Home care reimbursement for intravenous ganciclovir therapy.

Abstract

Variability in reimbursement for home i.v. ganciclovir therapy among three types of payers was investigated. A survey was developed to estimate reimbursement for drug and medical supplies and nursing services associated with preparing i.v. ganciclovir and administering it to persons with cytomegalovirus (CMV)-associated retinitis in the home care setting. The questionnaire was mailed to 45 home health care agencies and 11 nursing agencies. Of the 56 surveys mailed, 26 (46%) were returned and considered usable. Of the 26 respondents, 22 were home health care companies, 4 were nursing agencies, 22 served patients covered by managed care or state assistance that reimbursed on a per diem basis, and 9 did not provide care to fee-for-service patients. The mean total daily reimbursement rate (for ganciclovir, supplies, and nursing services) from managed care per diem plans was $137.69 per patient, compared with $129.18 from fee-for-service plans and $72.68 from state assistance per diem plans. The dissimilarity may have been due to geographic variations in reimbursement and different mechanisms of reimbursement. Providers of home i.v. ganciclovir therapy for persons with CMV retinitis received the highest mean total daily reimbursement from managed care per diem plans, followed by fee-for-service plans and state assistance per diem plans.