Nutrition and Metabolism Research Oral Paper Session Abstracts

Background: Providing home parenteral nutrition (HPN) therapy has become increasingly challenging.The National Home Infusion Association reported HPN costs rose 75.4% from 2016 to 2024 while monthly payments decreased by 5.47%.Additionally, between 2022 to 2024, the number of pharmacies that submitted claims for HPN decreased by almost 16%.This study aims to gain insights into the impact of reimbursement on the continuity of care and clinical management of HPN patients.Methods: A survey of home infusion providers assessed HPN service experiences and challenges.Distributed via direct contact and social media, it assessed patient volume, ingredient costs, insurance impacts, and declined referrals due to reimbursement.Conducted over five weeks (September-October 2024), a total of 29 surveys were completed.Respondents were mainly dietitians (90%).Results: Over half (52-55%) of the responding providers report they declined HPN referrals based on the payor's reimbursement rate (Figures 1 AND 2).During the survey period, 45% of providers transferred patients to other service providers within the prior three months due to poor reimbursement.Most providers (90%) feel PN ingredient costs have become more problematic in recent years, and 38% agreed this affects formulation decisions.One-third (35%) of providers agree that reimbursement affects the clinical management of patients.A smaller portion (13%) reported spending more time managing and adjusting HPN formulas when rates are low (Figure 2).Providers frequently restrict or remove PN components due to cost, with 54% doing so at least monthly and 12% as often as weekly.Many providers (87%) reported modifying or limiting certain PN ingredients due to cost or reimbursement, including switching to oral alternatives (if available), reducing the dose or frequency of ingredients, or removing the ingredient entirely from the HPN formulation.Vitamin C and selenium were the most affected -65% and 52% of providers, respectively, reported removing or limiting their use.Specialty lipid and amino acid formulations, L-cysteine, and levocarnitine were not converted to oral due to lack of oral options or patient tolerability (Figure 3).With over half of the responding providers declining HPN referrals due to reimbursement rates, the results of this study uncover a barrier to the continuity of care for PN patients.Delays in transitioning patients from hospital to home may extend hospital stays and increase the utilization of more costly healthcare resources.Poor reimbursement coupled with rising PN ingredient costs may lead to unintended clinical decisions, compromising individualized care with suboptimal HPN formulations.Factors influencing HPN formulation management that were not addressed in this survey could include shortages and limited market availability for certain components.These results may also be limited by the small population of participants and potential non-participation from industry competitors.National organizations supporting the practice and clinical management of HPN therapy may be better poised to collect large-scale data on this issue.Conclusion: The findings of this survey highlight the financial pressures on HPN providers and the impact of reimbursement on operational and clinical decision-making.The rising costs of PN ingredients are a critical issue, affecting the ability to provide optimal, individualized care.With the need for a large-scale, national study, this small survey underscores the need for better reimbursement policies to match the rising costs of ingredients, ensuring patients can receive necessary nutrition support without delaying access or compromising the quality of care.Figure 1.Number of HPN referrals declined by home infusion service providers each month due to low reimbursement2