In past few years, commercial insurance and self-insured plans have noticed that infusion therapies incur different charges at different sites of care. Hospitals, outpatient infusion centers, physician clinics, freestanding infusion suites and home infusion all use different codes and bill different charges to these health insurance companies.
In general, they have identified that home and freestanding infusion are the two least expensive sites of care for patients receiving infusion therapy AND because of the lower costs, health insurers are asking patients to move from the more expensive sites, like hospital based infusion suites, to an independent infusion suite or to the home.
Of course, the move must be safe and “clinically appropriate” for the patient. Because of the safety issues, therapies for cancer (chemotherapy or immunotherapy) are not scrutinized for this migration to the lower cost site, but many acute therapies like intravenous antibiotics or routine therapies for Chron’s Disease or Rheumatoid Arthritis (think Remicade for instance) are safely and easily administered outside of the hospital or physician’s office settings.
The quality of care at home or an independent, freestanding infusion suite is normally equal to the care you receive at other sites of care. Pharmacists and nurses are highly trained, very experienced and well educated. Infusion therapy at home is much more convenient, less stressful and very appropriate for patients who have trouble walking or with transportation.
If you are receiving infusion therapy at one of the more costly sites of care, it’s very possible your insurance plan is eager to have you move to a lower cost site of care, saving them and you, healthcare dollars.
Don’t be surprised if you receive a letter or phone call from your health plan asking you to consider making the move and even giving you incentives to do so.
It’s important to know that Medicare and Medicaid have different benefits and are not proactively managed like private or commercial insurance plans and in most cases, do not ask patients to move to lower cost sites of care. Unfortunately, Medicare doesn’t even cover most infusion therapies at home or in an independent suite, so the sites of care choices are limited for patients.
If you want more information about “site of care” and your infusion therapy, or to see if changing your infusions to the home or freestanding suite is an option, please contact us at Big Sky IV Care for more answers, 406.752.0440