At least 1.65 million of inpatient stays in the U.S. are made by patients without health care coverage whether from a private company, Medicare or Medicaid in 2014. Moreover, the average actual cost per stay of uninsured patients in the same year is at least $8,700.1 It is of utmost importance to set aside a portion of one’s income for emergency medical expenses especially when you’re living a lifestyle that could lead to conditions requiring special medicines via infusion therapy.
Infusion therapy is done by delivering the treatment directly into your body through subcutaneous or intravenous procedures and is often performed when oral medicines are not effective any longer. Conditions that require this treatment option include cancer, heart malfunction, multiple sclerosis, cellulitis and gastrointestinal disorders.
In 2013, acute myocardial infarction (heart attack) ranked the 5th most expensive condition in terms of inpatient hospital costs across the country. It amounted to at least $12 billion in aggregate hospital costs with around 602,000 recorded hospital stays.2
But setting aside a budget for medical expenses aren’t only for those who are with high health risk. Accidents can happen when you least expected them. And when you’re in a hospital bed with a resistant infection that doesn’t respond to traditional oral antibiotics, a more advanced medicine administered via infusion may be required.
The cost of infusion therapy treatments will largely depend on various factors including the condition on why you need to undergo the procedure. A huge chunk of the entire cost is due to the acquisition of the medication required to treat the condition. In fact, a recent study3 analyzing hospital-based infusion therapy expenses in the US for patients with moderate to severe inflammatory bowel disease revealed that acquisition of the drug comprises at least 90% of the total cost of treatment.
Cost of Infusion Therapy in Hospitals
Aside from the fact that medicines often comprise a massive part of the total treatment cost, analysis on hospital inpatient drug spending (not just in infusion therapy) from 2013 to 2015 revealed that the average expenses increased quickly by 23.4%. On a per admission basis, the spending increased by 38.6% in the same period.4
Another major consideration on the expected expenses related to infusion therapy in the hospital is the rate for an inpatient private room with nursing care. A clinical research revealed that such facility is charging patients a daily rate of around $950 and comes with basic hygiene necessities and a regular meal plan. For someone in need of six-week intravenous antibiotics, the hospital room alone can cost the patient approximately $39,900.5
Home Infusion Therapy Costs
Thankfully, getting a treatment outside the hospital can eliminate a portion of the total infusion therapy costs. With the advancement of medical technology, the procedure is now doable at home.
The market value of home infusion therapy worldwide is forecasted to soar as high as 28.3 billion by the year 2024.6 This is an indication that patients, especially those with chronic diseases in need of long-term infusion, will see the greater cost saving benefits of home-based therapy versus inpatient services. Compared to the $950 daily inpatient room rate previously mentioned, outpatient infusion therapy via home health care can cost as little as $100 per visit.5
But the benefits of having the infusion treatment at home often go beyond the monetary savings, the most obvious of which is that you are in the comforts of your home with an environment that’s familiar to you. Unless your condition mostly requires you to be in bed, you will also be able to immediately go back to what you normally do such as hobbies, chores or work because you’re just at home.
All one needs to do is coordinate, with a licensed home infusion therapy provider, treatment sessions based on your attending doctor’s prescription. Regular monitoring of the patient’s progress is also necessary but depending on the diagnosis and treatment, a nurse or pharmacist may be able to train the patient or family members. If appropriate the patient can take a more active role in their own treatment plan, which could lessen nurse visitations while further reducing some costs and potential inconveniences.
Having the procedure at home, however, may not apply to everyone. The attending doctor will still have to access the patient’s condition before deciding that infusion treatment is feasible outside the hospital. Once cleared, the patient and their caretakers are advised on what needs to be done to ensure an environment conducive to treatment.
The Alternate-Site Therapy Options
If having the treatment at home is not feasible (such as when there’s no available area or room to conduct the procedure with absolute safety and caution), your other cost-saving alternatives are healthcare facilities built specifically for infusion therapy patients. One can go to an infusion clinic based in a hospital or receive treatment in a physician-based infusion clinic. Alternatively and growing in popularity a patient may be able to receive treatment within the Ambulatory Infusion Suite of their home infusion therapy provider, which often allows for greater privacy and comfort than the traditional hospital or physician based setting.
