| Home Infusion/Specialty Injectable Questions Michigan Visiting Nurses
MedEquip
Home Infusion/Specialty Injectable Questions
What is infusion therapy?
Home infusion therapy involves the administration of medications using intravenous, subcutaneous, and epidural routes (into the bloodstream, under the skin, and into the membranes surrounding the spinal cord).
Drug therapies commonly administered via infusion include antibiotics, chemotherapy, pain management, parenteral nutrition, and immune globulin. Diagnoses commonly requiring infusion therapy include infections that are unresponsive to oral antibiotics; cancer and cancer-related pain; gastrointestinal diseases or disorders which prevent normal functioning of the GI system; congestive heart failure; immune disorders; growth hormone deficiencies; and more.
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Why are Infusions Performed at Home?
Until the 1980s, patients needing infusion therapy had no option but to remain in an inpatient setting until the completion of their therapy. With the heightened emphasis on cost-effectiveness and cost-containment in health care, clinicians began to search for strategies to eliminate or reduce these costly inpatient stays. For individuals requiring long-term therapy (such as those requiring lifelong intravenous nutrition support) inpatient care is not only tremendously expensive, but also prevents the individual from resuming normal lifestyle and work activities.
Home infusion has been proven to be a safe and effective alternative to inpatient care for many disease states and therapies. For most patients, receiving treatment at home or in an outpatient clinic setting is preferable to inpatient care. A thorough patient assessment and home assessment are performed before initiating infusion therapy at home to ensure that the patient is an appropriate candidate for home care.
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Who Provides Infusion Therapy?
Infusion therapy always originates with a prescription from a qualified physician who is overseeing the care of the patient. A provider of infusion must be a licensed pharmacy or work in conjunction with a licensed pharmacy such as HomeMed. Home nursing services are also provided to ensure proper patient education and training and to monitor the care of the patient in the home. HomeMed nurses work in both the hospital and in the home settings and provide can provide direct infusion-related nursing care (e.g., venous access catheter placement, catheter dressing changes, blood draws for laboratory analysis) when needed. Additionally, HomeMed works very closely with Home Health Agencies, such as Michigan Visiting Nurses , to ensure that all patients in home infusion nursing needs are addressed throughout the State of Michigan and Northern Ohio and Indiana .
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Who Provides Infusion Therapy to patients who do not reside in Michigan or who reside in Michigan, but travel outside of the area for extended periods?
Nationwide, there are approximately 4,500 infusion therapy sites of service, including local and national organizations, hospital-affiliated organizations and national home infusion organizations. UMHHC Discharge Planning Service and/or HomeMed will identify the best home infusion therapy provider option for the patient. Note that it is a usual and customary practice for HomeMed to send medications, equipment and supplies to patients through out the United States when they travel, and sometimes to foreign countries when export/import laws allow. Alternatively, infusion services can be initiated with or transferred to a provider in a vicinity closure to the patient when clinical or service requirements necessitate, or the patient and their physician desire.
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What are the primary I.V. therapies administered at home?
By far, the major home I.V. therapies are I.V. antibiotics, prescribed primarily for such diagnoses as cellulitis, sepsis, and osteomyelitis; other diagnoses include urinary tract infections, pneumonia, sexually transmitted diseases, and sinusitis.
Other major home I.V. therapies include total parenteral nutrition, chemotherapy, pain management, enteral nutrition, IV immune globulin, dobutamine, growth hormone, and other therapies.
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What specialty injectable drugs are administered in the home?
The most common specialty injectable drugs are IV immunoglobulin, anti-hemophilia factor, low molecular weight heparins, blood component stimulating factors such as erythropoetin, and filgrastim. There are many others as well. Patients often learn how to self-administer these medications and nurses are available to administer medications and monitor administration when the therapy or patient's condition require such.
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What is the difference between filling prescriptions and providing comprehensive pharmacy services?
Filling a prescription is an episodic event and comprehensive pharmacy services extend beyond dispensing and include ongoing patient follow-up, clinical monitoring and care coordination with the prescriber and other members of the health care team. Specific components of comprehensive pharmacy services include, but are not limited to the following.
