Hyder staff warn pump cassette costs and delivery strains end‑of‑life care

Julie, Hyder House nurse and site manager, told the Strafford County Commissioners on Jan. 15 that infusion pumps remain necessary for many hospice and high‑acuity patients but that pharmacy supply and delivery logistics are becoming a financial strain. “We’re not going to be able definitely not going to be able to eliminate pumps altogether, because we need them,” Julie said.

The pumps provide continuous infusions of opioids such as fentanyl and Dilaudid, which staff said reduce “peaks and valleys” in pain control compared with intermittent IV dosing. Julie said Hyder recorded 244 admissions last year and ordered 92 pumps in 2024. She also said the pharmacy must compound pump cassettes in a clean room—currently available in Vermont—which adds significant labor and delivery costs.

“Right now it’s covered under the general rate,” Julie said of current reimbursement; commissioners were told that individual cassettes cost about $175 to $192 each and that delivery is the major cost driver. Staff cautioned that if the county must directly pay shipping or compounding fees, Hyder’s operating expenses could rise substantially.

Commissioners discussed alternatives including increased use of scheduled IV pushes by covering physicians and internal ideas to reduce pharmacy burden, but speakers emphasized pumps remain clinically necessary for some patients. A county official said the medical director was not present for the briefing and that the covering physician on recent calls was less inclined to use pumps but that staff will continue to prioritize patient comfort.

The presentation did not propose a formal county policy change; staff said they will continue internal discussions with the facility’s medical leadership and the pharmacy to seek cost‑mitigation options and will report back to the commission if additional funding or policy changes are needed.