In an Era of rapidly rising health care costs, patients are actively seeking ways to reduce expenditures while maintaining the highest levels in quality of care. At the same time, we’re experiencing decentralization in health care delivery. Increasingly larger numbers of health services are being delivered at sites distant from a hospital setting - including the patient’s home.
Home infusion affords patients independence and a better quality of life by providing them their treatments in the comforts of home within a schedule that best fits the patients’ needs. A principal reason for hospitalization has long been the need for intravenous medication. However, with advances in infusion technology, coupled with the emergence of skilled nursing, home infusion has become a reality and carries several advantages worth considering.
Prolonged hospital stays can expose patients of greater risk to hospital-acquired infections (HAI), which are caused by more virulent pathogens than those that are community-acquired. Approximately 1 out of every 25 hospitalized patients in the United States has an HAI. More than one million HAIs occur annually across the U.S. healthcare system. These infections can lead to significant morbidity and mortality, with tens of thousands of lives lost each year. Not to mention related costs to the system in the billions. With studies showing that HAI are increasingly caused by antibiotic-resistant pathogens and the fact that most infusion patients are immuno-compromised, it is particularly critical and easy to see why avoiding a prolonged hospital stay is key.
Additionally, many studies have presented significant figures on the cost savings associated with home infusion. A July 2016 study of patients treated for cellulitis with infusions at home shows that 97% of the patients were able to avoid costly hospitalization. Another study, published in 2016 by a Dutch group showed that patients with Crohn’s disease could be successfully treated at home with a cost savings of $58 per infusion. Congress also has recently taken several steps toward creating a broader Medicare reimbursement for home infusion that recognizes these remote professional services.
The 21st Century Cures Act, going into effect in 2021, and the Balanced Budget Act of 2018 together create a temporary reimbursement beginning January 2019. These are two such examples working towards that goal.
The American Pharmacists Association defines special pharmacy as focusing on high cost, high touch medication therapy for patients with complex disease states. Medications in specialty pharmacy range from oral to cutting edge injectable and biologic products. The disease states treated range from cancer, multiple sclerosis and rheumatoid arthritis to rare genetic conditions. Managing specialty pharmacy requires specialized expertise, clinical and supportive services, and specialized facilities.
Intravenous Immune Globulin Therapy
Premier Infusion Care undertook a variety of Immunoglobulin (“IG”) infusion projects that included both intravenous Immunoglobulin (“IVIG”) and subcutaneous Immunoglobulin (“SCIG”) infusions. IG therapy may be administrated via a pump either intravenously (“IV”) or subcutaneously (“SC”). Specifically, IG infusions help patients treat immune deficiencies such as thrombocytopenia, Kawasaki disease, Guillan-Barre syndrome, chronic inflammatory demyelinating polyneuropathy, myositis, multiple sclerosis (“MS”); and other such immune system disorders, idiopathic diseases and many infectious diseases. For each IG project, the Company aimed to design and develop an appropriate formulation and infusion methodology to meet quality and performance indicators.
To overcome the aforementioned uncertainties encountered at the outset and throughout the duration of each IG project, Premier undertook a systematic process of experimentation. Step One: Premier received the prescription for the IG infusion with Figure 1 demonstrating as an example. This prescription details the administration directions and supplies dictated for RX 140204, an SCIG infusion of fourteen grams of Hizentra 20% for a patient with non-familial hypogammaglobinemia. The Company immediately evaluated alternative delivery protocols and methods, as well as the appropriate infusion rate to achieve performance requirements. Specifically, they evaluated factors such as patient weight, medical history and venous access to further ensure the safety of the IG infusion.
Premier also developed a specific delivery plan to increase the functionality and performance of the IG infusion for patients prescribed smaller doses of 100 milliliters. They then developed a delivery system using a pump and tubing which branched into five different administration sites to increase the absorption rate of the medication under the skin, as well. Throughout this course, Premier engaged in a protocol to determine the optimal number of leads to administer the medication.
Additionally, Premier evaluated the administration of pre-infusion medication such as Tylenol or Benadryl to prevent any adverse side effects. As an example, for RX 175330, Premier administered 100 milligrams of Tylenol and 5 milligrams of Benadryl 30 minutes prior to each IG infusion (Figure 2 below).
Ultimately, Premier utilized its experience in pharmaceuticals and infusion to develop an engagement with a systematic trial-and-error process to determine appropriate infusion rates and methods. Focusing on flow rates as an example, in this case, Premier commenced an infusion at a slow rate, increasing it every 10 to 30 minutes (project RX 173352 – Gammaplex).
By tapping into the latest technology, their pumps where able to facilitate and adequately infuse the appropriate dosage to the patient. During this process, Premier constantly monitored for the potential of any adverse reactions - such as headaches, nausea, or vomiting. In the event of an occurrence, treatment could be tapered off, or intervened with formulation improvements.
This further helps demonstrate the flexibility and customization these services provide while showcasing the abilities Premier maintains in developing, designing and improving upon IG delivery methods.
In-home services allow patients to receive day-to-day help with the personal care they need at their own home, preserving their dignity and maintaining a good quality of life. A patient may not have, or live thousands of miles away from other family members that can help. Quite often, even if they live nearby, tackling the demands and pressures of providing care can result in caregiver burnout — a state of physical, emotional, and mental exhaustion. It occurs when family caregivers, who lack the necessary medical knowledge and experience, take on far more than they can handle.
Thoroughly supervised nurses that are certified, licensed and extremely knowledgeable can now deliver skilled medical care at home. The managed services they provide ensure that the patient’s complex medical needs are met in a safe, healthy and comfortable living environment. These comprehensive services include not only drug administration, medical emergencies and prevention of complications, but also patient education and customized personal care such as dressing, feeding, bathing and grooming.
Dedicated Registered Nurses (RN) can be sent out to create a plan for assigned Licensed Vocational/Practical Nurses (LVN) to follow; and Certified Home Health Aides (CHHA) can be utilized to provide light housekeeping services, as well as acute and extended care services. Whether complex or fairly routine, these plans often are renewed to ensure all specific needs are met with the best possible care being provided.
Research shows patients stay healthier with social interaction and home care aides can often become trusted friends; while incorporating walks, reading, cards, games, movies, meals and other social activities. Home health care services are truly unique, providing meaningful, one-on-one personal and skilled care that builds strong bonds between professionals and their clients. Companionship on errands such as grocery shopping, medical appointments or other activities all become part of the value added benefits.
Many clinical results indicate better outcomes for those who obtain home care service, with proven data showing fewer complications for those who have been provided with home care. This is especially true for patients with chronic conditions like pneumonia, diabetes or COPD.
With the average cost of care at a skilled nursing facility being $544 dollars per day and the average cost of a home health care visit at $132 dollars, according to the National Association of Home Care, the choice to recover in the comforts of home starts to make a lot more sense.