Infusion Center Blog

3 Challenging Terms for Hospital Administrators

Posted by Mark Huizenga on Thu, Jan 21, 2016 @ 05:38 PM


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.  


REIMBURSEMENT

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.

 

 

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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. 

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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. 

hospital infusion center

 Here's a brief video that describes infusion services  https://www.youtube.com/watch?v=axzOcDiytu4

 



 

Infusion Centers: 3 Key Indicators for successful infusion startups

Posted by Mark Huizenga on Tue, Aug 25, 2015 @ 09:39 PM


Infusion Center Business Plans: 3 Key Indicators for a successful Infusion Center startup:

Clients often ask, how do we know if we will be successful in starting an infusion center - There are 3 Key Indicators that can help you as you explore the development of an infusion center.   No matter what type of infusion center you developing the same factors will apply:

  • Large Hospital Based Infusion Center
  • Small Hospital Based Infusion Center
  • Independent Ambulatory Infusion Center
  • Specialty Practice Infusion Center - Infectious Disease, Gastroenterology, Rheumatology.... Infusion_Center_Rehydration

 

 

The 3 most important factors are:

1) Identify key referring physicians

2) Know your products that you will be infusing and their profit margins

3) Optimize the schedule to allow for efficient use of space, chairs and staff

We know that health care varys dramatically from state to state, but also, within each state there are various factors which will impact the opportuinties for physician referrals.  As more and more physicians are acquired by hospitals they may or may not have the latitude to refer to an outside organizations.  At the same time, we know that as hospitals continue to grow, there are significant opportunities to help practices become more efficient with infusion (by aggregating infusion patients to one center - either hospital based or provider based) as well as for hospitals to utilize their physicians more efficiently to enhance population health goals, mitigate readmissions or even to develop strategies to avoid an admission.

 


 

Step 1: Getting Started - Identify key referring physicians:

It sounds like common sense, but you have to know who will be referring cases to your infusion center.  It starts with getting to know the market that you are working in .  Often the MSA (Metropolitan Statistical Area) is a good place to start as you identify what the market is or could be for your center.  Identify large groups of physicians that may want to refer to you.  Typical providers may include:

  • Infectious Disease Physicians - Consultative services in the Inpatient Setting is where they typically spend most of their time, but after they make a diagnosis they recommend the patient receive IV Antibiotics inpatient or potentially outpatient.  If they have their own infusion center - they're probably not the right group to target.
  • Rheumatologist:  Many of the preferred products that are used to treat RA are infused.  Many of the smaller rheumatolgy practices are challenged by pricing pressures and declining reimbursement.  If they provide infusion therapy it may be a small part of their business and they may be interested referring their cases to another infusion center as long as there aren't conflicts for competing services
  • Gastroenterologist:  Similar to Rheumatology Gastroenterologists often use infused products to treat diseases such as Crohn's, Colitis and other diseases.   Depending on the market, there may be opportunities to work with smaller groups or individual providers.  Even for larger groups thay may make referrals to your infusion center.  

Step 2: Do Your  Research to identify which products that you will be infusing - and ensure that there will be adequate margins:

Drugs that are infused can be very inexpensive or very costly.  Products often have relatively small margins,and therefore it is very important to identify the margin of the products that you will be infusion.  You may also be surprised to learn that the methods of reimbursement by carrier can vary significantly as well.  Make sure you calculate the margin on drugs you contemplate infusing by:

  • Evaluating the margin based on the "typical dose" for your patient - often multiple vials of a product will be required.  Evaluating the total cost to deliver the product is important as these products can be very expensive.
  • Make sure that you have the correct J-Code to bill to product correctly  - erroneous coding can cost your center a significant amount of money. 
  • To learn more visit our website for infusion center start-up http://www.huizenga-consulting.com/infusion-center-consulting-start-up

 

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Step 3: Once your center is open - ensure that you have optimized the schedule:

Anticipating growth, even significant growth can be exciting - but plan for what you need.  Building in significant additional capacity only adds expenses.  Focus on utilizing the chairs and equipment you have as efficiently as possible:

  • Match the number of infusion chairs to staff you have - typically 3 chairs to 1 nurse
  • Do not schedule your complex patients all at once - complex infusions require labor intensive monitoring such as frequent:
    • Blood Pressure
    • Pulse oximitry
    • Temperature
  • Create "slots" for blending complex biologic drug patients with relatively routine antibiotics or rehydration.