Healthcare Insurance Plans
The costs associated with infusion therapy treatments can be further reduced for the patients and their family when there’s health care coverage especially for those who are getting inpatient care. This insurance plan may come from a commercial private insurance company, a government-funded social welfare program (e.g. Medicaid) or a social insurance program (e.g. Medicare).
· Private Insurance Companies
Private health insurance owners who opt for home or alternate-site infusion therapy will have their treatments considered as a reimbursable medical benefit instead of as a prescription drug benefit. In short, you’ll be spending a considerable amount first before getting your money back. Specifically, the costs of clinical equipment, professional services and medical supplies obtained from an infusion pharmacy will be paid for on a per diem basis. Nursing visits and medicines are paid separately. Most home infusion pharmacies, of course, will advise and assist you regarding your options.
· Government Insurance Companies
For patients with low income or limited resources, the government’s social welfare or protection programs such as Medicaid may be able to help fund a part or all of the infusion therapy treatments. In the case of home infusions, reimbursements will be provided.
On the other hand, most patients enrolled in the fee-for-service plan of the Medicare social insurance program will often realize that home and AIS infusion treatments will cost them more than having the procedure in the hospital or nursing homes. In essence, most of their medicines are covered under Part D (Prescription Drug Plan), which unfortunately doesn’t include medical services, equipment and supplies that a licensed pharmacist can provide. It is therefore recommended that you discuss your coverage options first with the infusion therapy provider prior to committing to treatment.
Those under Medicare Part B (Medical Insurance) may still have some of their prescription drugs covered when administered through an infusion pump and other “durable medical equipment” but with limited conditions.7
- Healthcare Cost and Utilization Project (HCUP) (2016) HCUP Fast Stats – Trends in Inpatient Stays. Available at: https://www.hcup-us.ahrq.gov/faststats/NationalTrendsServlet?measure1=01&characteristic1=04&time1=10&measure2=02&characteristic2=04&time2=10&expansionInfoState=hide&dataTablesState=show&definitionsState=hide&exportState=hide (Accessed: 5 February 2017).
- Torio C (AHRQ), Moore B (Truven Health Analytics) (May 2016) ‘National Inpatient Hospital Costs: The Most Expensive Conditions by Payer, 2013’, HCUP Statistical Brief #204. Agency for Healthcare Research and Quality, Rockville, MD.Available at: http://www.hcup-us.ahrq.gov/reports/statbriefs/sb204-Most-Expensive-Hospital-Conditions.pdf (Accessed: 5 February 2017).
- Afzali, A., Ogden, K., Friedman, M.L., Chao, J. and Wang, A. (2017) ‘Costs of providing infusion therapy for patients with inflammatory bowel disease in a hospital-based infusion center setting’, Journal of Medical Economics, , pp. 1–35. doi: 10.1080/13696998.2017.1285779.
- NORC at the University of Chicago (2016) Trends in Hospital Inpatient Drug Costs: Issues and Challenges. Available at: http://www.aha.org/content/16/aha-fah-rx-report.pdf (Accessed: 5 February 2017).
- Odom, E.B., Patel, K.B. and Odom, D.C. (2016) ‘Inpatient Care versus Subacute Care for Long Term Intravenous Antibiotics: Cost from the Patient Perspective’, American Journal of Hospital Medicine, 8(3).
- Grand View Research, Inc. (2016) Home Infusion Therapy Market to Reach $28.3 Billion by 2024: Grand View Research, Inc. Available at: http://www.prnewswire.com/news-releases/home-infusion-therapy-market-to-reach-283-billion-by-2024-grand-view-research-inc-579151981.html (Accessed: 5 February 2017).
- Medicare.gov (no date) Prescription drugs (outpatient). Available at: https://www.medicare.gov/coverage/prescription-drugs-outpatient.html (Accessed: 5 February 2017).