Home Infusion Therapy

THE BIG IDEA

A New Opportunity to Expand Into Home Infusion Therapy

The hassle with diving into home infusion therapy until now? Navigating the maze of Medicare's evolving benefits, not to mention setting up shop in a regulatory tightrope. You can benefit from opportunities in a market projected to hit $29 billion by 2032, without getting tangled in red tape. Perfect for the healthcare entrepreneur eyeing a slice of this lucrative pie without the headache of starting from scratch.

In this edition:

- Infusion Innovation: Dive into the future with home infusion therapy's expanding market.

- Medicare Moves: Key updates on Medicare's embrace of home therapy.

- Legislative Lens: New bills could change the game for Medicare patients.

- Market Momentum: Why home infusion is healthcare's next big thing.

- Plus: Navigating regulations, expert insights, and how to tap into a booming industry.

Welcome to the latest edition of your go-to newsletter for aspiring nurse entrepreneurs! In this issue, we delve into the critical aspects of home infusion therapy, guiding you through the intricacies of this field with insights from recent research. Whether you're new to the practice or looking to deepen your expertise, this newsletter is your resource for evidence-based information and best practices.

Infusion Innovation

The landscape of home infusion therapy, particularly in relation to Medicare, is evolving with significant implications for therapy specialists. The U.S. home infusion therapy market is projected to grow significantly, from $11 billion in 2022 to over $29 billion by 2032. This growth is driven by the increasing prevalence of chronic diseases, an aging population, and rising income levels. The Medicare home infusion therapy benefit, introduced in January 2021, covers professional services associated with the administration of specific drugs through a durable medical equipment pump, provided the treatment is ordered by a physician and part of a physician-monitored plan of care.

However, the benefit does not extend to the drugs, pumps, or other equipment themselves, or to services associated with insulin pump systems or self-administered drugs. For providers, including pharmacies and homecare agencies, serving Medicare patients who require these qualified drugs, home infusion therapy accreditation can offer a good return on investment, but it's essential to understand the details and consider several factors​​.

Medicare Moves

Despite the established benefits and growth potential, the National Home Infusion Association (NHIA) has reported ongoing challenges with the Medicare Part B home infusion therapy services benefit. Utilization of the benefit has remained low, with only a small fraction of eligible Medicare beneficiaries receiving these services. This low uptake has been attributed to insufficient participation from providers, leading to limited access for beneficiaries across the U.S. The lack of provider participation and the resulting geographic disparities in access have raised concerns, especially given the critical nature of nursing support for all home infusion patients​​.

Legislative Lens

In response to these challenges, new legislative efforts are underway to improve access to home infusion services for Medicare patients. The NHIA has applauded two new bills, one each in the House and Senate, aimed at ensuring Medicare patients can receive necessary IV medications at home. These bills, known as the Preserving Patient Access to Home Infusion Act, aim to address the shortcomings in the current implementation of the Medicare home infusion benefit and promote a more accessible and effective model of care that aligns with the needs of Medicare beneficiaries.

The proposed changes include allowing CMS to pay home infusion providers for professional services on each day the drug is administered, removing the requirement for a skilled professional to be present in the home for billing, and defining covered pharmacy professional services. These legislative efforts are seen as critical steps towards enhancing the quality of life for patients and their families by facilitating safe and convenient access to IV treatments at home​​.

Essential Guidelines for Practice

Patient Selection and Evaluation: Understanding which patients are suitable for home infusion therapy is crucial. The process involves assessing the patient's medical condition, home environment, and support system to ensure safety and effectiveness. For instance, patients requiring complex medication regimens like those for Parkinson's disease might need careful consideration due to the intricate nature of their treatment requirements.

Infrastructure and Training: Ensuring the right infrastructure is in place, including medical equipment and trained personnel, is fundamental for a successful home infusion program. Education for both healthcare professionals and patients on managing the infusion process is key to minimizing complications and enhancing therapy outcomes.

Infection Control and Complication Prevention: Maintaining stringent infection control practices is vital for home infusion therapy. Specialists must be adept at preventing, recognizing, and managing potential complications to ensure patient safety and therapy efficacy.

Administration Methods and Patient Education

Infusion Administration Techniques: Familiarize yourself with various infusion methods and devices to cater to diverse patient needs and medication types. Mastery of these techniques ensures effective therapy delivery and patient comfort.

Comprehensive Patient Education: Empowering patients with knowledge about their therapy, including how to manage their infusion devices and recognize signs of complications, is essential. Effective education fosters independence, enhances therapy adherence, and reduces the risk of adverse events.

Collaborative Care and Continuous Learning

Interdisciplinary Collaboration: Working closely with a team of healthcare professionals, including physicians, nurses, pharmacists, and dietitians, ensures a holistic approach to patient care. Collaboration enhances the quality of care and supports the patient's overall health and well-being.

Diving into the world of home infusion therapy, especially with the recent Medicare update on IVIG (Intravenous Immunoglobulin) becoming a permanent benefit, opens a cool lane for nurse entrepreneurs like yourself. This change signals a growing acceptance and need for in-home care services, which you can tap into.

Now, about billing Medicare. Yes, RNs can bill for certain services, but it's not super straightforward. You usually need to work under a physician's orders and within an agency that's Medicare-certified. This means your agency needs to pass a survey proving it meets specific federal health and safety standards. Once you're in, you can bill Medicare for covered services, but keep in mind that Medicare has specific guidelines on what services are covered and how they should be provided.

As for whether you should go the staffing agency route or home health agency, it leans more towards a home health agency if you're looking to provide direct patient care like IVIG therapy. Staffing agencies are more about supplying healthcare professionals to other institutions rather than providing care directly.

It's a bit of a journey, but for a nurse entrepreneur looking to make an impact and catch the wave of at-home care, it's a promising path. Keep those vibes positive and your focus sharp, and you're on your way to making a significant impact in the healthcare world.