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Contact us to to learn more how we can help you grow your center strategically - we have experience with all types of infusion therapy

 

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The infusion center business is complex.  Any infusion start-up business can be a challenge whether you are a small hospital, a physician practice or a large hospital system.  Our team can help you with our expertise to help you learn how to take a systematic approach.  Planning is the key -  much of what makes an infusion center successful is about knowing the details.  If you would like some help, please call us today for a free 30 minute consult.  Call 1-866-222-4488 to to learn more - or use this contact form  /contact-us  to schedule a time to talk with one of our experts

 

 

 

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Tags: Infusion Center Consulting

5 Things you need to know about hospital outpatient infusion

Posted by Mark Huizenga on Tue, May 26, 2015 @ 08:55 PM


Today many hospitals are being asked to review cost centers and reduce expenses.  Hospital Outpatient Infusion Centers are often under this scrutiny to cut costs.  Infusion center managers are challenged by this request because more and more expensive drugs are being used in the infusion center setting.  This brief article will help you understand some of the pitfalls hospitals typically have with infusion centers as well as some ideas to sustain and grow profitability in the Hospital Outpatient Infusion Center or HOPD.

Here are 3 reasons why infusion therapy should be important to your hospital:

  • Hospitals are employing more physicians - hospitals need to take a systematic approach for caring for complex patients with chronic disease such as multiple sclerosis and Chrohn's disease and others.  Infusion centers can bridge that gap in the continuum by transitioning patients from inpatient to out patient quicker and reduce length of stay.  Infusion centers can also be part of an admission avoidance strategy.
  • Chronic disease requires chronic management - hospitals are equipped to provide comprehensive care - if the care is provided in the outpatient setting costs are lower.  providing care to patients in the outpatient setting keeps costs down for both patients and the hospital.
  • The pharmaceutical industry has a large "pipeline" of products - many of these products will require infusion.

Should you consider an infusion center?  Make sure you know your market place.  I tell my clients that "all health care is local" have a solid understanding of the service gaps in your community.  Don't develop services that compete with the services a large referring physician provides and make sure you create a service environment that helps your patients, your community and your hospital.  

 Hospital_Infusion_Center_large_room-5Infusion Center Consultant

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The #1 reason why hospital based infusion centers are not profitable is that they lack the resources to verify the patients insurance coverage - but there are 3 components you need to evaluate prior to infusion:  Verification, Eligibility and Pre-Authorization.

  • Verification: Does the patient have insurance and what other key information do you need to know about specifics of their coverage.
  • Eligibility: Is the patient eligible for the time period that you will be performing infusion (I recommend checking the eligibility each month or each infusion if possible)
    • Patient Insurance can terminate in the middle of a month or at the end of the month for various reasons - make sure you know they have coverage.
  • Pre-Authorization: Does the patients insurance requirepre-authorization of this drug?  If so, make sure that the patient meets the requirements of the carrier, be prepared to share patient records.  In some cases you may need to "prove" failure on certain other products.
    • Pre-Authorization is a precise process - if the submitted claim does not match the product pre-authorized the claim may be denied for example IVIG is a category not a product.  If they patient needs IVIG, make certain to pre-authorize the correct product i.e. Carimune, Flebogama, Gamunex, Gammagard, Octagam, Privigen etc.
    • For example I was recently working with a hospital system, we conducted a revenue cycle audit for the hospital and identified that IVIG was not being authorized correctly - a spot audit of 30 IVIG claims indicated that charges were generated of over $236,000 but actual receipts received was less than $7,000 - the primary reason for denial? Lack of authorization, or specific product authorization. 

