肠外营养患者未获得联邦医疗保险 (Medicare) 赔付
By: Option Care
February 21, 2017
Many Home Parenteral Nutrition Patients Denied Medicare Reimbursement 尽管接受了 A.S.P.E.N.指导方针导向治疗
Option Care 研究强调需要将护理和承保范围相结合
ORLANDO, Fla., Feb. 9, 2017 — Many home parenteral nutrition (HPN) patients who struggle to gain or maintain weight due to complex medical conditions may be falling through the cracks due to an outdated Medicare qualification process, suggests Option Care research being presented at the American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) Clinical Nutrition Week (CNW) conference. The study determined that Medicare coverage often doesn’t match up with A.S.P.E.N. guideline recommendations, forcing patients to pay for some or all of their life-saving care.
研究人员发现，超过一半的 HPN（静脉输液）患者的护理符合 A.S.P.E.N. 指导方针，但却不符合 Medicare 的承保资格。这些研究结果表明，Medicare 采用了过时的 HPN 资格标准，包括无法体现当前推荐治疗的营养不良诊断工具。
“HPN is an expensive therapy and understandably Medicare wants to ensure that patients require that level of nutrition,” said Natalie S. Tu, RD, lead author of the study and clinical nutrition support dietitian for Option Care. “However, many malnourished patients have a clear need for HPN but don’t qualify for Medicare coverage. Care team members — including doctors and dietitians — need to diligently document the patient’s need in an attempt to secure Medicare coverage.”
In some cases, appeals providing additional documentation of need may be successful in securing coverage for patients initially denied by Medicare. Medicare patients who don’t qualify for coverage pay out of pocket costs which can be up to $250 a day and are prohibitive for many people. The average length of therapy for Option Care HPN patients is three months.[*] Option Care data on file.Patients who have supplemental insurance may be partially covered, but will be required to pay a daily deductible, which also adds up.
目前，大约 20% 的 Option Care 家庭肠外营养 (HPN) 患者有联邦医疗保险 (Medicare)。随着人口的老龄化，这一比例将会继续增加，突显了 Medicare 保险与 A.S.P.E.N. 指导方针应更好地保持一致的需求，Tu 说道。
这项 Option Care 研究因其卓越与创新被提名为 A.S.P.E.N. 临床营养周 (CNW) 优秀论文摘要。研究人员分析了接受 HPN 治疗的 142 名患者，确定有 49 人 (35%) 符合 Medicare 的 HPN 资格标准，56 人 (39%) 不符合标准，而 37 人 (26%) 则停滞不前，因为资格审查过程中断或未完成。在 56 名没有资格获得联邦医疗保险 (Medicare) 的患者中，31 人 (55%) 确实达到了 A.S.P.E.N. 指导方针推荐。
患者被开出 HPN 的处方，是因为他们具有如癌症、中风、胃肠道疾病或手术并发症等病症，无法通过口服或喂食管（肠内营养）来满足他们的营养需求。虽然 HPN 可以在医院进行施用，但每年大约有 40,000 名患者在家中安全地接受营养治疗，费用更低，避免了医院获得性感染的风险，可重返工作并且过着积极向上的生活。
Option Care 的营养支持项目遵循一个多学科团队的护理方法，该团队包括输液护士、药剂师和获得营养支持认证的营养师，他们与医师密切合作，为家庭营养患者提供最高品质的护理。全美各地的每个护理管理中心都有一名注册营养师提供支持。
关于 Option Care
Option Care Enterprises, Inc. (Option Care) is one of the nation’s largest and most trusted providers of home and alternate treatment site infusion services. An industry leader, the company draws on nearly 40 years of clinical care experience to offer patient-centered therapy management. Option Care’s signature Home Infusion Plus services include the clinical management of infusion medicines, nursing support and care coordination. Option Care’s multidisciplinary team of more than 1,800 clinicians — including pharmacists, nurses and dietitians — are able to provide home infusion service coverage for nearly all patients across the United States needing treatment for complex and chronic conditions. Learn more at www.OptionCare.com.
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