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Norrie Rabinowitz
Home care Companies Refusing to take New Catheter Care Referrals

 I live in MD and have heard from our Home Care company in Baltimore that many home care agencies are not taking  new catheter referrals. We have patients who have new Hickmans, pheresis catheters and PICC's who don't need home IVF, IV antibiotics but leave the hospital with their catheter. They only require flushes and dressing changes. The issue is the insurance companies are not paying for catheter supplies or if they do it is only $60.00/ month reimbursement and 1 nurse visit a week which doesn't cover the Home care company cost. Medicare doesn't cover any catheter supplies. So patients end up paying out of pocket. Is anyone else having this issue and has anyone developed  creative ideas of ways we help these patients with their catheter supplies.

Thanks Norrie Rabinowitz-Hirsch RN

Craig Farris RN CRNI
Catheter Care

Norrie,  I would encourage you and all members of the forum to contact their Member of Congress and Senators.  Ask them to support The Home Infusion bill currently in committie.  For the US House it is HR. 574 and in the Senate it is S. 254.  These bills are identical.  You can get further information on how to contact them at NHIA.ORG. These short commings are addressed in these bills.  Good luck!  We have been working on this since 2006 when Medicare D went into effect.  Craig

Craig Farris RN, CRNI

Clinical Nurse liaison

Catheter care only referrals

This is becoming more and more of an issue in home care with the Medicare situation. If we accept a patient who requires only catheter care and has no secondary coverage for their Medicare D then we must secure a method of payment. I encourage everyone involved in home infusion therapy to become familiar with the bill before Congress.

Marvin Siegel RN CRNI

Director of Clinical Services

Town Total Health


Karen Day
Karen Day's picture
We have had this happen and

We have had this happen and while we generally do not d/c a patient with a central line unless it is going to be used in the home for infusions, abx or whatever, we do come across the occassional patient who is getting the picc line for chemo treatments.  For these patients, we do not recommend Home Health for the same reasons as you mentioned, they won't approve it or pay for it. Our patients who are getting chemo have arrangements made with their outpatient chemo center to perform their weekly dressing changes and flushes.  As for the patients with the Hickman's and pheresis caths, can you make arrangements with the facility who is going to be using the catheter to perform the dressing changes and flushes on a weekly basis?  I don't know what the solution may be if they aren't being seen weekly.

ann zonderman
In many years of home

In many years of home infusion nursing I have taught many patients and families to be independent in dressing changes and flushing techniques.  This is a great empowering alternative to having to travel to a facility for the catheter maintenance.

Most learn quickly and there are loads of teaching tools , even on this site.

As patients should always be included in making a plan of care... this may be presented and see if they would like to go with this option. 

Supplies may be an issue if no insurance reimbursement, but any infusion company will likely take a cash client.

Ann Zonderman, BSN, JD, CRNI

I have read this thread with

I have read this thread with great interest and my primary thought has not been raised by anyone, so here goes. Why do you have so many patients with CVCs and no infusion therapy to be delivered? In hospitals, the emphasis is now to assess the line on a daily basis for removal. Longer dwells equal greater risk of infection, thrombosis, etc. I might be able to see leaving a tunneled cuffed catheter or implanted port in place longer that the prescribed therapy thinking that therapy may be prescribed again very soon. But for PICCs, I see absolutely no reason to allow those to dwell longer than the therapy. You have explored one issue - the cost of maintenance. But there is also a significant cost of treating the ensuing complications. So the goal should be to remove these catheters when no longer essential for medical management - the same goal as in the hospital. Lynn

Lynn Hadaway, M.Ed., RN, BC, CRNI

Lynn Hadaway Associates, Inc.

126 Main Street, PO Box 10

Milner, GA 30257


Office Phone 770-358-7861

Norrie Rabinowitz
Just to clarify: All of our

Just to clarify: All of our patients are Oncology patients who need the PICC, port or Hickman when they are D/C from the hospital for a variety of reasons. Either they are getting their blood drawn 2-3 times a week, chemo, depending on their regimen. and IVF in the clinic. I just was wondering if anyone else was experiencing these issues. Thank You Marvin and Craig about the bill that is out in congress.

I have heard from our

I have heard from our outpatient oncology unit that when a patient is discharged from the inpatient side with a new catheter and will receive treatment on the outpatient side, home care of the catheter is not covered.  Basically, the care is left up to the patient as these people are mobile and not receiving infusions at home.  When they come in to the outpatient clinic, catheter care occurs, i.e. flushing, alteplase, dressing/cap changes.  This is why it has been difficult when choosing the best catheter for the patient, open-ended or valved, (CT injectable or not).

Ann Williams RN CRNI
Hi, I have worked in a

Hi, I have worked in a hospital based home infusion pharmacy for the past 15 years in southern Indiana.  We deal with this situation quite often.  Mostly on the Medicare patients as (stupidly) Medicare would rather pay for hospital tx than home tx.  Anyway, that's another soap box.  We also have patients with no inusrance or for whatever reason they will be responsible.  I don't think we have encountered any private insurance that doesn't cover "maintenance".  My biller just came by and I got her have to ask a LOT of questions to be sure insurance gives you the correct answers.  she said if the insurance says they have to be home bound for coverage, and they are not, then "no" they won't be covered.  If we have a situation as you described, we give the pt the option of coming to our office and I change the dressing (they only have to pay supplies) or we get them into the outpatient area of a hospital & everything is covered.  If they are also having lab draws, it can all be done the same time.  As already stated, our chemo patients that don't need the nursing visits otherwise sometimes get theirs changed at the office when in for chemo.  If we do have patients that are taken care of by me, we also have to inform them that should they have a problem during off hours, they need to go to ER as my on call does not cover for me to make pt visits to the home. 

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