Revenue Cycle Management is critical to operate a successful infusion center - the revenue cycle starts with Verification, Eligibility and Pre-authorization.  If you are not sure how this process works, make sure you connect with your liaison from the central billing office or the finance department to learn about what you can do to ensure a great process for your department, the hospital and the patient. If your not sure how your center is performing - consider a revenue cycle audit - our team can provide you with the assurance your systems are working, or help you understand opportunities for improvement.

 

Hospital Infusion Center

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The #2 reason why hospital outpatient infusion is not profitable is the fact that infusion billing is so complicated.

  • The pharmaceutical products are shipped in various size vials and they are billed in various increments.
    • Let's use the example of the product Tysabri / natalizumab:
      • The product is shipped in 300 mg vials
      • Patients will always receive the same amount each infusion (it is not weight based dosing) the full 300 mg
      • Tysabri is billed in 1 mg increments utilizing the HCPCS code J2323.  Therefore the quantity will be 300 units of J2323 for the drug (Plus the appropriate CPT codes for infusion) 
    • Let's also review an example for another product  Remicade /infliximab
      • The product is shipped in 100 mg vials
      • Patients will receive their dose based on their weight
      • Remicade is billed in 10 mg increments utilizing the HCPCS code J1745.  Therefore the quantity will be 10 units of J1745 for each vial infused (plus the appropriate CPT codes for infusion)
  • The  CPT Code for Infusion can vary depending on the product infused*  Selecting the correct code is very critical to ensure the correct reimbursement.  Here are 3 primary infusion categories:
    • Hydration:
      • 96360 Intravenous infusion, dehydration; initial 31 minutes to 1 hour
      • 96361 Each additional hour
    • Therapeutic:
      • 96365 Intravenous infusion, for therapy prophylaxis or diagnosis
      • 96366 Each additional hour
    • Chemotherapy / Complex Biologic Agent:
      • 96413 Chemotherapy administration 1 hour
      • 96415 Each Additional hour

*This coding information listed here is designed to be a general reference guide, coordinate billing and coding with the respective department, CPT is a copyright of the AMA

  •  Divisor / multiplier issues related to billing software
    • I was recently asked to conduct  assessment of a hospital outpatient department infusion center for profitability.  When we conducted the audit it was determined that the hospital billing software had been incorrectly built to calculate the units of billing.  When reviewed a particular product Cubicin / daptomycin (HCPCS J0878 @ 1 mg) it was determined that the hospital was charging for 1 vial (assuming that billing knew to bill to product at 500 units) unfortunately, the 1 vial was billed as 1 unit and yes that means that they were charging the insurance carriers only 1 / 500 of what they should have billed.  Unfortunately, this process had been in place for many years, needless to say the incorrect billing cost this center hundreds of thousands of dollars 
  • Know your payors and make sure you know how they expect to receive these complex claims.  Correct configuration is critical.  For example, we recently audited a hospital system that was transmitting claims as if they were a commercial payor - we identified over 4 thousand claims that needed to be resubmitted for total charges of over $20 million dollars.
HOPD_Infusion_Center_ChemoHospital Outpatient Infusion

Reason #3 why infusion centers are not perceived as financially sustainable - lack of communication to referring physician

Imagine this you're a physician and you refer a case to the infusion center.  You entrust your patient to their center, but  but don't get any communication back.  Yes, today the EMR from the hospital may transmit a huge file at the end of the encounter (sometimes days or a week after discharge )  But what I'm talking about is regular communication like:

  • Dr. Smith - your patient is not progressing well with the antibiotic you prescribed, Would you like one of our staff to identify alternative therapies or how would you like us to handle this?
  • Dr. Smith - your patient completed their course of therapy as you prescribed, all is well, thank you for allowing us to treat your patient.
    • Today, most doctors appreciate a quick fax or e-mail that their patient is doing well, yes compliance is a part of all of our lives so we send the voluminous documents - but think of this a a customer service opportunity.