Pharmacy Professional Services
- Dispensing
- Medication profile set-up and drug utilization review
- Monitoring for potential drug interactions
- Sterile procedures including intravenous admixtures, clean room upkeep, vertical and horizontal laminar flow hood certification, and all other biomedical procedures necessary for a safe environment
- Compounding of medications
- Patient counseling as required under OBRA 1990
- Clinical Monitoring
- Development and implementation of pharmaceutical care plans
- Pharmacokinetic dosing
- Review and interpretation of patient test results
- Recommending dosage or medication changes based on clinical findings
- Initial and ongoing pharmacy patient assessment and clinical monitoring
- Measurement of field nursing competency with subsequent education and training
- Other professional and cognitive services as needed to clinically manage the patient pharmacy care
- Care Coordination
- Patient admittance services, including communication with other medical professionals, patient assessment, and opening of the medical record
- Patient/caregiver educational activities, including providing training and patient education materials
- Clinical coordination of infusion services care with physicians, nurses, patients, patient's family, other providers, caregivers and case managers
- Clinical coordination of non-infusion related services
- Patient discharge services, including communication with other medical professionals and closing of the medical record
- 24 hours/day, 7 days/week availability for questions and/or problems of a dedicated infusion team consisting of pharmacist(s), nurse(s) and all other medical professionals responsible for clinical response, problem solving, trouble shooting, question answering, and other professional duties from pharmacy staff that do not require a patient visit
- Development and monitoring of nursing care plans
- Coordination, education, training and management of field nursing staff (or sub-contracted agencies)
- Delivery of medication, supplies and equipment to patient's home
- Supplies and Equipment
- DME (pumps, poles and accessories) for drug and nutrition administration
- Equipment maintenance and repair (excluding patient owned equipment)
- Short peripheral vascular access devices
- Needles, gauze, non-implanted sterile tubing, catheters, dressing kits and other necessary supplies for the sale and effective administration of infusion, specialty drug and nutrition therapies
- Multiple Categories of Pharmacy Professional Services
- Maintaining comprehensive knowledge of vascular access systems
- Continuing education to professional pharmacy staff
- Removal, storage and disposal of infectious waste
- Maintaining accreditation, including:
- Outcomes assessments and analysis
- Ongoing staff development and competency assessment
- Continuous quality assessment and performance improvement programs
- All other policies and procedures necessary to remain in compliance with Joint Commission on Accreditation of Healthcare Organizations (JCAHO), Community Health Accreditation Program (CHAP), Accreditation Commission for HealthCare (ACHC), and other professional accreditation standards
- Certification fees and expenses
- Other applicable accreditation expenses
- Maintaining the substantial insurance requirements (e.g. liability), including compliance with all state and federal regulations related to minimal insurance coverage
Back to Top Administrative Services
- Administering coordination of benefits with other insurers
- Determining insurance coverage, including coverage for compliance with all state and federal regulations
- Verification of insurance eligibility and extent of coverage
- Obtaining certificate of medical necessity and other medical necessity documentation
- Obtaining prior authorizations
- Performing billing functions
- Performing account collection activities
- Internal and external auditing and other regulatory compliance activities
- Retrieval and storage of medical and reimbursement records
- Maintaining inventories of drugs, equipment, administration supplies and office supplies
- Maintaining physical plant and offices, including building, equipment and furnishings, utilities, telephone, pagers, office supplies, etc.
- Maintaining computer clinical and administrative information systems
- Postage and shipping
- Design and production of patient education materials
- Quality assessment and improvement activities
- Continuing education to administrative staff
- Legal and accounting services
- Licensing application activities and fees
Back to Top Does Medicare cover home infusion?
The short answer is no. But the real answer is that certain therapies are covered when administered using durable medical equipment (a mechanical or electronic infusion pump). Only a select few therapies are covered and only under very specific conditions. These include antiviral therapies, some chemotherapies, some inotropic therapies (i.e., dobutamine), and some pain management therapies. More specific information can be obtained by contacting the Medicare durable medical equipment regional carriers (DMERCs) or by visiting their websites at:
Region A - HealthNow New York Inc.
www.umd.nycpic.com
Region B - AdminaStar Federal, Inc .
www.adminastar.com
Region C - Palmetto GBA
www.pgba.com
Region D - CIGNA HealthCare
www.cignamedicare.com
Beginning in 2005 the Medicare Prescription Drug, Improvement and Modernization Act of 2003 (MMA) will significantly expand infusion and specialty injectable drug coverage available to millions of Medicare beneficiaries. The specific details of this new benefit are currently being developed by CMS.
Back to Top What if a patient does not have a home infusion and/or specialty injectable drug benefit?
At UMHHC there are currently both Hospital Accommodation and Charity Programs that either pay for or assist the patient in paying for home services. Because of the current complexity of insurance benefits, and possibility that a patient may qualify for public assistance it is recommended that the referring source contact a HomeMed Reimbursement Specialist (734-975-7441) to validate benefits available to the patient.
Back to Top What are physician's responsibilities in managing infusion and specialty drug therapies?
Again, Infusion therapy always originates with a prescription from a qualified physician who is overseeing the care of the patient.
