HOME CARE REIMBURSEMENT FOR INTRAVENOUS GANCICLOVIR THERAPY

Variability in reimbursement for home i.v. ganciclovir therapy among t hree types of payers was investigated. A survey was developed to estim ate reimbursement for drug and medical supplies and nursing services a ssociated with preparing i.v. ganciclovir and administering it to pers ons with cytomegalovirus (CMV)-associated retinitis in the home care s etting. The questionnaire was mailed to 45 home health care agencies a nd 11 nursing agencies. Of the 56 surveys mailed, 26 (46%) were return ed and considered usable. Of the 26 respondents, 22 were home health c are 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 serv ices) from managed care per diem plans was $137.69 per patient, compar ed with $129.18 from fee-for-service plans and $72.68 from state assis tance per diem plans. The dissimilarity may have been due to geographi c variations in reimbursement and different mechanisms of reimbursemen t. Providers of home i.v. ganciclovir therapy for persons with CMV ret initis received the highest mean total daily reimbursement from manage d care per diem plans, followed by fee-for-service plans and state ass istance per diem plans.