See the chart on page 2 of Ensuring Sustainable Access to Home Parenteral Nutrition: The Cost Crisis and Path Forward showing the compounded increase in PN bag cost reaching 75.4% by 2024.
1.
HPN payment structure masks cost shocks and underpays complex care.
Standard HPN components are locked inside a fixed per-diem, so ingredient inflation and shortages drive costs up while payment rates stay flat—unlike other drugs where payment adjusts to benchmarks (Average Wholesale Price, Average Sales Price). Wage growth and USP <797> updates also require sustained investments in facilities, training, and QA.
Recommendations: Update contracted rates to reflect ingredient, labor, and compliance pressures and allow separate billing for PN components (via NDC/HCPCS—e.g., B-codes for grams of protein/lipids).
2.
HPN provider capacity is shrinking due to the costs–payment gap.
Compounded HPN bag costs rose 75.4% (2016–2024) while average monthly payments decreased from 2022–2024, contributing to declining claims-submitting pharmacies and access challenges. In addition to the expense associated with compounding HPN, pharmacies provide advanced clinical support through a multi-disciplinary team to ensure safe and effective therapy. Services tend to be more intense when patients first transition home, amplifying the up-front risk of serving patients under a per-day payment model.
Recommendations: Ensure adequate, in-network HPN providers (same-day nursing/deliveries) and pilot value-based HPN models that reward outcomes such as reduced re-hospitalization in the first 30 days, lower catheter infections, and lower total cost of care. Consider legislative incentives for PN cleanrooms, equipment, and staff training. States should also examine whether sufficient access exists for HPN among the Medicaid population and look to early state action such as Colorado SB25-084 to improve access for Medicaid patients.
3.
Medicare’s Competitive Bidding program depressed allowables for HEN, leaving clinical support services unfunded. As a result, few providers offer HEN.
Since 2014, Medicare HEN beneficiaries and kit suppliers have both declined, and average allowables were lower in 2023 than a decade prior—straining access and clinical services.
Recommendations: Recognize and fund the clinical nutrition support services (assessment, education, monitoring, troubleshooting) required to keep patients safe at home.
Modernize HEN payment & oversight. Direct CMS to study HEN access/quality/costs; add service codes for clinical care; and consider removing EN from competitive bidding—including demos designed to reduce total care costs while preserving access.
What’s inside: Eight-year cost trend analysis (2016–2024) showing 75.4% compounded rise in PN bag costs; reimbursement declines 2022–2024; effects of shortages, UDI, USP <797>, and staffing; time burden (pharmacists average 42 minutes/day per HPN patient).
Key steps: Update rates; enable separate billing for PN components; ensure adequate networks; pilot value-based PN; consider legislative support; note Colorado’s Medicaid steps.
What’s inside: HEN overview and population size (~220,000); modality mix (~55% pump-feeds); Medicare policy timeline; analysis showing 31% fewer suppliers and 27% fewer beneficiaries since 2014; call for modernized service payments.
Key steps: CMS study of HEN services; develop supplier quality standards; add service codes or episodic payments for clinical care; remove EN from CBP.
What’s inside: Early evidence of pandemic-era shocks—50.12% cumulative PN bag cost increase over 2016–2021 and 9.88% average increase across 223 disposable SKUs in 2021; explains how PN “standard ingredients” bundled in per-diems obscure inflation.
Key steps: Adjust per-diems to actual costs; allow separate billing for non-standard PN components (e.g., lipids, specialty amino acids).
The National Home Infusion Association (NHIA) has developed recommendations for commercial, Medicaid, and Medicare Advantage payors to improve patient outcomes and experience, reduce administrative burden, and improve timely access to home infusion services.
The National Home Infusion Association (NHIA) is pleased to hold its second annual one-day Payor Summit. The event, designed to bring together representatives from commercial health insurance plans with home and specialty infusion leaders, will
The National Home Infusion Association (NHIA) is pleased to announce that it successfully petitioned the Centers for Medicare and Medicaid Services (CMS) to secure a new billing code for injectable immunotherapies and revise an existing
The National Home Infusion Association (NHIA) has prepared a white paper summarizing the impact of cost increases incurred by infusion providers due to pandemic-related supply shortages with a particular focus on parenteral nutrition (PN) components