Back to Top Michigan Visiting Nurses
How long has Michigan Visiting Nurses (MVN) been in business?
MVN has more than 90 years experience in helping patients of all ages and their families remain independent in their home and community.
Back to Top What is MVN's service area? http://www.umvn.org/AboutTerritory.asp
Back to Top Is MVN accredited? Michigan Visiting Nurses is accredited by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO).
Back to Top What type of services are available? MVN provides a broad range of services, for patients of all ages, that include:
- Nursing services, before, during and after a hospital stay
- Intravenous therapy
- Home ventilator support
- Respite care for families who are caring for an ill person
- Personal care and assistance with activities of daily living
- Light housekeeping
- Transportation
- Companionship
Back to Top What is the cost? Please call MVN for current rates. Our phone number is 734.677.0020 or 800.880.0020
Back to Top How will I know if charges are a covered benefit? MVN will review the payor information you provide and inform you verbally and in writing, at the time of admission, the approximate maximum dollar amount for care, if any, that will be borne by the patient.
Back to Top What is the billing procedure? MVN generates bills on a monthly basis and at the time of your discharge.
Back to Top What are MVN's service hours? MVN's office hours are 8:00 a.m. to 5:00 p.m. , Monday through Friday. MVN professionals are available by phone 24 hours a day, 7 days a week.
Back to Top How do you select employees? MVN selects employees based upon appropriate screening/testing, application review, interview and verification of references, licensure and/or certification, and other credentials as appropriate to ensure that suitable hiring decisions are made.
Back to Top Are your employees bonded? Yes, all MVN employees are bonded.
Back to Top Is the patient and their family involved in the development of the Plan of Care? You, your physician, and our experts develop a personalized Plan of Care based on your specific needs. We tailor the plan to fit you.
Back to Top How quickly can services be provided? It is possible for MVN to provide care within 24 hours of the initial request. However, dependent upon employee availability and geographic location, MVN may require additional time to fulfill your request.
Back to Top Can I change the schedule? Yes, the schedule may be changed. Please contact MVN as soon as possible when making a schedule change.
Back to Top How much advance notice is needed if I want to cancel service? If you wish to cancel MVN services, MVN requests that you give a 24 hour advance notice to the office. A 4 hour minimum service (show up) fee will be charged if you do not give sufficient advance notice to MVN so that MVN can cancel or reschedule staff.
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MedEquip
What is Home Medical Equipment?
Home medical equipment are items which allow a patient to enjoy the fullest life possible by assisting the patient with any medical needs they may have in their home. For instance, a patient who may have an unsteady gait will benefit from the use of a cane or walker. By offering this assistance, the patient is able to ambulate more freely and live a much independent lifestyle.
Back to Top What will it cost?
Please contact our customer service department at (734) 971-0975 or (800) 530-0714
Back to Top Will my insurance pay for Home Medical Equipment?
Typically, most payers will offer reimbursement for equipment and/or supplies (urological, ostomy, diabetic testing, wound care, etc…). We will contact your insurance for you and determine your coverage. Should you have any out of pocket costs, we will work with you to understand them and maximize your coverage. We will offer verbal and written communication regarding your benefits.
Back to Top Do I have to contact my doctor?
For any Home Medical Equipment and/or medical supplies to be covered, your doctor will have to write a prescription for them. We will assist you with the documentation requirements and file the insurance claims for you.
Back to Top What is your service area?
MedEQUIP serves most of southeast Michigan . In addition, we can ship medical supplies to anywhere in the world via UPS. Please contact our customer service department at (734) 971-0975 or (800) 530-0714 for specific locations.
Back to Top What are your service hours?
Customer Service representatives are available Monday-Friday from 8:00 AM to 5:00 PM . Our trained service technicians and Respiratory Therapists are available 24 hours per day for your urgent needs.
Back to Top Do you offer specialty services?
MedEQUIP will work with you to obtain any medical equipment and/or medical supplies you may need. We will also work with your insurance company to maximize your coverage. Please contact our customer service staff to arrange for specific items.
Back to Top Do you deliver and offer instruction?
MedEQUIP has highly trained delivery technicians and Respiratory Therapists to deliver and ensure you have the maximum help with your home medical equipment. Furthermore, should you encounter a urgent issue or experience a malfunction, they are available 24 hours a day.
Back to Top Can you ship me my supplies?
MedEQUIP can ship your medical supplies to you. We use services provided by UPS to ensure the safe and timely delivery of your supplies.
Back to Top What insurances do you accept?
MedEQUIP can bill Medicare, Medicaid, and most other commercial insurances. Please contact our customer service department at (734) 971-0975 or (800) 530-0714 for further information.
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