Reviews of infectious diseases
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Outpatient parenteral antibiotic therapy in a health maintenance organization (HMO), as carried out at the Lovelace Medical Center in Albuquerque, New Mexico, has been effective for ambulatory patients (who received their injections at one of the HMO facilities) and for nonambulatory patients (who were visited in their homes by members of the HMO's home health care team). Over a 17-month period, implementation of these procedures resulted in savings of as much as 73% per day over the costs for similar treatment of similar infections in hospitalized patients. The savings derived from treating nonambulatory patients were slightly less than those from treating ambulatory patients because of the costs for home health care personnel.
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Outpatient parenteral treatment of infectious diseases has developed from primitive beginnings to its present state as the standard of care in many areas. The large infusion center described here is headed by physicians who specialize in infectious diseases and occupies a free-standing building where the pharmacy, laboratory, physicians' offices, examination rooms, and finance departments are centralized for efficiency, flexibility, and convenience. ⋯ Costs in the center run between 50% and 60% lower than those in the hospital. Reimbursement, although difficult in the past, has improved considerably, but some third-party payers, including Medicare, have not reimbursed for outpatient intravenous antibiotic therapy.
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This office-based program for parenteral therapy began with the im administration of therapy to outpatients in 1981. Since then it has expanded in scope and staff and has provided more than 1,200 courses of i.v. antibiotics. ⋯ This office model has resulted in excellent quality of care for patients who have experienced few adverse effects or complications. The cost savings of an office program are significant compared to hospitalization for i.v. administration of antibiotics, but issues related to reimbursement are a constant issue.
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Reimbursement policies of third-party payers, including Medicare, reflect a variety of coverage patterns. For a limited group of Medicare patients who are, in Medicare terms, confined to home and require skilled and intermittent care, Medicare Part A covers home care services deemed medically necessary by a physician. Medical equipment and supplies may be included under this coverage. ⋯ The latter must be administered directly by a physician or by an employee of a physician with direct supervision by a physician. These restrictions have, in general, prevented reimbursement by Medicare for iv antibiotic therapy in the home. Medicaid, Blue Cross/Blue Shield, various commercial insurers, and health maintenance organizations usually cover iv antibiotics, but in many cases prior approval is necessary for coverage.