How Penn Medicine Delivers High-Quality Home Infusion Therapy

Penn Home Infusion Therapy was started in the mid-1990s when Penn Medicine began offering TPN at home. Since then, Penn Medicine has continued to invest in the service line. The value proposition is providing patients an option to receive high-quality infusion therapy in desired site-of-care. Penn Medicine sees the service line as an alternative to adding more outpatient infusion therapy chairs while reserving hospital bed capacity.

In 2017, some of Penn Medicine’s major payers stopped reimbursement for hospital- based suite for infusion, requiring the services to be provided either in an outpatient setting or at home. This spurred an expansion of home infusion therapy. In January 2021, Medicare began reimbursing for certain home infusion therapies and associated professional services under the Medicare home infusion therapy benefit.

While Medicare reimbursement promotes the service line’s expansion, Penn Medicine is even more optimistic about the shift from acute to post-acute care. Payers and providers are increasingly recognizing that infusion therapy can be done in the home.

Certified by the Joint Commission, Penn Home Infusion Therapy offers services for: hemophilia (factor therapy); parenteral and enteral nutrition; Immune Intravenous Immunoglobulin (IVIG); colony stimulating factors; inotropic therapy; chemotherapy; pain management; IV fluids; antibiotics; biologics.

Penn Home Infusion Therapy has clinical care teams focused on different conditions, including hematology and oncology, gastroenterology, nephrology, cardiology, pulmonary, infection disease, musculoskeletal, and dermatology. Each is comprised of pharmacists, RNs, patient supply representatives, and patient service associates. Disease-specific clinical care teams allow for expertise across oncology, nutrition, infectious disease, cardiology, neurology, and pain management.

Pharmacists perform clinical monitoring and assessments, offering recommendations for dose and therapy adjustments. The nurse coordinator reviews physician orders and coordinates care with the patients. The patient supply representative is in contact with patient at least weekly to coordinate supply needs, including equipment and medication deliveries and waste pickups. A patient services representative confirms and schedules upcoming visits.

Each discipline, including nursing, has a training and onboarding program that spans eight to ten weeks. The program allows staff to gain familiarity with each clinical care team prior to specializing in one.

As part of the training, every team member has the option to ride along with the driver and shadow a nursing visit. During Covid-19, supplementary training has been provided over Microsoft Teams. Penn Medicine also has an ongoing performance improvement process, which focuses on anaphylaxis kits and trainings to reduce Central Line-associated Blood Stream Infections (CLABSI).

Direct care staff have a minimum of two years of critical care experience and are chemo certified. This level of experiences helps oncology colleagues feel more comfortable sending patients to receive this care at home. New staff are assessed for individual therapy competency by a preceptor, who attends home visits with the new staff member. While this can be cumbersome from a scheduling perspective, it is necessary to make sure staff are successful.

Staff closely monitor the patient's clinical status, dosage frequency, and treatment efficacy. They then use specialized expertise to identify, communicate, and respond to any changes in the patient's status related to the applied therapy. Penn Home Infusion Therapy also maintains a quality improvement program to ensure exceptional care and patient satisfaction.

Make referrals easy

Penn Home Infusion Therapy’s centralized intake and access system makes referring a patient easy and convenient. A single call will put a patient's health care provider in touch with an RN trained in all Penn Medicine At Home programs. The RN can then triage a patient for all services.

Dedicated insurance authorization staff take care of reimbursement issues, such as obtaining up-front authorizations. Before the start of care, these representatives also contact the patient to discuss coverage and co-pay issues, if applicable.

Leverage resources from the integrated health system

As a part of an integrated program, home infusion staff can easily assess patients for additional skilled needs. When nurses identify patients that would benefit from additional skill, Penn Medicine can get patients what they need. Penn Home Infusion Therapy coordinates with Penn’s home health agency and contracts with them to provide nursing. Their services are also integrated with hospice and home palliative care. Penn Medicine’s nursing directors work closely to manage services.

Penn Medicine creates interdisciplinary care plans for each patient. There are objectives and goals based on condition, therapy and medicine. Each goal has a target date. On every visit and interaction with a patient, the care plan is updated. These interdisciplinary care plans are shared among the care team and the health system providers. Being part of an integrated health system, the care staff can go to physician partners to solve any problems.

Ensure patient access to staff and timely medication delivery

Patients have 24/7 access to an administrator, pharmacists, nurse coordinators, and drivers. They also have 24-hour ability to request a home visit. This is logistically feasible because Penn Home Infusion Therapy’s service area is of a manageable size. On-call nurses are assigned to cover different geographies. Visits can be available within 4-6 hours.

Penn Home Infusion Therapy can quickly deliver medication and medical supplies. They operate our own infusion therapy pharmacy, including a supply warehouse and delivery staff. Emergency services are available 24/7. Medications and supplies are delivered to patients in time for their first dose.