Medicare cuts endanger hemophilia sufferers

Some home care pharmacies have adopted a "personal care" treatment service model to help improve a patient's lifestyle for--instance, attendance at school and in the workforce. The model includes community service representatives who assist hemophilia sufferers with home delivery of factor: additional patient care items to ensure treatment outcomes through training and information support; constant follow-up care; and assistance with processing the reimbursement claims with insurance providers.

There is quantifiable evidence that the support and assistance of HTCs and home care companies improve patient outcomes and lower system costs. Studies by the Centers for Disease Control have found hospitalization and morbidity are reduced by 40% for individuals with hemophilia who receive proactive care.

Providing the reimbursement to allow for home care services and keeping patients out of hospitals negates a host of future costs to Medicare. By eliminating the delay between injury and treatment, much less factor is required to treat a bleed. Furthermore, the cost for factor alone might be several thousand dollars more per unit in a hospital emergency room. Add to that total the emergency room bill and further costs from delayed treatment and subsequent complications, such as surgery, rehabilitation, and physical therapy--all of which typically are covered by Medicare, Medicaid, or other insurance.

"The more you delay, the more product it takes, and the more expensive it gets," Hamilton points outs. "A bleed that might have started out costing two to three thousand dollars could wind up costing $12,000 instead."

The reduction in Medicare reimbursement could result in home care suppliers reducing or eliminating many of these key services. Snyder stresses that it is imperative for consumers and providers to educate regulators continually on the difference between the provision of factor and what it does for quality of life. "The initiative right now for the hemophilia community is to help the government to come up with the appropriate dollar amounts through the administrative Ice that adequately reimburses specialty pharmacies that offer a whole range of services."

Adds Ligda: "Specialty pharmacies are simply looking for a Medicare payment structure for hemophilia blood clotting factor that accounts for, and adequately reimburses for, the critical services ancillary to the furnishing of factor product.'"

For this reason, Curative Pharmacy Services is appealing directly to the CMS for a separate payment from the administrative fee proposed in the Medicare bill for blood clotting factor that is adequate to cover the critical costs provided by specialty pharmacies to Medicare beneficiaries. "We believe that HHS's development of the separate payment for the administrative costs associated with furnishing hemophilia blood clotting factor will be critical to assuring continued quality and access to care," Ligda stresses.