Making At-Home Infusion Therapy More Accessible for Medicare Patients

Challenges in Medicare Home Infusion Therapy

• ⚠️ Current Medicare payment policy for home infusion services is restrictive, often requiring a clinician to be physically present for reimbursement, even when only care coordination and monitoring are needed.
• 📉 This rigid policy, similar to past cuts in durable medical equipment and home health oxygen, limits patient access and provider participation.
• 🎯 The Preserving Patient Access to Home Infusion Act aims to address these issues by removing fragmentation and the strict face-to-face requirements.

Impact of Current Policies on Access

• 🚫 The current limitations mean fewer than 70 providers nationwide participate in the Medicare home infusion benefit, leaving many patients without access, particularly in certain states.
• 💊 This restriction effectively removes options like IV antibiotics, a common home infusion treatment, forcing patients to seek care in more costly facility-based settings.
• 🏥 The lack of accessible home infusion therapy can lead to patients not receiving necessary treatment at all, rather than experiencing delays.

Rural Healthcare and Laboratory Services

• 🔬 Small, independent laboratories that provide routine tests for Medicare beneficiaries are disproportionately affected by reductions in the clinical laboratory fee schedule.
• 📉 The upcoming fourth round of reductions under PAMA, following three years of cuts, threatens the capacity and continued operation of these vital rural laboratories.
• 🩺 Ensuring adequate reimbursement for these labs is crucial for maintaining access to timely diagnostic services for rural Medicare recipients.