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The home infusion industry started in the late 1970sin USA. One of the reasons for the growth of this industry was to infuse Total Parenteral Solution (TPN) into patients who could not eat regular food or could not take enteral feedings. Medicare created a policy which supported the payment for TPN at home, hence leading to the start of home infusion therapy (HIT).
Later in the early to mid-1980’s, the HIV/AIDS pandemic also supported the growth of HIT because most of the drugs were given intravenously (IV) to treat the disease. Because of ambulatory infusion pumps, the HIV/AIDS patients were able to continue infusing the drugs while maintaining their normal lifestyle. The elastomeric and mechanical ambulatory pumps could be filled with the drugs and infused through a central or venous catheter. The pump could be hidden under clothing.
Over the last 50 years or so, HIT has proven to be a safe and effective method to give IV drugs for a wide variety of diseases. At home, we can treat infections with antibiotics, cancers with chemotherapy, enteral and parenteral therapies for eating disorders, hydration and many other injectable drugs given either subcutaneously or intravenously.
In 1992, I established Crescent Healthcare, which was a home infusion company providing intravenous immune globulin (IVIG), among other acute and chronic drugs, to patients at home and in infusion centers. I consider myself a pioneer in treating neuromuscular diseases with IVIG in California. We saw patients getting out of wheelchairs and start walking. CIDP, Myasthenia Gravis, some cases of Multiple Sclerosis, Guillain Barre’ Syndrome, Stiff-Person Syndrome, Small Fiber Neuropathy, Pemphigus and Pemphigoid diseases, and several other diseases are treated with IVIG with remarkable results. My current company, KabaFusion, provides all infusion therapies, including IVIG.
Over the years, with the advent of high-caliber infusion pumps, competent infusion nurses and state-of-the-art clean rooms, HIT has proven itself to be a safe and effective way to provide patients with IV drugs. Besides its safety level, there are a lot of cost savings when the drug is infused at home. Most importantly, the patients also feel more comfortable getting the infusions at home. They do not need to drive to a particular ambulatory infusion center (AIC)-either an MD based or hospital based- nor pay for gas and parking or for food. Our nurses go to the patients’ homes at their desired times. The drugs are infused safely, and patients’ homes are also monitored for safety.
Currently, the problem we face as HIT providers is that the hospitals and physicians who are supposed to tell the patients that home infusion is a viable option are in direct competition with us. Therefore, most hospitals and physicians who have AICs will insist that the patients receive treatment at their infusion centers. It costs patients more out of pocket since costs in AICs are much higher, as well as the cost and inconvenience of commuting to the AIC. More so, the patients have to get there when these places are open, hence there is very little flexibility in scheduling infusions. Another serious concern is that AICs may have patients with many diseases other than the one the patient is getting infusions for, exposing the often severely immunocompromised patients to an increased possibility of infections.
Payors should encourage home infusion therapy instead ofinfusions done at AICs. The patients should also demand the infusions done at home by established home infusion companies. Home infusion therapy is a win-win scenario for both payors and patients.