A New Opportunity to Expand Into Home Infusion Therapy

Since the Centers for Medicare & Medicaid Services (CMS) added the home infusion therapy benefit in January 2021, there have been a lot of questions about who qualifies, how reimbursements work and if it’s worth the cost of accreditation. Because use of Medicare’s Part B Home Infusion Therapy services benefits among providers remains low, the National Home Infusion Association is campaigning for changes.

In mid-June, U.S. Sens. Mark Warner (D-VA) and Tim Scott (R-SC), joined by Reps. Vern Buchanan (R-FL-16), Debbie Dingell (D-MI-06), Diana Harshbarger (R-TN-01) and Terri Sewell (D-AL-07), reintroduced legislation to provide technical clarification that the full scope of professional services provided in home infusion, including pharmacy services, are covered by the reimbursement structure.

If you are among those who have previously thought that pursuing this benefit is not worth an additional accreditation, here are five reasons that the home infusion therapy benefit might be worth further consideration for your organization.

1. Improved patient satisfaction: Home infusion therapy may be the best way to support patients’ health while keeping them in their homes where they are most comfortable. Research shows that the vast majority of patients who receive their infusions at home are highly satisfied with the service.

2. Improved efficiencies: Infusion at home provides an efficient and cost-effective location to deliver care. The U.S. Government Accountability Office reports that in-home care generally costs less than treatment in other settings. The home infusion therapy benefit may help you increase reimbursement for services already provided or expand services for existing clients.

3. Improved patient outcomes: Because home infusion is less disruptive, patients overwhelmingly prefer it and are more compliant. There has been evidence to suggest adverse drug events are no worse—and clinical outcomes were
as good or better­—than with other infusion services.

4. Increased market size: The U.S. home infusion therapy market size is projected to grow from $11 billion in 2022 to more than $29 billion in 2032. The prevalence of chronic diseases, an aging population and increasing per-capita income will accelerate the need for at-home infusion therapy services through the years.

5. Reimbursable professional services: Nursing services that are bundled under the home infusion benefit reimbursement include medication administration, patient training and education (not otherwise covered under the durable medical equipment benefit), and monitoring services (including remote monitoring) for the provision of home infusion drugs furnished by a qualified home infusion therapy (HIT) supplier.

If these issues interest you, home infusion therapy accreditation from an accrediting organization may be a good fit for your organization. Providers including infusion pharmacies, home health and homecare agencies currently serving Medicare patients who require qualified drugs may benefit from home infusion therapy accreditation. This accreditation is generally a good return on investment for organizations administering infused medications to a patient population with a significant percentage of Medicare coverage; however, it’s important to understand the details and consider several factors.

What’s Covered

The home infusion therapy benefit covers the professional services associated with the administration of specific drugs delivered through a pump that is an item of durable medical equipment when the order is written by a physician and the plan of care is monitored by a physician. The benefit does not cover drugs, pumps and other equipment or services associated with insulin pump systems or self-administered drugs. If the medication is ordered by another professional with prescribing authority, infusion nursing accreditation is the better option.

The drug can be administered at any time in the home and the infusion must last for a period of 15 minutes or more. Reimbursement for the initial visit can be compensated at a higher rate. The limited list of drugs is determined by CMS and reimbursement is only available for services administered in the home.

Home infusion therapy accreditation is not recommended for organizations that:

• Only plan to serve the non-Medicare population and do not bill Medicare
• Do not provide services in the home
• Do not provide the specific approved medications covered under the
• HIT benefit
• Are responding to orders written by non-physician providers
• Contracts nursing staff to another provider that provides and bills for the infusion therapy

Although changes to the Medicare Part B home infusion therapy services benefit could expand the usage, it might be worth considering how your organization could expand billing opportunities and determining if it would help expand your Medicare reimbursement potential.