Home Infusion Services: An Update

Published April 28, 2020

During COVID-19 outbreak in early 2020, hospitals and clinics began shutting their doors to patients who required routine care. Administrators scrambled to find ways to deliver services while avoiding clustering groups of patients in one location. For patients who required regular treatment with intravenous medications, a location already existed: their home.

Conditions That Can Be Treated at Home

There are five types of chronic conditions requiring intravenous medication that can be provided in a patient’s home as well as in a hospital or infusion center.

Nutritional problems

Many young individuals with disabilities, in addition to chronically ill and elderly patients, are unable to eat and drink adequately. At the most basic level, intravenous therapy can be used to prevent dehydration in patients unable to drink enough fluids. Other patients with various nutritional deficiencies can also be treated this way. Finally, patients with temporary or episodic conditions benefit from home infusion of fluids: these include patients taking medicines that cause nausea, such as chemotherapeutic agents.

Chemotherapy

Many chemotherapeutic agents themselves must be delivered by the intravenous route. However, most patients being treated for cancer are not sick enough to require hospital-level of care, and can receive their treatments in infusion centers. When these centers needed to close during the COVID-19 pandemic, home infusion became a much more attractive option. This was particularly important because patients with cancer have weakened immune systems and consequently are at much higher risk of dying from the severe viral infection.

Chronic inflammatory conditions

A weakened immune system is also a feature of chronic inflammatory diseases such as Crohn’s disease and ulcerative colitis. These are also known as “inflammatory bowel diseases (IBDs)”. When patients with IBDs suffer from flare-ups, they may require intravenous fluids and medications. Whereas these patients could be treated in hospitals or possibly infusion clinics, the risk of contracting viral illnesses is such that it could be safer for them to be treated at home. Multiple sclerosis (MS) and rheumatoid arthritis (RA) are two other chronic inflammatory conditions that must occasionally be treated with intravenous medications, particularly in the context of flare-ups. Like the other conditions already mentioned, MS and RA weaken the immune system and place the patient at increased risk of severe illness or death should they contract the COVID-19 virus.

Infections

During the pandemic, it was perhaps easy to forget that there remained a substantial number of other infectious diseases that required treatment, sometimes intravenous treatment. For severe soft tissue infections such as those caused by methicillin-resistant Staphylococcus aureus, hospitals often ask patients to return to their emergency departments on a daily basis to undergo wound checks and receive intravenous therapy. During the COVID-19 outbreak, this became a practical impossibility. Patients with MRSA and various other infections requiring intravenous therapy could be treated at home.

Pain treatments

For some patients with end-stage cancer and other conditions, pain management becomes difficult with oral medications alone. For these patients, intravenous pain management sometimes becomes necessary. Otherwise healthy patients who have undergone emergent joint surgery, after accidents for example, are sometimes treated with patient-controlled analgesia (PCA), which involves controlled delivery of narcotic pain-killers, delivered via an intravenous pump. The ingenious mechanism of PCA is that the patient is not able to deliver so much medication so quickly that they would harm themselves or develop dependency. The total daily dose of medication is pre-set by the responsible physicians. In theory, PCA could be provided at home, particularly in unusual circumstances such as the COVID-19 outbreak.

Is it Covered?

As far back as 2016, lawmakers in Washington acted to facilitate reimbursement for home infusion services. In 2016, Congress passed the 21st Century Cures Act, that among other things, mandated funds to be appropriated to cover home infusion services. By 2020, the details were still being worked out. Nevertheless, the COVID-19 crisis highlighted the importance of home infusion services, not only for the cost savings involved, but for the health and safety of vulnerable patients.

Who Will Deliver the Medications?

During the COVID-19 pandemic, the value of the services provided by home health providers became more apparent than ever. Intravenous medications involve access through the skin, either semi-permanent, such as long intravenous lines, or implanted catheters. Some patients can be taught how to care for these devices; nevertheless, the safest and most cost-effective way to monitor home intravenous therapy is to employ skilled nursing services.

The events of early 2020 provoked a fair amount of consideration regarding changing the way that we provide health care services. Fortunately, we do not need to invent new solutions to manage patients with non-emergent illnesses, or those with chronic diseases: these solutions are already in place. All that remains to firmly establish these services is the political will to reimburse providers appropriately.