Is an infusion suite in your future?
How to measure potential before the investment
(Editor's note: In the first of a two-part series on alternate site infusion suites, Home Infusion Therapy Management provides you with advice on how to gauge your potential for an alternate site infusion suite before making the investment. Next month, experts will discuss specific areas of difficulty you'll need to consider as you establish your infusion center.)
Ask 10 people if infusion suites have seen better days, and you'll likely get 10 different answers. But there's a reason for the varying opinions: It's personal. What can be a perfect business opportunity for one home infusion provider could very well be a money pit for another. There's no need to find out too late that you fall in the latter category.
Karen Flores, PharmD, president of Health Management Associates, a consulting firm in Woodside, CA, says that alternate site infusion is showing new signs of life. "It's entering another growth stage and re-emerging as an opportunity because of a lot of the reimbursement changes that have occurred," she says.
The following are three markets that are prime candidates in the current health care environment to open alternate site infusion suites, including tips on how to attract business:
· Urban-based, managed care-focused providers.
According to Michael Tortorici, RPh, MS, president of Alternacare of America, a Dayton, OH-based national health care consulting firm specializing in alternate sites, the market is reaching a plateau. "The only people who are paying for freestanding administration are basically the commercial insurers," he says.
But Flores says that can be to your advantage. If you have capitated contracts, an infusion suite may be beneficial.
"If you have a high percentage of managed care patients and you're in a fairly densely populated area, then from a cost standpoint, it can make a tremendous amount of sense to have an ambulatory infusion center," notes Flores. "It lets you cut down on some of the operational expenses of running your home infusion business for certain patient types. Instead of sending a nurse out to see a patient, you can bring the patient into the center, and the same nurse can see four or five patients in the same amount of time."
Tortorici recommends looking at your managed care contracts and your reimbursement mix to see if your current payer sources are likely to pay for alternate site infusions.
"There is a certain amount of hype in the industry indicating individuals should establish a suite, but there is always a caveat to take a look at reimbursement first," he says. "It is absolutely critical to find out who will use the service and what the reimbursement will be before you spend a dime."
He adds that even if a payer source agrees to reimburse for infusions in an alternate site, there may be a reduction in price. It's best to have an in-depth conversation with payer sources before you open a suite.
"Talk to them about what kind of usage may be seen and even the possibility of an exclusive," says Tortorici. "If a multitude of providers build these, what kind of return will you get on your investment? It's important that people look at this from a fiscal perspective."
If the dialogue proves successful, Flores says, you may want to take it one step further and ask what they'd like to see in your clinical policies and procedures. "That way when they're ready to use the center, they'll have the confidence that patients will be treated the same way they would as an inpatient," she says.
· Those with relationships with physician-based suites.
"Reimbursement from the physician side of Medicare for ambulatory infusion is being cut, which favors home infusion providers," says Flores. "They have all the costs associated with the care, such as a chemotherapy certified nurse but not a lot of patients to spread out the cost over."
If a home infusion provider can contract with a physician group or several different physicians to manage the infusion center, the costs would be spread over a greater number of patients.
By creating a more cost-effective method of treating patients through volume, combined with the additional charges such as nursing time and the number of hours each patient uses the suite, the alternate site can become a profit center.
There are certain patient types who are prime candidates to use an ambulatory infusion center, predominately those who require medications that are infused over a number of hours that must be supervised by a nurse. Flores says examples of therapies that are frequently done in an alternate site setting include:
- complex chemotherapy;
- certain AIDS therapies;
- some of the high-risk antibiotics.
That's not to say that only patients receiving such medications are likely to use your facility. The bottom line is still saving payer sources money, regardless of the patient's diagnosis.
"We also see it useful for patients who cannot be trained to do any of their care on their own and who don't have a caregiver," says Flores. "Coming to a center can be a lot more efficient than sending a nurse to the home twice a day."
· Hospital-owned providers.
"One of the areas where it makes the most sense is for infusion companies that are part of an integrated delivery system of a hospital," says Flores. "It makes a lot of sense for them to keep patients within the framework of their system."
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