Infusion Centers Help Navigate Cost of Care

Marcia Frellick

June 11, 2019

AUSTIN, Texas — The number of ambulatory infusion centers is growing as more payers refuse to cover biologic infusions for patients with chronic illnesses in hospitals because of the higher costs.

"We tend to be half the cost of the hospital," said Doug Ghertner, chief executive officer of Infusion Express, which has 10 centers in and around Chicago, Kansas City, Philadelphia, and the San Francisco Bay Area.

The centers, which focus on patients with complex, chronic conditions, including Crohn's disease, multiple sclerosis, rheumatoid arthritis, psoriasis, and lupus, are open 6 days a week, 12 hours a day. And each patient gets a private room with a flat-screen TV, wi-fi, and snacks.

Private rooms were cited by 76% of patients as the top source of satisfaction on an internal survey of its patients, and flexible scheduling was cited by 64%, Ghertner reported.

The company, which plans to double the number of centers this year, locates its centers close enough to a hospital so that patients can get care in case of emergency, but the focus is to place them where people shop and live, he told Medscape Medical News.

When people leave the centers in the evening, there is comfort in knowing that the parking lots are active and other businesses are still open, he said.

Clinicians at the centers do not diagnose, develop treatment plans, or write orders, but they do take care of prior authorizations for the drugs and let physicians know when the drug has been authorized, Ghertner explained.

"We also send a full set of clinical notes back to that referring physician after each encounter," he added.

The care of patients who need costly infusions starts before they enter infusion centers, said David Evans, MBA, chief executive officer of Texas Neurology, a private outpatient practice with an infusion center owned by 20 physicians who work in tandem with infusion nurses and patients in Dallas.

Putting Families at Ease

Having a conversation about the cost of the complex drugs and biologics and payment assistance before therapy starts can help put families at ease, said Evans, who will present tips during a session on the best and worst practices for running an infusion center here at the National Infusion Center Association 2019 Meeting.

When patients know there are assistance programs and foundations that can help them pay for some or all of their copays or care, they can focus on the pros and cons of a drug rather than paying the bills, he told Medscape Medical News.

"Patients are very appreciative of that," he said, adding that the previsit contact is a good time to let patients know that even if their insurance or employment changes, the patient-assistant programs are designed to adapt to their needs.

Social Worker Help

Texas Neurology also employs a social worker who helps patients with assistance programs and helps them determine whether they need supplemental insurance for Medicare or Medicaid.

Before patients enter the center, providers tell them what to expect, covering everything from what the center looks like, to where to park, to making sure the patient responds to calls from specialty pharmacies so that the shipment of medications can be approved. Failure to answer such calls could mean that a required drug might not arrive in time for the infusion, Evans pointed out.

Strategic scheduling and proper staffing are key, especially for people just starting infusion therapy, he added.

It is important to have a one-on-one provider–patient experience, especially for the first visit when reaction to the drug is unknown and the patient needs to be more regularly monitored, he said.

Advice on how to navigate step-therapy restrictions — when payers require that patients fail less-expensive therapies before authorizing more expensive treatments — will be provided during the session by other speakers.

This issue has been especially challenging for patients with multiple sclerosis or headache, "who sometimes are clinically compromised and affected by their inability to work for years" while they try various treatments, Evans explained.

More than half of all states have passed regulations to loosen such restrictions, he said.

Evans is chief executive officer of Texas Neurology and a presenter for Genentech. Ghertner is chief executive officer of Infusion Express.

National Infusion Center Association (NICA) 2019 Meeting. Presented June 22, 2019.

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