Home infusion industry still fighting

Industry groups pressing for more favorable reimbursement

As usual, it’s a mixed bag of news coming out of Washington, DC, for home infusion providers. Depending on your main concerns, your legislative glass is either half full or half empty.

Alan Parver, JD, president of the Washington, DC-based National Alliance for Infusion Therapy (NAIT), says one of the main issues concerning home infusion providers is prescription drug coverage.

President Clinton did not ask for prescription drug coverage in his budget request, says Parver. "He’s waiting to see what the Medicare Commission asks for. There is some fairly strong sentiment on the commission to have some form of an outpatient drug benefit, but there’s the question of how to pay for it."

Parver notes such coverage would be expensive — to the tune of $20 billion or more each year. That said, don’t expect the discussion to lead instantaneously to sweeping legislation.

"There probably will be a fair amount of discussion about a drug benefit, but it is unlikely that one will be enacted this year," he says.

Clinton’s budget proposal did call for a reduction in the payment for drug coverage though. At average wholesale price (AWP) minus 5%, the president’s budget proposal calls for a reduction to AWP minus 17%. Parver says it’s too early to tell if such a reduction will fly.

"There is a big issue as to whether Medicare should pay more than acquisition cost, and for a lot of drugs, [AWP minus 17%] would be the actual acquisition cost."

There’s more

While these issues will affect home infusion providers directly, other issues could have an impact as well. Most alarming is where inherent reasonableness could be headed.

"The administration is looking at so-called enhanced inherent reasonableness authority," says Parver. "It’s not clear what that is, but what we think that might mean is the removal of the 15% reduction cap."

On the inherent reasonableness front, the Health Care Financing Administration (HCFA) already has its eyes on using inherent reasonableness to reduce reimbursement for Category 1 enteral nutrition.

"That process has been delayed, but they may do something this summer," says Parver. "We have filed comments showing that the process is flawed, and the inclusion of enteral formulas in the inherent reasonableness initiative was flawed, as well as having met with HCFA since that time. It is a bit early to offer an opinion on how this is going to turn out."

Parver notes the NAIT is continuing to speak to HCFA and Congress on that issue.

There’s also word the Florida Association of Medical Equipment Dealers brought a lawsuit against Medicare’s competitive bidding for medical equipment and supplies. No word on when the demonstration project will be fully up and running.