Clinical Integration - Population Health - Accountable Care Organizations
These three terms give many hospital administrators heartburn. How do we manage the inpatient and outpatient business with less dollars and still manage to meet the needs of the ACA, Population Health and Clinical Integration? This article describes some techniques to assist with improving outcomes by utilizing a ambulatory infusion centers. - But what does infusion therapy have to do with managing a hospital, improving the health of the population or the accountable care act for that matter? The answer is that all three can be enhanced by developing a deliberate approach to hospital Based Outpatient Department Infusion. Most hospitals do in fact have an infusion center - but it is often an "after thought", a place to provide hydration to patients, a facility where blood ins transfused or a place where patients without insurance receive antibiotics - typically space that is highly underutilized.
Probably not a single CEO, Administrator, Vice-President, Director or Manager in the hospital industry today would say that they are not concerned with reimbursement. Finance departments across the country are asking management to reduce spending and to find ways to reduce their budgets. The pharmacy budget is often a target for reduced expenditures. Today, complex biologic drugs, antibiotics, and lifesaving orphan drugs are causing pharmacy budgets to grow dramatically. Expensive products like Remicade Infliximab, Orencia abatacept, Cubicin daptomycin, IVIG and others seem to be causing pharmacy budgets to expand dramatically. Many pharmacy leaders are concerned with these increases, consequently they have asked staff to pare down expenditures on complex products, to find alternatives such as self injectables or to utilize a specialty pharmacy for these costly products. However, many in the pharmacy department, finance and management fail to realize that when these products are provided in the outpatient setting they ARE reimbursed. Outpatient Infusion Centers are NOT impacted by DRG pricing or per Diem case rates in the way inpatient services are reimbursed. That's right - when you shift to the outpatient setting the place of service changes and the reimbursement, even for Medicare is different.
Clinical Integration: Coordinates care across the continuum of services.
Hospital outpatient department infusion is a natural component of clinical integration. altering traditional referral patterns i.e. automatically referring cases to the emergency department for acute cases such as cellulitis allows for lower costs for the patient the hospital provides coordinate care across the services. In fact, if you look at some of the top reasons for admission that have excess length of stay many of those cases can be cared for in an ambulatory infusion center more efficiently wit a lower cost to the patient and to the hospital. For example, let's review a cellulitis case. When the patient presents tat the primary care physician office and the provider recognizes that the case needs IV antibiotics, the traditional next step is to send the patient to the Emergency Department. Often these cases are then admitted to the to the facility for several days of IV Antibiotic treatment. An integrated scenario is to have the patient referred directly to the hospital Outpatient department (HOPD) Infusion Center. When the patient arrives at the HOPD the nurse and staff will likely conduct all of the same procedures as the emergency department such as drawing blood for cultures, administration of a parenteral antibiotic. Think about what happens when the case is shifted from the Emergency Department to the infusion center:
- Emergency department volume decreases - decompressing work load in the ED. By increasing the efficiency by freeing up additional space for more acute cases.
- Patients not sent to the emergency department are much less likely to be admitted saving valuable inpatient beds for more complex patients.
- Patients today often have large deductibles and co pays for Emergency department and Inpatient admissions. By sending the patient to the infusion center the patient often has reduced financial exposure.
Population Health: A systematic approach that aims to improve the health of a set group of people
Managing a "population" sounds daunting, but in todays environment IDN's have the ability to work with their employed physicians to provide the systematic approach to health. For example, GI Bleed is often an admission that is either denied or not payable for the duration of the admission resulting in decreased revenue. By taking a proactive approach and treating patients with chronic disease such as Crohn's Disease with Remicade infliximab patients can significantly reduce their admissions. Although the product is costly it can still result in a positive outcome, particularly with the goal is to help the broad population. Imagine reducing the denials for GI bleed and how that can impact revenue numbers. Infusion centers are the ideal setting to provide these complex and expensive products. The caring staff of the infusion center takes care of these chronic patients and can facilitate their care and coordinate activities with their Gastroenterologist.
Accountable Care Organizations: Providers / Hospitals that provide coordinate high quality care to their Medicare Patients
The verdict is still out on ACO's but most hospitals anticipate that there will be bundling of payments that encompass the entire care of the patient (both inpatient and outpatient) in the future, and that payment will be based on the performance of how their patients are treated and the corresponding outcome. Infusion Centers are an ideal mechanism to help manage and coordinate this care. Think of the previous examples of both acute (cellulitis) and chronic (Crohn's disease) and how taking a strategic approach helps manage the care. Not only can you utilize the HOPD facility for mitigation of admission, but also for decreasing the length of stay. Medicare does not cover home care, so those patients with infection that are admitted can often be sent home early, with q 24 antibiotic therapy not only do you save the facility money by reducing the length of stay, but you also will likely mitigate nosocomial infections.
The strategy behind developing a successful infusion facility should be easy, our team can help you develop a plan that is both efficient and effective. To learn more about how your facility can benefit by taking a deliberate approach to infusion therapy visit our webpage http://www.huizenga-consulting.com/infusion-center-consulting-start-up then call us for a free 30 minute consultation. We can walk you through our approach as well as share references.
Here's a brief video that describes infusion services https://www.youtube.com/watch?v=axzOcDiytu4