Is an alternate-site infusion suite for you?
The experts tell you how to decide
Simply opening an alternate-site infusion suite isn’t all that difficult if you are a home infusion provider, but opening a successful suite is another story. And the first step in making sure your business venture is a success is to do your homework.
Steven Taglianetti, president of alternate-site therapy for Baton Rouge, LA-based Amedysis, says there are six questions you must answer prior to opening a site:
1. Where will your referrals come from?
The bottom line is to make money. If there aren’t enough referral sources in your area willing to send patients to your suite, then opening one isn’t an option.
Marcia Wise, RN, past president of the National Association of Vascular Access Nurses (NAVAN) and director of clinical support for Catheter Innovations of Salt Lake City, has helped many providers open infusion suites. She agrees that referral sources are critical.
"Interview your current referral base," she says. "What typically happens in home infusion is, if you are seeing 100 patients a month, a third of those may end up becoming ambulatory patients. You may gain some new referrals, but for home infusion it’s often more just trading for a more cost-effective place of treatment."
However, she does note that there is the possibility of adding new referrals if you know where to look.
"There may be patients who are not being referred to home care," says Wise. "Blood transfusions are tough to do in the home, and financially they’re not cost-effective. But if local oncologists send patients to short-term stay or hospital outpatient, they can then send them to your infusion center."
2. Is there physician support?
Obviously, having physicians who believe in alternate-site infusion therapy goes hand-in-hand with referrals. Taglianetti notes that not all physicians are comfortable with such a setting.
"Some will only support a center that you manage within their office," he says. "We find that infectious disease doctors and surgeons are most willing" to use alternate infusion suites, Taglianetti adds.
3. Is there managed care support?
If you’re currently involved in managed care contracts, you will have to approach the MCO to see what, if any, agreement you can reach. For many providers, this is a major sticking point.
"Most companies have problems dealing with managed care because they are cutting deals that are not profitable," says Taglianetti. "We’ll walk away from managed care business that will not be profitable. It has to benefit the payer, the provider, and certainly the patient."
Wise agrees that pricing is a critical issue that often presents problems for providers.
"People have a hard time understanding how to price their services," she says. "But if I’m a home infusion provider with an MCO contract, I should be able to go to the MCO and offer a discount on patients that can come to the suite."
By offering a discount, you may find your referrals picking up as a result.
"We have gone in and said, We have a $100-a-day contract with you, but if a patient is a candidate for the ambulatory infusion center, we’ll do it for $85 a day.’ The MCO then funnels patients to that lower-cost setting to save money," according to Wise.
4. Is there payer support?
Look at your entire list of payer sources and touch base with each to address reimbursement issues. Don’t leave such a critical area to chance. Find out what will change for your reimbursement staff before treating the first patient in the ambulatory setting.
5. What will your setting be?
Taglianetti says you need to consider whether you will focus on a rural or urban setting.
"Some rural physicians will support a center because they know there is a real issue where you don’t have hospital coverage," he says.
Your present service area will dictate how much you are able to benefit from opening a suite, according to Wise.
"A nurse can see 10 patients a day in an ambulatory infusion center and maybe four a day in a rural home care setting or in big urban centers where traffic makes it difficult," says Wise. By doing away with travel time, you’re increasing each nurse’s productivity.
However, the flip side of the coin is that you’ll need to consider how much space your office will need. This will depend not only on the number of patients who come into the suite each day, but also on the duration of their therapy.
"If you’re going to be primarily doing blood transfusions and chemotherapy infusions that are going to take four to six hours, that is going to be more difficult than if you do a lot of antibiotics that come in and out in 30 or 40 minutes," she says.
6. Can you handle the billing?
"The billing is complex, but anyone can learn it," says Taglianetti. "But you need a billing center that bills properly for an alternate-site center." (For a comprehensive look at billing issues with ambulatory infusion suites, see Home Infusion Therapy Management, July 1998, p. 77.)
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