intravenous or subcutaneous admission of drugs or biologicals to an individual at home.

“Data shows patients overwhelmingly prefer to receive care in their homes when able,” Kristen Fano-Schultze, vice president of home infusion at Compassus, told HHCN. “Since COVID, Compassus has seen an increase in demand for home infusion therapy, which allows patients to receive high-quality intravenous therapy treatment for acute and chronic diseases wherever they call home.”

Compassus, based in Nashville, Tennessee, provides a full suite of care services, including home health, palliative care, home infusion, hospice and advanced care management, to individuals in 30 states.

Many more treatments require IV or subcutaneous infusion today, according to Sullivan. A host of new treatments being approved for chronic disease are biologics and must be infused or injected. Home infusion providers specialize in providing these treatments and offer a high level of expertise and support for these complex therapies.

HIT is a safe and effective alternative to inpatient care for acute and chronic therapies and diseases. The components needed to perform this therapy include the drug, equipment and supplies. Likewise, nursing services are necessary to train and educate the patient and caregivers on the safe administration of infusion drugs in the home.

“Home infusion can be a preference for many patients,” Sullivan said. “Often, it is a necessity due to disability, lack of access to specialists in rural areas or for those with transportation challenges.”

Conditions commonly requiring infusion therapy include infections that are unresponsive to oral antibiotics, cancer and cancer-related pain, dehydration, gastrointestinal disease or disorders and immune system diseases. The most common reason for needing home infusion is a severe infection requiring IV antibiotics, according to the NHIA.

“HIT includes anti-infective therapy or the use of intravenous medication to treat or prevent infection,” Fano-Schultze said. “Compassus offers total parenteral nutrition, which delivers nutrients directly into the patient’s vein, hydration therapy to administer electrolytes and a variety of specialty intravenous therapies to treat gastrointestinal, neurological, rheumatoid and rare diseases.”

Adding infusion therapy to a home health care agency’s list of services can be a natural fit as visiting nurses often play a significant role in HIT.

“Home infusion is often recommended alongside other home health services,” Fano-Schultze said. “Home-based care providers who can offer high-quality HIT are better equipped to meet patients’ growing needs and desires for care at home. Compassus’ home infusion services are in high demand, and we are expanding our coverage area to serve patients’ needs better.”

Nurses typically train the patient or caregiver to self-administer the drug, educate them on the side effects and goals of therapy, and visit periodically to assess the infusion site and provide dressing changes. The home infusion process typically requires coordination among multiple entities, including patients, physicians, hospital discharge planners, health plans, home infusion pharmacies and home health agencies.

Depending on local regulations and availability, infusion nursing services are provided directly by the infusion pharmacy by employed nurses or through a collaboration with an affiliated nursing or home health agency. In either situation, infusion nurses are critical members of the patient’s care team and work closely with the pharmacy to coordinate care plans and other activities.

The quarterly average of HIT service visits was about 7,500 from 2021 to 2023, according to the Centers for Medicare & Medicaid Services (CMS). Usage has been mostly concentrated in the Mid-Atlantic states, but also in Texas and Florida, reflecting the concentration of Medicare FFS enrollment in those areas.

The range of variables the infusion pharmacy must manage to ensure safe and appropriate administration has led nearly all commercial health plans to treat home infusion therapy as a medical service. Patients are reimbursed under their medical benefits and paid using a per diem for clinical services, supplies and equipment, with separate payments for drugs and nursing visits.

“Many insurance providers cover home infusion therapy services and certain medications or treatments,” Fano-Schultze said. “At Compassus, our care coordinators work with referring doctors and insurance providers to determine eligibility and coverage limits so patients understand their options.”

Government health plans such as Medicaid, TRICARE, and the Federal Employees Health Benefits Program also reimburse for home infusion therapy. However, Medicaid coverage can have gaps in some states.

Medicare does not completely cover home infusion therapy services. Although its prescription drug plan (Part D) may cover the cost of infusion drugs, it does not cover the costs of services, supplies, equipment or nursing.

“Almost all commercial payers, Medicaid and Medicare Advantage plans cover home infusion,” Sullivan said. “Medicare is the outlier and does not have a comprehensive home infusion benefit for traditional beneficiaries. NHIA is promoting legislation that would expand coverage for certain therapies under the Medicare program.”

This legislation is the Preserving Patient Access to Home Infusion Act, compelling Congress to restore the intended comprehensive Medicare home infusion benefit to the 21^st Century Cures Act and to promote access to home-based care by mirroring the successful model employed by commercial payers.

“The biggest challenge in expanding home infusion therapy is similar to the challenge faced throughout home-based care,” Fano-Schultze said. “The cost of goods is increasing while reimbursement fails to capture the value of these services sufficiently. To help move home-based care forward, we need to focus on enacting policies that support peoples’ overwhelming preference to receive care at home as they age. Adjustments to reimbursements do not adequately reflect patient preference for care at home or the increased volume of aging individuals requiring care.”