February 2, 2024
This week, during a House Energy and Commerce Health Subcommittee hearing on Health Care Spending in the United States, Rep. Debbie Dingell (D-MI) addressed Medicare costs and the potential for home infusion to lead to significant cost savings.
“Many of you have heard me speak about my experience with home infusion,” says Dingell. “Several studies in fact have found that home infusion can lead to significant cost savings when compared to inpatient costs.”
Rep. Dingell then asked witness Sophia Tripoli, MPH, Senior Director of Health Policy at Families USA, if she believed transitioning care away from traditional health care settings can be an effective way to reduce costs and improve patient outcomes.
“Absolutely,” said Tripoli. “We know that shifting out of institutionalized care into the home or community setting with appropriate levels of care and support is not only important for consumers and patients maintaining their dignity, but also is critical for having emotional connectedness, which has a direct impact on quality of life.”
Related to cost savings, Tripoli went on to say, “The shifting into community-based settings does have a cost savings effect, and I think on average about 30-35% in reduced savings because of that shift.”
Dingell is a cosponsor of the “Preserving Patient Access to Home Infusion Act (H.R.4104),” which would address issues with Medicare coverage that would allow greater patient access to this home-based therapy.
NHIA submitted comments to CMS on a new proposed rule on interoperability and prior authorization for drugs. While NHIA is mostly supportive of standardizing prior authorization (PA) processes for Medicare-covered drugs, it wants CMS to know that home infusion may not fit neatly into processes designed for medical and pharmacy benefits.
NHIA strongly opposes CMS’s proposed HCPCS coding and billing unit changes for immune globulin products, arguing that the changes would create significant administrative, operational, reimbursement, and patient care challenges without providing meaningful clinical or financial benefit.
The National Home Infusion Association (NHIA) has received clarification from CMS regarding enrollment options for home infusion pharmacies under the current nationwide DMEPOS enrollment moratorium.
