Practices and patients can reap the benefits of in-office infusion. But it must be carefully managed, as infusion comes with substantial financial risk.
Infusion therapy is effective and life-changing for many patients with complex medical conditions, and today many new infusion therapies are available to patients who just a few years ago did not have these treatment options.
Because of these promising advancements, in-office infusion has grown tremendously across many specialties over the last decade, including rheumatology, gastroenterology, and neurology.
While in-office infusion offers a multitude of benefits to both practices and patients, not all practices have the qualifications and capabilities needed to succeed with it.
Even if the practice is a good fit for the service, it must be carefully designed and managed, as infusion comes with substantial risk that can quickly cause financial harm. Following best practices when deciding whether to open an infusion center, as well as when setting it up, can support sound decision-making and provide a solid foundation for building the operation. Consequently, it is worthwhile to examine some of these time-tested guiding principles.
Do not rush the decision
Practices make a serious mistake when they plunge into setting up an infusion center without thinking it through carefully, viewing it as an easy way to increase revenue. There are many factors that determine whether a practice can succeed in offering infusion, and these should be carefully examined.
First, practices should perform a risk analysis, looking at various key elements.
For instance, does the practice have enough patients eligible for infusion to offset the cost of running the office? Does it have the right payer mix to be viable? I’d recommend a ratio of 60/40 to 70/30 in commercial versus government payers. Does the practice work with a GPO and distribution partner to reliably secure drugs at competitive pricing?
Defining how much space is needed is also critical. Project the anticipated patient volume and then determine if the practice has the space to comfortably accommodate this number of patients, keeping in mind the infusion center must be in the same suite as the practice. Space is also needed for drug storage, a nurse workstation, and whatever else state regulations require.
There are other key areas to examine. Make certain the practice is credentialed with payers and contracted to deliver infusion drugs at competitive reimbursement rates. Also, take a close look at staffing. Does the clinical nursing staff have infusion experience, and can the practice ensure a rendering provider is always on site as required whenever infusing occurs?
Billing staff is also critical, as they must have experience in acquiring authorizations and billing complicated infusion codes, which is more complex than office visit billing.
Best practices build a strong foundation
Once the decision has been made to open a center, implementation should be driven by proven best practices for infusion, including the following:
Employ experienced clinical staff
The golden rule of an infusion center is to provide excellent patient care, so nurses must have experience in infusion therapies and thoroughly understand specialty drug protocols. I believe each nurse should not be caring for more than four patients being infused at once.
Provide strong revenue cycle support
Make certain the in-house billing team has infusion experience, and if not, employ a reputable billing company or infusion management company knowledgeable in complex infusion procedures. Prior authorizations from payers are required before treatment, and denials are common, so staff must know how to manage the authorization and appeal processes. Financial assistance programs for financially challenged patients must also be carefully managed.
Utilize appropriate technology
Select a highly rated infusion scheduling software, as it can reduce costs by optimizing chair time. Top-rated inventory management software is essential, as costly specialty drugs can cause cash flow disruptions leading to great harm if not properly managed. Likewise, good billing software must be in place.
Offer comprehensive patient support
To create a good patient experience and build patient loyalty, practices should provide a high level of support. Patient education is vital to ensure patients understand their treatment. Financial counselling and assistance are also essential so patients understand out-of-pocket expenses and can access financial assistance programs.
Enhancing an infusion center
Practices currently offering infusion services may be able to improve their operation with a few adjustments.
First, make certain reimbursement rates are at 100% of Medicare for commercial fee schedules, and if not, renegotiate better rates. Also, make sure the practice collection rate is 98% or above. If below this target, consider whether the right people and infrastructure are in place. Finally, practices can market their services to other providers in the community to gain infusion patient referrals to grow the business.
Proceed with caution
In-office infusion centers are not viable for all practices, and careful consideration is required before opening one.
Profitability is the key consideration, because if not carefully executed, the high costs of infusion drugs can cause great financial harm.
When deciding whether to offer the service, it is essential to thoroughly investigate the return on investment, to understand the risks associated with infusion, and to ensure those risks have been mitigated as much as possible.
Following best practices, both when making the decision to open a center as well as when setting it up, will help ensure success for patients and the practice.
Luke Rubie is vice president of provider engagement at Intrafusion by McKesson, which offers infusion management services.