9 Ancillary Services That Can Boost Practice Revenue

Leigh Page

Disclosures

August 07, 2014

In This Article

Why This Field Is Growing for PCPs

The emergence of PCPs seems to be a recent phenomenon, tied to the growth of allergy vendors. For a share in payments, the vendor helps doctors and their staff get trained, test patients for allergies, and prepare immunotherapy doses.

UAS, founded in 2009, now works with more than 3000 providers in 29 states. "This is not a turnkey operation," DelVacchio said. The doctor still assesses the patient, decides on the therapy, and oversees medical care. Once started, patients often self-administer injections at home, which is more convenient and less expensive than coming into the office, he said.

Florida-based allergiMed, another immunotherapy vendor that caters to PCPs, sends practices a complete kit to provide allergy testing and treat patients mostly using sublingual immunotherapy, which involves placing drops under the tongue.

"You can make money on this by just providing services to your existing patients," said Ken Salzman, a partner in allergiMed, but he declined to define how much money practices could make. Whereas immunotherapy injections are usually covered by insurers, until recently the US Food and Drug Administration (FDA) had not approved drops; doctors therefore have had to provide drops off-label, meaning that insurers won't cover them and patients have to pay the full cost.

In April, however, the FDA approved Oralair®, the first immunotherapy drops. These are only for grass allergies, and the agency still has not approved drops for allergies to dust mites, ragweed, cat dander, and tree pollens. These drops have shown efficacy in a few studies and are already allowed in Europe.

Meanwhile, allergists are not happy with the use of such vendors as UAS, claiming that many PCPs don't have enough training and are relying too much on the companies for expertise.

You'll hear a different view from PCPs who provide these services and formed the Academy of Allergy and Asthma in Primary Care (AAAPC) in 2013. "As a board-certified family care physician, allergy services are within the scope of my practice and are a valued service for my patients," said AAAPC President and UAS client Jeff Bullard, MD, in a statement in January.

In January, the AAAPC and UAS filed an antitrust lawsuit against 3 major allergists' groups. The lawsuit alleged that the allergists have been asking insurers to stop covering immunotherapy by PCPs and that 4 insurers, including the Texas and Kansas Blue Cross Blue Shield plans, have withheld at least some payments to PCPs for allergy treatments. (A spokeswoman for the American Academy of Allergy, Asthma & Immunology, one of the allergists' organizations, declined to comment on the issue, citing the ongoing litigation.)

How do these turf wars affect PCPs wishing to enter the field? DelVacchio said the "vast majority" of insurers still cover immunotherapy. He added that in the settlement of a similar lawsuit in 2013, Texas allergists' organizations agreed not to advise insurers against covering PCPs who use UAS.

Peggy Binzer, Executive Director of the AAAPC, said some of her members provide all the services in-house rather than rely on the vendors, whereas others limit their role to allergy testing or just prescribing the shots, which are then provided elsewhere.

PCPs can also limit the kinds of allergies they cover. Pope said her practice doesn't provide therapy for food allergies because they are riskier, and UAS stated that patients with severe asthma or comorbidities should still be referred to allergists owing to the risks.

PCPs may also benefit from more use of allergy drops, which are easier to administer. Binzer said the recent FDA approval could lead to use of drops for more conditions, thus improving insurance coverage. "I think the drops are going to have a great impact on the marketplace, and there is a great future for PCPs in this space," she said.

Allergy Therapy Scorecard

Start-up costs: Minimal, if you contract with an allergy vendor.

Potential income: $70,000-$120,000 per year.

Pros: Your existing patients are a ready-made patient base, and in most cases they would rather see you than go to an allergist.

Cons: Some allergists oppose a greater role for PCPs, and they have managed to convince a handful of insurers to deny payments.

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