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Reason # 4 why hospital based infusion centers are not profitable - charge master pricing

 

  • Hospital charge masters are typically updated on a regular basis (annually) but the volatile drug prices typically do not work well in that environment.  Make sure you know what your drug acquisition costs are, what the reimbursement is by payor and what Medicare and others pay based on the HCPSC reimbursement.  I was recently reviewing a hospital system and identified that there were a number of drugs that were being billed less that what Medicare was paying.  Not only did this mean that they were not getting reimbursed correctly for Medicare, but their percentage of charges payors were reimbursing less than the Medicare rate. As you might expect there was a substantial negative margin on these products.  After reviewing the charge master for a number of other products it was determined that by setting the correct fee the system could realize more than $12.9 million dollars in additional charges and actual revenue capture would be more than $6 million dollars.
  • Some hospitals have constantly increased pricing on drugs year over year, without regard for how this impacts the patient and how they are perceived in the market place.  A recent study published in the newspaper for the same drug in the same state for various hospitals indicated that the product ranged in price from $6,000 - $22,680.  Our team can help you with strategic pricing strategies that will ensure adequate margin, and keep you out of the newspapers (for the wrong reason)

 

 

Reason  # 5 why hospital based infusion centers are not profitable - is a secret, they actually typically are.......

  • Accounting systems at hospitals are notoriously complex and are not designed to provide net profit margin for cost centers like Hospital Out Patient DepartmentsHOPD.  You have to remember that infusion revenue is derived from two primary sources:
    • Professional Services:
      • The CPT Codes for Hydration / Therapeutics / Chemo & Biologic drugs provide some of the revenue - this is typically considered "professional revenue" because it is derived from the professional nurses that infuse the products
    • Pharmaceutical Products:
      • The products that are infused typically represent the majority of the profit.  
  • Because of the complexities of hospital accounting, those two revenue sources 1) Professional Services and 2) Pharmaceutical Products are not "merged" into the one cost center.  Instead, the pharmacy department often has revenue "mapped" to the pharmacy department.

To learn more about how well your infusion center is performing, please contact us for a free 30 minute consultation from an infusion expert.  

 

Hospital based infusion centers are challenging, but infusion centers can and will likely be part of any hospital organizations strategy to reduce length of stay or to provide a venue to mitigate admissions.  If you want to lean more about our consulting services, call us today for a free thirty minute telephone consultation.  

hospital infusion center


 

Tags: Hospital Consultant, Health Care Consultant, Infusion Center Consulting, Infusion Customer Service, Biologic Drugs, Remicade, Hospital outpatient infusion therapy profitability

3 Critical Components to Hospital based infusion therapy

Posted by Mark Huizenga on Sat, Nov 15, 2014 @ 02:53 PM

hospital infusion

Hospital based infusion therapy is something nearly all hospitals provide.  However most do not consider their infusion centers to be a service line or part of their core business. 

If you believe infusion therapy provides an opportunity for a reduction in length of stay, a strategy to avoid re-admission and a way to help your organization accelerate population health remember the follow three components:

It's key to remember that Hospital based Infusion centers can be very profitable!

1) The revenue for a hospital based infusion center originates from both the infusion center professional services (Nurse charges for the hourly infusion charges) and from the pharmacy department (Revenue from the drug that is infused).   Often administration looks at the infusion cost center and it is perceived that they are unprofitable, because typically this just includes the charges for the nursing time.  The majority of the profit will be in the central pharmacy department.  Infusion Centers can be profitable, but analyzing how profitable requires analysis of both departments.  I recommend that an analysis of both payors and products be conducted to identify profitability.

 

2)  Developing a methodology to ensure that the pharmaceutical agents your infusion center utilizes is critical.  The hospital’s traditional methods of pricing pharmaceuticals can be challenging for the infusion center patients - patients are savvier these days and will compare your prices to other hospitals and to physicians.   Also, with new complex expensive biologic drugs (monoclonal antibodies) I find that the traditional methods of setting fees often does not work well.  Fees can either be too high or too low resulting in not maximizing profit.  We can help with this type of analyses. 

3) Knowing who will be sending cases to your infusion center is critical – each market is different and knowing who your referring physician is can help you to not only help care for the patient, but to reduce length of stay.  For example, as patients are discharged from the hospital, hospitalist or infectious disease physicians can refer to the infusion center.  To mitigate admissions cases of cellulites or other infections can be referred directly to the infusion center. 

