|[February 16, 2017]
Many Home Nutrition Patients Denied Medicare Reimbursement Despite Receiving A.S.P.E.N. Guidelines-Driven Treatment
Many home parenteral nutrition (HPN) patients who struggle to gain or
maintain weight due to complex medical conditions may be falling through
the cracks due to an outdated Medicare qualification process, suggests
Option Care research being presented at the American Society for
Parenteral and Enteral Nutrition (A.S.P.E.N.) Clinical Nutrition Week
(CNW) conference. The study determined that Medicare coverage often
doesn't match up with A.S.P.E.N. guideline recommendations, forcing
patients to pay for some or all of their life-saving care.
Researchers found that more than half of HPN (intravenous) patients
whose care met A.S.P.E.N. guidelines did not qualify for Medicare
coverage. These findings suggest Medicare employs outdated HPN
qualification criteria, including malnutrition diagnostic tools that do
not reflect current recommended care.
"HPN is an expensive therapy and understandably Medicare wants to ensure
that patients require that level of nutrition," said Natalie S. Tu, RD,
lead author of the study and clinical nutrition support dietitian for
Option Care. "However, many malnourished patients have a clear need for
HPN but don't qualify for Medicare coverage. Care team members -
including doctors and dietitians - need to diligently document the
patient's need in an attempt to secure Medicare coverage."
In some cases, appeals providing additional documentation of need may be
successful in securing coverage for patients initially denied by
Medicare. Medicare patients who don't qualify for coverage pay out of
pocket costs which can be up to $250 a day and are prohibitive for many
people. The averge length of therapy for Option Care HPN patients is
three months.1 Patients who have supplemental insurance may
be partially covered, but will be required to pay a daily deductible,
which also adds up.
Currently, about 20 percent of Option Care HPN patients have Medicare.
That percentage will continue to increase as the population ages,
underscoring the need for better alignment of Medicare coverage with
A.S.P.E.N. guidelines, Tu said.
The Option Care study was named an A.S.P.E.N. CNW Abstract of
Distinction for excellence and innovation. Researchers analyzed 142
patients receiving HPN, determining 49 (35 percent) met Medicare's HPN
qualification criteria and 56 (39 percent) did not, while 37 (26
percent) did not move forward because the qualifying process was
interrupted or incomplete. Of the 56 patients who did not qualify for
Medicare, 31 (55 percent) did meet A.S.P.E.N. guideline recommendations.
Patients are prescribed HPN because they cannot meet their nutrition
needs orally or via a tube feeding (enteral nutrition) due to conditions
such as cancer, stroke, gastrointestinal disease or surgical
complications. While HPN can be administered in the hospital, about
40,000 patients annually receive their nutrition therapy safely and with
less cost at home, avoiding the risk of exposure to hospital-acquired
infections, returning to work and living active lives.
Option Care's Nutrition Support Program follows a multidisciplinary team
approach to care including infusion nurses, pharmacists and dietitians
certified in nutrition support who work closely with physicians to
provide the highest quality of care to home nutrition patients. Every
Care Management Center is supported by a registered dietitian nationwide.
About Option Care
Option Care Enterprises, Inc. (Option Care) is one of the nation's
largest and most trusted providers of home and alternate treatment site
infusion services. An industry leader, the company draws on nearly 40
years of clinical care experience to offer patient-centered therapy
management. Option Care's signature Home Infusion Plus services include
the clinical management of infusion medicines, nursing support and care
coordination. Option Care's multidisciplinary team of more than 1,800
clinicians - including pharmacists, nurses and dietitians - are able to
provide home infusion service coverage for nearly all patients across
the United States needing treatment for complex and chronic conditions.
Learn more at www.OptionCare.com.
1. Option Care data on file.
View source version on businesswire.com: http://www.businesswire.com/news/home/20170216005926/en/
[ Back To Insurance Technology's Homepage ]