Pharmacists manage the revenue cycle for home infusion

Getting pharmacists involved key to success

What Health Systems Are Doing in Home Infusion

Home infusion care providers have been seeing increased competition from health systems. That may not be surprising, given the depth of expertise-sharing at a recent pharmacy leadership meeting.

At the 2021 ASHP Conference for Pharmacy Leaders, held virtually, Nancy Palamara, PharmD, the vice president for diagnostics and therapeutics at Holy Name Medical Center, in Teaneck, N.J., shared several strategies that healthsystems are using to succeed in this competitive market.

One key strategy is to align infusion care services under pharmacist leadership, Dr. Palamara noted. Although this can be done at any health system, no matter how large or small, there may still be a lack of awareness that such a model can be implemented, at least based on an informal poll of session attendees.

Dr. Palamara asked attendees as to who at their institution has operational oversight of the outpatient infusion center and all of its staff. The most common response was a nurse manager (35%), followed by a nonclinical manager (15%), pharmacist (4%) and physician (2%); 31% of respondents said oversight was handled by a mix of those roles, while 13% did not know.

“This tells us that pharmacists are not very often the ones in charge of infusion center,” she said. “We need to make the case that pharmacy is well suited to manage infusion therapy departments or office-based outpatient infusion centers. Pharmacy must ensure that hospital leaders have a full understanding of infusion services, the outpatient infusion revenue cycle and the impact of clinical factors.”

She cited her own institution’s experience as an example. “Our infusion services had long been integrated with the cancer center, and the cancer center director always oversaw the infusion space,” she said. “Over 25 years, that director often reported to the chief nursing officer or the chief medical officer, depending on the individual’s background.”

But more recently, the institution’s leadership recognized that infusion therapy needed to be a department in its own right, since about 25% of its services were unrelated to oncology, including neurology, immunology, rheumatology and other infusion categories such as a dedicated migraine program. “We spend close to $65 million annually supporting outpatient infusion services,” Dr. Palamara said. “Because we are a community hospital and do not do heart transplants and other services that produce a high inpatient drug spend, our outpatient drugs, primarily infusion, now represent about 92% of our drug spend.”

When the new department was created with Dr. Palamara as its director, it was the first time that Holy Name had a pharmacist in charge. “It’s so important that pharmacy oversees your infusion revenue cycle all the way back to prior authorization,” she said. “It’s a tough battle to go back if things have been messed up in prior authorization and try to get that reversed, so we fought to get into the drug denial space.”

Educating financial professionals about the clinical side of outpatient infusion proved very valuable, she said. “For example, most of our drugs now use weight-based dosing, where your case volume does not directly equal your expense. For a CT of the neck without contrast, your technician time is approximately the same and your scanner time and expense is approximately the same. But that’s not the case with an infused drug.

“I had one of our clinical pharmacy specialists put together a presentation to show our accountant with actual patient cases. One month, we had four patients infused with trastuzumab, and all were over 100 kilos. The previous month, we only had two patients who were over 100 kilos,” Dr. Palamara said. “That produced a significant difference in expenses month over month, and they need to understand that. Having the manager overseeing the pharmacy revenue cycle be a pharmacist has proven to be huge benefit.”

‘It’s so important that pharmacy oversees your infusion revenue cycle all the way back to prior authorization. It’s a tough battle to go back if things have been messed up … and try to get that reversed, so we fought to get into the drug denial space.’ —Nancy Palamara, PharmD

—Gina Shaw

Dr. Palamara reported no relevant fi nancial disclosures.

IN FLUX

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Help the leaders understand the value of pharmacy as it relates to managing costs and improving quality outcomes. • Align the pharmacy team around your strategy.

You’re not going to be able to get everyone, but at least incorporate key individuals. • Evaluate where your team’s time is spent, and what actions and outcomes are being achieved. • Make sure the pharmacy executive has influence at the executive table.

Are Your Services Worthy?

Another important piece of staying ahead—or at least keeping pace—with managed care trends is having a strategy o managing related to partnerships, Dr. Brummond y said. To that end, make sure that the clnical and other patient management services you offer will attract other health systems or for-profit entities as your partners. That creates more of an offensive than defensive strategy, he noted. It’s also important to understand the business and have the data to know where you are now m’s and where you want to go. ti

5 Tips for Striking at the Right Time

The smartest managed care strategy can fail if pharmacy leaders don’t recognize when it is time to put those strategies in play. To strike at the right time, be sure to: 1. Learn about the market players and dynamics. 2. Understand your capabilities. 3. Identify subject matter experts for different areas of focus. 4. When needed, engage consultants or other industry experts. 5. Meet regularly with your managed care leaders to review payor policy updates related to pharmacy, offer your expertise and develop strategies for upcoming contract negotiations.

Source: Philip Brummond, PharmD.

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