Parenteral and Enteral Nutrition—From Hospital to Home: Will It Be Covered?

Bonnes, Sara L.; Salonen, Bradley R.; Hurt, Ryan T.; McMahon, Megan T.; Mundi, Manpreet S.

doi:10.1177/0884533617734491

Cited by 10 publications

(15 citation statements)

References 46 publications

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“…In the United States, 1 year of therapy has been estimated to cost around $150,000 . However, trends in reimbursement are limiting payments made by coverage providers to amounts closer to $120,000 annually . Inevitably, this means that patients are faced with the challenge of ever‐increasing fees to bridge this gap.…”

Section: Costs and Coveragementioning

confidence: 99%

“…This coverage scheme can be cumbersome and restrictive in practice. It is not unusual for a patient who has had coverage for HPN for years through private insurance to face coverage issues when he or she transitions to Medicare . These issues can include denials or appeals, which can require significant time and attention from the provider's office as well as the patient.…”

Section: Costs and Coveragementioning

confidence: 99%

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Navigating the Challenges of Home Parenteral Nutrition

2019

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Providing parenteral nutrition at home has significant challenges for both patients and providers alike. Some of these challenges are systemic and are secondary to the way the healthcare system is designed to deliver care. Others are more practical and require educating patients and their families to ensure success at home. Overall, the nutrition support team was designed to help deal with these challenges in an effective way. The changing realities of the modern health system are challenging the nutrition support team to adapt to new obstacles. Providing patients with the tools to succeed at home requires a significant amount of time and investment but will pay dividends in the future as patients thrive for years to come.

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Section: Costs and Coveragementioning

confidence: 99%

Section: Costs and Coveragementioning

confidence: 99%

Navigating the Challenges of Home Parenteral Nutrition

2019

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“…Malnutrition occurs in 30%–50% of hospitalized patients, and these patients are likely to require ongoing medical services from nutrition support teams after discharge from acute care centers . Providing adequate nutrients with home enteral nutrition (HEN) can reduce hospital readmission rates, which is one of the reasons the number of HEN patients has increased . In 2013, it is estimated that there were 437,882 patients receiving HEN in the United States .…”

Section: Introductionmentioning

confidence: 99%

“…In 2013, it is estimated that there were 437,882 patients receiving HEN in the United States . With those increases, clinicians must learn how to navigate the complex decentralized reimbursement processes in a diverse patient population . HEN patients have significant comorbidities and feeding challenges that require a team‐based approach and caregiver competence .…”

Section: Introductionmentioning

confidence: 99%

Addressing Frequent Issues of Home Enteral Nutrition Patients

et al. 2019

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The home enteral nutrition (HEN) population is a medically diverse group whose number has increased substantially in recent decades. Although medically stable compared with acute care patients requiring nutrition support, HEN population needs are unique and require a team approach to manage nutrition. Frequently encountered issues by the HEN team include mechanical issues of the tube site, gastrointestinal and metabolic problems, and patient preferences regarding tube weaning, formula selection, and compliance. A thorough search of the published literature on how to manage these issues was conducted using scientific healthcare databases with the following inclusion criteria: English only, last 10 years, and reviews and clinical trials. Where appropriate, references from the retrieved articles were hand‐searched for relevant articles older than 10 years and cited in this review. The purpose of this review is to provide the HEN team with strategies to address the top issues of home enteral feeding.

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“…Attempts will be made to provide clinicians with guidelines to identify, minimize, and manage these challenges. Reimbursement for HPN and home IV fluid therapy, especially as it relates to Medicare requirements, will not be addressed but remains a significant challenge, as discussed elsewhere …”

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confidence: 99%

Challenges and Obstacles of Long‐Term Home Parenteral Nutrition

Kumpf

2019

Nut in Clin Prac

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Patients receiving long‐term home parenteral nutrition (HPN) and clinicians managing their care face complex challenges not fully addressed by existing clinical practice guidelines. This review aims to increase awareness of some of the challenges encountered when managing patients receiving HPN and provide strategies for management. The ability to optimally manage these patients starts with involvement of a qualified team of clinicians, which is sometimes difficult to find. There are unique challenges related to the parenteral nutrition (PN) prescribing and compounding process that are not typically encountered with inpatient use. Clear communication is required between the HPN prescriber/team and the home infusion pharmacist to prevent errors related to misinterpretation of the order and PN product shortages. Dependency on HPN and living with chronic disease create a number of psychosocial, financial, and other lifestyle restrictions that can negatively impact a patient's quality of life. HPN nonadherence is a challenge that complicates the clinician's ability to accurately assess and make appropriate adjustments to therapy. HPN adherence may be improved by incorporating a patient‐centered approach to care that allows patients to prioritize those issues most meaningful and valuable to them. Patient‐centered care also encourages self‐care and relies on a high level of HPN education. Clinicians are encouraged to use an interactive interview style when engaging patients to prioritize goals of care and make self‐motivated decisions for change. In spite of challenges, HPN therapy has allowed patients the ability to maintain adequate nutrition and thrive in the home setting when the oral/enteral route fails.

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Parenteral and Enteral Nutrition—From Hospital to Home: Will It Be Covered?

Cited by 10 publications

References 46 publications

Navigating the Challenges of Home Parenteral Nutrition

Navigating the Challenges of Home Parenteral Nutrition

Addressing Frequent Issues of Home Enteral Nutrition Patients

Challenges and Obstacles of Long‐Term Home Parenteral Nutrition

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