 

To find out how you can ensure you have a profitable infusion center or if you are interested in developing a hospital infusion center, call today to learn more.

 

hospital infusion center

 

 

3 Things to evaluate to ensure a successful Infusion Center

Posted by Mark Huizenga on Thu, Dec 15, 2011 @ 12:33 PM

What makes a successful infusion center?  Clients often ask me how can we grow or develop this business to be a center of excellence for my community, and program that is financially sustainable and maybe even profitable.    Obviously having a good payer mix is helpful, having patients with insurance is good and a good revenue cycle process is important.  But, perhaps the most important component to a highly successful infusion center is ownership.  No, I’m not talking about equity stakeholders but rather 1) Ownership of the Problems 2) The Processes and 3) most of all, ownership of the Patients.

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Sometimes it is difficult to see if an organization’s staff has real ownership.  If processes are moving swiftly without issue you might assume that there is ownership, but there is now guarantee.   Sometimes it is easier to identify organizations that have staff that do not have good ownership.  Have you ever been told “I don’t know”, or “It’s not my job”, “I’m sure somebody could tell you, just not me” Compare that to “I don’t know, but I’ll make sure I find out for you” – it really comes down to providing not just good but great customer service.

Medical practices are complex organizations, hospitals are even more complex.  Just because an organization is complex does not mean that it cannot provide high quality service and high quality customer service.   I work complex hospitals and practices all the time.  It does not take much observation to find out if staff is taking ownership.

 

The Problems:  Let’s face it, in complex systems there will inevitably be problems some of them very challenging.  In infusion medicines problems can range from not having the correct authorization for a medication to not having the right supplies.  Most of the time, there is a way around the problem that will still allow for the patient to receive the medication they need in a timely manner.  The solutions often are with the nurse or medical assistant that has the “can do attitude” that makes the delivery of the drug a reality.

The Processes: The process of infusion medication often starts with a complex verification and authorization of insurance information.  The process of treating the patient likely was started long before the patient arrived.  Practices routinely review charts in advance of the patient, they anticipate the medication they will use and prepare the tube sets and other devices and supplies they need for their work.  If the process of scheduling is not developed to specific drugs that are being infused there will be problems.  Process problems are usually worked out by evaluating the work flow on paper – identifying the gaps in the program and reworking the process.  Systems consulting can help you and your team with process evaluation.

The Patient:  The patient as everyone knows is realistically where things can go wrong most frequently.  For example, the veins are challenging, or the concerned nurse notices that an error from the pharmacy indicates that there may be a potential medication error.  Quality staff is trained to know what to do, when to ask for help and when to “red flag” a process are critical.  When you have staff that understands the patient and takes ownership of their problems healthcare becomes individualized. 

Put yourself in the patients’ position, it will not be long before you assess your team and if they have ownership!  Ultimately, that is why most of us are in healthcare?

If you or your team needs Infusion Center Expertise - call our team we can help with workflow, profitability, program development (Maybe you just need a "check-up"  please call us today for a free 30 minute consult today 1 866 222 4488

hospital infusion center

Tags: Infusion Center Consulting, Infusion Customer Service

3 Most Common Types of Infusion Centers

Posted by Mark Huizenga on Tue, Jun 28, 2011 @ 10:34 PM

Many people follow the growth of the pharmaceutical industry and see that there are many new biologic drugs on the horizon. Naturally, where there is an opportunity for growth the assumption of profit draws in a greater audience. 3 of the most common locations for providing infusion therapy are as follows..

1. Hospital Outpatient Department (HOPD) This is the traditional location that drugs have been infused, and are often comingled with chemotherapy, blood transfusions, biologics and fluids for rehydration.

