Home Infusion Therapy Frequently Asked Questions
A. Infusion therapy involves the administration of medication through a needle or catheter. It is prescribed when a patient’s condition is so severe it cannot be treated effectively by oral medications but the rest of the patients clinical condition does not require hospitalization . Typically, “infusion therapy” means that a drug is administered intravenously, but the term also may refer to subcutaneous infusions. Prescription drug therapies commonly administered via infusion include intravenous immune globulin (IVIG), antibiotics, antifungals, antivirals, chemotherapy, hydration, pain management and parenteral nutrition. Infusion therapy is also provided to patients for treating a wide assortment of often chronic and sometimes rare diseases for which “specialty” infusion medications are effective when given on a weekly or monthly basis.
A. Diseases commonly requiring infusion therapy include neurological, dermatological and immune diseases and infections that are unresponsive to oral steroids or oral antibiotics, cancer and cancer-related pain, dehydration, gastrointestinal diseases or disorders which prevent normal functioning of the gastrointestinal system, and more. Other conditions treated with specialty infusion therapies may include congestive heart failure, Crohn's Disease, hemophilia, rheumatoid arthritis, and more.
A. “Specialty infusion therapy” is a term in use when “specialty” infusion medications are administered. In this situation the term “Specialty” indicates that the drug therapy itself requires significant pharmacy expertise to safely administer the therapy in the patients home as well as to obtain third party payment for the therapy, and finally coordinating the interactions between the home infusion pharmacy and the home health nursing service.
A. Until the 1980s, patients receiving infusion therapy had to remain in the inpatient setting for the duration of their therapy. Heightened emphasis on cost-containment in health care, as well as developments in the clinical administration of the therapy, led to strategies to administer infusion therapy in alternate settings. For individuals requiring long-term therapy, inpatient care is not only tremendously expensive but also prevents the individual from resuming normal lifestyle and work activities and may increase the chances of contracting a hospital acquired infection.
The technological advances that enabled safe and effective administration of infusion therapies in the home, the desire of patients to resume normal lifestyles and work activities while recovering from illness, and the cost-effectiveness of home care are important. Consequently, home infusion therapy has evolved into a comprehensive medical therapy that is a much less costly alternative to inpatient hospital treatment.
Home infusion has been proven to be a safe and effective alternative to inpatient care for many disease states and therapies. For many patients, receiving treatment at home or in an outpatient infusion suite setting is preferable to inpatient care. A thorough patient assessment and home assessment are performed before initiating infusion therapy at home to ensure that the patient is an appropriate candidate for home care.
A. An infusion therapy provider is most normally a “closed-door”, state-licensed pharmacy that specializes in provision of infusion therapies to patients in their homes or other alternate-sites. The infusion therapy always originates with a prescription order from a qualified physician who is overseeing the care of the patient. Extensive professional pharmacy services, care coordination, infusion nursing services, supplies and equipment are provided to optimize efficacy and compliance.
Qualified infusion pharmacies must satisfy licensing and other regulatory requirements imposed by state pharmacy boards as well as accreditation standards required by most third-party payers. Home infusion pharmacies may also provide additional professional therapies and services.
Q. What are the highly specialized services, supplies and equipment obtained from an infusion pharmacy that are necessary to ensure quality practices and outcomes?
A. Pertaining directly to the medications used, the infusion pharmacy ensures that infusion drugs are:
A. To ensure safe and proper administration of infusion drugs, infusion pharmacists provide the following services:
A. Depending on local practices, regulation and availability of skilled infusion nurses, infusion nurses are provided directly by the infusion pharmacy or by an affiliated or separate nursing agency. Along with the infusion pharmacy staff, infusion nurses are key members of the patient’s infusion care team and work closely in the coordination of care plans and other activities with the infusion pharmacy and the ordering physician. When infusion therapy is provided in a patient’s home, the infusion nurse will ensure proper patient education and training and monitor the care of the patient in the home. Infusion nurses will have special education, training and expertise in home or other alternate-site administration of drugs and biologics via infusion. Services they typically provide include evaluation and assessment, education and training for the patient or caregiver, inspection and consultation of home environment, catheter insertion and patient assessment.
A. Medicare part B covers some IV and Enteral nutritional and cancer treatment drugs in the home but their admission criteria to assure payment is complex and often not obtainable for many patients' under actual clinical conditions. Most infusion drugs, including those not covered under part B may be covered by the Medicare Part D prescription drug benefit. However, the Centers for Medicare & Medicaid Services (CMS) has determined that it does not have the authority to cover the infusion-related services, equipment and supplies under Part D. Thus, it is recommended that you speak directly to a reimbursement specialist to determine eligibility for your individually ordered medication and services since the Medicare approval process involving Parts B and D can be complex.
1. Information modified from the National Home Infusion Association (NHIA): Infusion FAQs. Available at: http://www.nhia.org/faqs.cfm. Accessed January 10, 2011.
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