Correspondence

Medicare Reimbursement for Intravenous Vancomycin at Home

N Engl J Med 1995; 332:1037April 13, 1995

Article

To the Editor:

The clinical benefit of vancomycin, useful for over 30 years in the treatment of patients infected with gram-positive bacteria, has recently been compromised by the development of resistance — especially by enterococci.1 The Centers for Disease Control and Prevention (CDC) have drafted guidelines for the judicious use of vancomycin in an effort to minimize selection for these strains.2 We are concerned that Medicare reimbursement policies may result in increased use of vancomycin.

As the largest national purchaser of health care, the Medicare program can profoundly influence health care delivery through its reimbursement policies. Medicare does not routinely provide reimbursement for intravenous medications administered at home but does pay for medications that require the use of an infusion pump. Vancomycin is included in this category; other commonly used parenteral antibiotics (e.g., cefazolin and ceftriaxone) are not. This policy may result in the preferential use of vancomycin for patients requiring intravenous antibiotics at home. In our practice it is quite common to treat Medicare patients with home intravenous vancomycin for a variety of indications (e.g., osteomyelitis and septic arthritis). For patients with methicillin-susceptible Staphylococcus aureus infections, we have even switched from cefazolin or oxacillin during hospitalization to vancomycin on discharge because of this reimbursement policy.

Given the strong incentive provided by the policy of reimbursement for vancomycin but not for other agents, outpatient use of vancomycin by Medicare beneficiaries can be expected to increase. The CDC and Medicare should resolve this problem, and Medicare should consider a policy of reimbursement for alternative intravenous antibiotics.

Peter J. Weiss, M.D.
Timothy C. Poirier, M.D.
200 E. Sheridan Rd., Melbourne, FL 32901

2 References

1. 1

   Frieden TR, Munsiff SS, Low DE, et al. Emergence of vancomycin-resistant enterococci in New York City. Lancet 1993;342:76-79
   CrossRef | Web of Science | Medline

2. 2

   Centers for Disease Control and Prevention. Preventing the spread of vancomycin resistance — a report from the Hospital Infection Control Practices Advisory Committee prepared by the Subcommittee on Prevention and Control of Antimicrobial-Resistant Microorganisms in Hospitals. Fed Regist Document 94-11913 Filed 5-16-94; 8:45 AM.