2) Physician Specialist / Sub-specialist practice infusion centers. As monoclonal antibodies appeared in the market, certain segments such as Rheumatologist or Gastroenterologist infused biologic drugs such as Remicade

3) As more biologic drugs are infused the development of free standing ambulatory infusion centers are growing. These centers essentially operate as a physician office, yet are actually delivering care / services on behalf of their referring physician customers.The "Place of Service" defines how a practice or hospital will bill for these services. We can help you navigate through this complex process and learn more about the types of infusion, products infused and what you need to develop a sustainable model. Want to learn how you can learn more about developing an ambulatory infusion center, improve your hospital outpatient department or extend the growth of your practice infusion center?

Call us today to learn how we can help your organization grow in this exciting market.

hospital infusion center

We offer a free 30 minute telephone consultation 1-866-222-4488 or review our website

http://www.huizenga-consulting.com/infusion-center-consulting-turn-around/

Ambulatory Infusion Center

Tags: Infusion Center types, biologic drug

3 Strategies to Increase Efficiency at your Infusion Center

Posted by Mark Huizenga on Fri, Jun 10, 2011 @ 02:55 PM

 

Infusion centers today are challenged by many issues today from ASP + 6 pricing, increased costs, and more insurance rejections - it just seems like margins are getting "thinner". Here are 3 ideas to enhance your bottom line. Remember, to increase your profits you can either increase revenue or decrease expenses - typically there are opportunities for improvement on both the revenue and expense side.

1. Know your customer – in health care we are often challenged by the question “who is my customer”? Unfortunately it is often not clear. A nurse will almost always see the patient as the customer; the administrator identifies the insurance company as the gatekeeper of the money and therefore the customer. Traditionally the employer has carried the greatest burden of the cost so they can be a customer as well, but let’s dig deeper. If you’re running an infusion center and trying to garner additional patients often times the customer is a bit more tangential. Think of the case manager at the health plan that may recommend your center, what about the referral coordinator at the referring doctor’s office, or a sub-specialty physician who identifies your venue as a more appropriate place of service? As you can see, there are many customers, and it is important to make sure that they know they are important, that they receive the information they need to do their job (such as communication on the status of the patient, any change in meds etc). The insurance companies measure lots of things, but if you conduct survey’s or studies they might be interested in learning how you operate and in the long run refer more patients to you.describe the image



2. Develop a process to manage and maintain the eligibility of patients, and verify that insurance before each visit. Many of the drugs infused at your facility are extremely costly many biologic pharmaceuticals or orphan drugs can cost several thousand dollars. We try to encourage front desk staff to remember a) Verification – that they have insurance and b) Eligibility – are they eligible to receive this product. Insurance companies have developed protocols to save the plan, the patient and the employer money – unfortunately, that does not always fit with your treatment plan. So, even if a patient is eligible, develop a strategy to ensure that each patient is eligible for the treatment before you begin the infusion. It may not feel like you’ve developed a model of efficiency, but in the long run your revenue cycle (the amount of time it takes to treat, bill and collect) will improve.



3. Create a Charge Master a.k.a. fee schedule that will help you identify if you will have a profit margin on the drugs you infuse. With the volatility of the reimbursement of drugs and the ever changing prices of pharmaceuticals you owe it to the organization to develop a charge master. First, identify 80% of the payers, likely that will be four or five insurance carriers. Next, compile a list of drugs and procedures that you perform in your facility. You can do this on paper, but due to the dynamics of this business we always recommend you have an Excel spreadsheet charge master (need help to configure this? Just send us an e-mail we’ll send you a free spreadsheet template with the formulas already built). Finally, you’ve got to find out what the carriers pay for their products and what your acquisition costs are. Of course you have to manage this whenever there are changes in reimbursement or acquisition costs, you need to update the spreadsheet. You will be surprised, once the spreadsheet is designed, the maintenance will really enhance the revenue at your infusion center.


Do you additional ideas to improve your infusion center? Call us today for a FREE 30 minute telephone consult to learn how we can help you 1-866-222-4488, or review our website http://www.huizenga-consulting.com/infusion-center-consulting-turn-around/ .
Mark Huizenga

Tags: Infusion Center Efficiency, Orphan Drugs, Efficiency Strategy, Revenue Cycle, Biologic Drugs