Is chemotherapy going back home?
Oncologists provide fewer in-office treatments
Although clinical advances in drug therapies have allowed more and more chemotherapy patients to receive care outside the hospital, the latest trend has been anything but a boon for home infusion providers. But that trend appears ready to change, says Vincent J. Paravecchia, RPh, a home infusion consultant based in Philadelphia.
In preview of his seminar at the upcoming National Home Infusion Association's May 6-9 conference, Paravecchia notes that the '90s may close with a bang for home infusion providers that offer chemotherapy services.
"Home care for cancer patients peaked in the '80s and has been on a steady decline since then," he says. "Chemotherapy ordinarily done at home or in the hospital is now being done in the oncologists' offices."
As a result, the revenues for home chemotherapy have decreased during this decade, having been transferred to oncologists. But Paravecchia sees a light at the end of the tunnel.
"It is plateauing even in the physician's offices, and there may be a trend to go back into the home setting or alternate site setting," he says.
There are several interrelated reasons why you're likely to see more chemotherapy infusions coming your way, says Paravecchia. And it all relates to the bottom line.
Doctors are in the same boat as any other health care provider: In the current health care environment, all involved parties must think like a business first and foremost. In light of decreasing reimbursement rates, doctors are looking for ways to reduce their expenses.
"Doctors' revenues have been flat, and they're looking for alternatives that offer economies of scale," says Paravecchia. "They're also looking to reduce overhead, so this is an opportunity for home infusion providers to play a vital role in supporting the oncologists."
Paravecchia says two areas provide home infusion providers with the opportunity to increase business through oncologists:
1. Ancillary home infusions.
"Home infusion is still critical and advantageous in pain management and other therapies that support chemotherapy, such as colony stimulating factors," notes Paravecchia. "The home infusion provider can increase their business through supportive measures that go along with treating a cancer patient."
He adds that "For certain long-term infusion protocols, such as people on multiple chemotherapeutic agents, the service can be initiated in the physician's office and then followed by the home infusion company."
Paravecchia says to think beyond chemotherapy agents, as well.
"In addition to chemotherapy, there are supportive and ancillary measures," he says. "The oncologist can't supply everything. For fungemia, the physician is not going to have the drugs in his office to administer that, so he's going to have to rely on a provider."
In addition to pain management, Paravecchia also recommends focusing on antiemetic therapy and nutritional supplementation.
2. Pharmacy services.
Many doctors have their nurses mix chemotherapy treatments for patients. But for the right price, you may be able to win this service over from the doctor.
"Along with nurses mixing the drugs comes labor costs, as well as nurses being exposed to the toxic effects of chemotherapy agents," says Paravecchia. "Your pharmacy can take that away, and the brunt of the liability then rests on the person who mixes the drug."
He adds that providing this service to an oncologist is particularly important for those physicians you can't convince to send patients home for chemotherapy. But don't think small. A recent trend among oncologists is to form clinics under which several oncologists operate. Consider such offices as potential business targets as well.
"The doctor can't do everything, and a good physician relies on support, which is where home infusion providers come in," says Paravecchia.
Getting your foot in the doorBeing a home infusion provider in and of itself does not guarantee that you'll be successful attracting new business from local oncologists. Two areas are critical to your success:
1. Develop relationships.
Paravecchia says the most important step in gaining any business from local oncologists is through trust.
"You have to establish a very close relationship with oncologists in your area, whether they be regional or even local," he says. "There is a tremendous opportunity for local companies to get into this arena mainly because of their close relationships with physicians who often prescribe drugs to their patients that the pharmacy of the home infusion providers provide."
Once you establish a new relationship, the physician may want to take your services for a test ride. You can accomplish this by offering the above-mentioned ancillary services, particularly supplying the oncologist's office with products and pre-mixed drugs.
2. Be prepared.
An oncologist will expect your staff to stay on top of the latest developments in drugs and therapies for patients. (See related story, p. 57.) Do whatever it takes to learn the ropes.
"There is no substitute for clinical experience," says Paravecchia. "You can read all the textbooks, but you've got to see the human element, as well."
So in addition to sending your staff to continuing education classes and seminars, try to set up an informal training session with the oncologist.
"Spend some time with the oncologist to get to know their protocols," he says. "It doesn't hurt to ask if you can spend a day with even the oncology nurse in a typical eight-hour day so you can see the agents they use, the side effects, and how the patients respond."
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