Home Health Is Beneficial, But In-Home Infusions Remain Risky, ASCO Says

While telehealth and home health could improve access to cancer care nationwide, leading oncology organizations are still concerned about in-home chemotherapy infusions.

The Association for Clinical Oncology (ASCO) recently commented on Centers for Medicare & Medicaid Services (CMS) recently came out with their proposed complete year 2021 Home Health Prospective Payment System Rate Update; Home Health Quality Reporting Requirements; and Home Infusion Therapy Service Requirements (CMS-1730-P).

Telehealth, Home Care Improves Treatment Access

“ASCO supports CMS’s proposal to permit patient services and/or monitoring performed through telecommunication technology on a permanent basis when such services are included as part of the home health plan of care,” ASCO said in a letter to CMS.

ASCO supports the rule’s allowance of home health agencies (HHAs) to use telecommunications to provide care, given that:

• The telecommunications technology is related to the skilled services provided
• The plan of care outlines the use of telecommunications technology
• The telecommunications technology is linked to specific goals and indicates how the use of telehealth will work toward those treatment outcomes

Patients with cancer can benefit from making telehealth a permanent part of the Medicare home health program, especially as this patient population may be more vulnerable and immune-compromised.

“Granting HHAs the flexibility to provide clinically appropriate and high-quality care to these beneficiaries through technology can help keep these vulnerable patients in their homes, reducing unnecessary exposure to all illnesses, not just COVID-19,” the letter said.

In-Home Infusions Pose Risks for Patients, Providers

However, CMS’ plan also includes the Home Infusion Therapy Services Requirements proposal, which would establish pay rates for home health infusions, including chemotherapy. The proposal also would separate home infusion benefits from home health benefits and establish enrollment standards for suppliers of qualified home infusions.

ASCO emphasized that anticancer drugs can be dangerous — to both the patient and provider – if they are administered incorrectly, spilled, or mishandled.

“These safety concerns are what prompted ASCO to develop chemotherapy administration safety standards with the Oncology Nursing Society’ however, these standards are specific to the outpatient setting and do not address specific safety concerns that could arise from home chemotherapy infusion,” ASCO said in the letter.

ASCO is not the only organization against in-home infusions. Earlier this year, the Community Oncology Alliance (COA) released a statement against home infusions of chemotherapy, immunotherapy, and cancer supportive drugs.

If CMS should move forward with their ruling on in-home infusions, ASCO is asking that they:

• Consult with oncology experts before the implementation of home infusion
• Require quality reporting for home infusion therapy services
• Work with oncology experts before making additional chemotherapies available for home infusion
• Require verification that necessary safety protocols and precautions are in place when giving cancer drugs in the home. This will protect health care providers, patients, and caregivers

“ASCO has significant concerns about the safety of home infusion for chemotherapy drugs and does not support its use, unless there are extraordinary circumstances and a treating physician — in consultation with the patient – has determined it is the most appropriate alternative,” the letter says.