How a ‘Christmas miracle’ became a nightmare for heart-failure patients



Infusions in a hospital cost about $2,000 a day, and patients are exposed to the diseases of a hospital setting, while it costs about $200 a day for the same setup at home.

As a health-care provider, one of the more rewarding (and frustrating) things I do is hack through jungles of regulation and insurance complexity to provide an easier path for some very sick patients.

Unfortunately, a crisis is looming in my space — home infusion therapy — due to a law passed in December that is having brutal unintended consequences. It’s creating a thicket of life-and-death problems for thousands of patients, and I’m not sure we are breaking through the bureaucracy in time for them.

Outside of those who benefit from this therapy, I suspect many people have never heard of it. Home infusion is an effective and cost-efficient treatment that keeps people with congestive heart failure and other serious illnesses such as cellulitis, hemophilia and immunodeficiency diseases alive and productive while remaining in their homes.

It’s a no-brainer. Infusions in a hospital cost about $2,000 a day, and patients are exposed to the diseases of a hospital setting, while it costs about $200 a day for the same setup at home. As the population ages, and more people want to stay in their homes as long as possible, it is a growing practice. Some 10 million people get home infusion today.

The treatment is paid for by private insurance companies, Medicaid, Tricare (for veterans) and even the Medicare Advantage program. But it’s not covered by traditional Medicare. Medicare used to pay more for the infusion drugs to compensate for the fact that it did not pay for the service, but that changed last December.

That’s when Congress passed the 21st Century Cures Act (CURES), which was aimed at boosting medical research, but threatens the infusion industry and patients who are covered by Medicare. Call it the law of unintended consequences. Like many things involving Washington and health care, this is a complicated story.

CURES boosts medical-research funding, cutting reimbursement for certain other things to cover those costs. It earmarks $4.8 billion for the National Institutes of Health, including $1.8 billion to advance cancer research — the Obama administration’s “cancer moonshot.” Understandably, CURES won widespread bipartisan support and praise. Republican Sen. Lamar Alexander, chairman of the Health, Education, Labor and Pensions Committee, went so far as to call it a “Christmas…

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