A question came up regarding at-home care and the dreaded insurance monster that seems to navigate the murky waters of outpatient care.... We are pulling out PICCs and replacing them upon readmission for many oncology patients due to the inability to find reimbursable care and management.  The PICC has become a less invasive and more desireable VAD for many of the oncology patients who do not want a port or tunneled catheter, yet need a central line.  Has anyone solved the problem by offering services at a hospital based out-patient clinic or other process to provide flushing or dressing or trouble-calls for VADs? It almost seems cost and vein-saving to keep the line in and offer a "care-inclusive bundle" rather than the constant remove and replace that can lead to 8-10 PICC insertions.    I am sure an implanted port would be one strong answer but many do not want them.  Thanks for your ideas and thoughts.
Scott