Dr. Emma Sing recently sat down with a patient and had a tough conversation. Although she has had this same dialogue many times the outcome does not get any easier to explain.
She was explaining care options to an 84 year old patient as his intitial shock turned to disbelief. She told him that Medicare would pay for treatment of his urinary tract infection if he received his intravenous medication at a nursing home, but it would not be covered if he opted to receive the therapy at his home.
They calculated that the four weeks of intravenous or IV therapy, dispensed through a needle or catheter, at a skilled nursing facility would cost Medicare about $15,000. The same treatments administered in the patient’s home by a nurse would cost $1,200. The wheelchair-bound patient knew the daily commute to a nursing home would be a tremendous burden to his family and aging spouse, so he had little choice but to stay home and pay out-of-pocket.
Like most of Dr. Singh’s patients facing this dilemma, the man asked, “Why won’t Medicare cover at-home IV therapy when it’s 10 times less expensive than going to a nursing home?”
The answer is a little known but glaring glitch in Medicare, the federal health insurance program for people over age 65. This gap forces patients who need intravenous medications to have these treatments in hospitals and nursing homes rather than in the safety and convenience of their own homes. Considering that almost every private insurance program covers the at-home therapy, this gap in Medicare is a blatant case of age discrimination for older Americans.
Not only is the at-home option far less costly, it’s far safer than typical medical-care settings. Requiring patients to receive treatment in hospitals and nursing facilities places them at increased risks of infection, particularly deadly infections like MRSA. The Centers for Disease Control and Prevention (CDC) estimates that two million Americans get hospital-acquired infections every year, and almost 100,000 of them die as a result.
Trying to understand why Medicare requires people to have IV therapy treatments in costlier and less-safe environments makes me as baffled as my patients. Medicare’s Part D program covers only the drugs administered intravenously, but not the supplies, equipment and pharmacy-related services that account for more than half the cost of the therapy. Most of Dr. Singh’s Medicare patients cannot afford to pay for the treatment out-of-pocket, so they are forced to undergo extended stays in hospitals, nursing homes and daily visits to outpatient clinics.
Over the past several months, Dr. Singh spoke with Sen. Pat Toomey’s (Pa.) office and other legislators about closing this gap in Medicare coverage. She is advocating for the reintroduction and passage of the Medicare Home Infusion Therapy Coverage Act. The bill was introduced last year by Sen. Olympia Snowe of Maine, but didn’t gain much traction even though it was supported by such prestigious groups as AARP, American Diabetes Association and American Association of People with Disabilities.
Dr. Singh states “Medicare’s short-sighted policy conflicts my duty as a physician to ‘do no harm.'”Ironically, Medicare is jeopardizing the well-being of the very people the program was established to protect. “Until Congress and the Medicare program corrects this wrongheaded policy, my elderly and frail patients will continue to be placed in harm’s way.”
Dr. Singh is medical director of Home Infusion Services at Healthcare Evolution in Reading, Pa.
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