Hospital-based infusion services important growth area for 2021
Factors for success include collaboration, holistic approach
For 2021 hospital-based infusion services will be an area of increasing emphasis. As hospitals and health systems scramble to recover financially from the pandemic, infusion services have become an important avenue for many organizations.
Infusion services are also an area where hospitals and health systems need to be aware of the current managed care contracting environment and changes with regard to site-neutral payment or site of care challenges. The U.S. Court of Appeals ruled in July of this year that Health and Human Services was within its rights to reduce payments to hospital outpatient departments. This decision reversed a district court’s earlier decision on action brought by a group of hospitals that claimed this rate reduction fell outside of HHS’ statutory authority. The case addressed HHS’ decision that the Medicare payment differential between hospital outpatient facilities and independent physician practices “gave rise to economic incentive that induced unnecessary growth in the volume of outpatient care” provided at hospital outpatient sites. HHS, therefore, reduced the rate it paid hospitals for patient evaluation and management so it was equal to the rate physician practices received for that service. We are seeing growing interest and actions from private payers around the country to also follow suit with site neutral payments for services like infusion.
Hospitals would be well advised to consider their infusion strategy to protect as much of this business as possible from shifting to external infusion providers. Creating a robust infusion strategy must include more than pharmacy to be successful in this constantly changing environment. Collaboration between all stakeholders including revenue cycle, care management, prior authorization services, provider offices, scheduling, nursing AND pharmacy is key.
Organizations are also taking a more holistic approach to infusion care covering all potential sites including home infusion. Many hospitals and health systems have had home infusion services but got out of the business several years ago due to increased competition and payor rates. Now there has been market contraction and with the pandemic raging and more patients are opting for therapy at home – in some cases, even chemotherapy – which is again fueling interest in adding home infusion services to the overall infusion portfolio.
We also see more organizations exploring the creation of hospital owned non-HOPD based infusion programs to give them a full range of infusion options from HOPD to non-HOPD to home infusion. This strategy provides maximum flexibility in determining payor contracts and site of care to support capture and retention of as much infusion business as possible.
Here are three things hospitals should be doing now in preparation for 2021:
- Understand with your managed care contracting group what is happening with your top payors, contracts coming up for negotiation and any language referencing site of care.
- Survey your organization for sites of care (HOPD, non-HOPD, home infusion), chair capacity and any external relationships for providing this care.
- Develop a strategy to retain care within your system and get help early before you are in a reactive mode.