Home chemo a growing niche for infusion agencies

Managed care cost reductions help lead the charge

Although chemotherapy has been provided in the home for quite some time, its popularity has grown and shows no signs of slowing any time soon.

"Home chemo is a trend," says Mary Jo Santicky, RN, OCN, associate nurse, with the Oncology Nurses Society in Pittsburgh. "The main reason is managed care. Patients are being discharged earlier so home infusion agencies are contracted to provide chemotherapy in the home."

She says that providing such care in the home is to the patient’s benefit and convenience. It can also be a source of referrals for home infusion agencies willing — and able — to provide such services.

"It is good for the patient, particularly when there is no change in drugs or the method of delivery, and it is on a weekly basis. Where patients used to have to come in to the doctor’s office or an ambulatory setting, now they can get it in the home."

Advanced Clinical Therapy, a nonprofit home care company in Milwaukee that works closely with the Medical College of Wisconsin, has been providing chemotherapy in the home since 1987 when physicians at the medical college saw the need to provide such services. Even with 10 years experience, Joan Dussault, RN, OCN, the business manager for Advanced Clinical Therapy, says her agency finds the niche is still ripe for the picking.

"We deal with all kinds of insurance," she says. "We have found that even though patients have HMOs or PPOs and we are not a member, often if I call, I can negotiate a price with them."

Dussault adds that getting reimbursed is rarely a problem. Most chemo is paid for by many insurers, and when a problem arises, it’s usually not too difficult to rectify it.

"If we have difficulty, sometimes the physician will call," she says. "It doesn’t work 100% of the time, but it works most of the time."

Once, Medicare balked at paying for one of Advanced’s chemotherapy patients who was receiving infusion through a hepatic arterial catheter. Dussault says she called and quoted a paragraph from Medicare’s manual regarding parenteral therapy, and reimbursement followed soon thereafter.

Not everyone has the longevity and experience of Advanced Clinical Therapy, however. Deaconess Home Medical Equipment and Infusion in Evansville, IN, just recently accepted its first home chemo patient.

"It was a referral from a doctor," notes Ann Williams, RN, an infusion nurse with Deaconess. "We’re hospital based, and there is an oncology clinic in the hospital."

The agency had in the past turned away numerous referrals for home chemo patients. Williams notes that her agency’s previous director chose not to pursue the niche.

"We were losing a lot of business by saying no," says Williams.

However, when the latest referral for administering 5FU came up, Williams and her pharmacist discussed the patient and, with the blessing of the agency’s new manager, chose to accept the referral.

She’s now looking forward to gaining more referrals in the future simply by letting physicians know Deaconess now provides home chemotherapy.

"We’ll get more referrals, and a lot of it is educating physicians about what can be done in the home," she says. However, rather than addressing every doctor in the hospital, Williams is going to simply let the hospital’s oncology specialist know that the home care agency is doing home chemo. Williams adds that Deaconess also is hiring a marketing person, which should help.