Offering Specialty Infusions May Be Worth the Work for Oncology Practices

Adding specialty infusion services to an oncology practice may provide new opportunities to offer comprehensive care and other benefits to patients while practices gain new revenue streams. Demand for non-hospital infusion centers is increasing for a variety of reasons, and oncology practices may have the opportunity to capitalize on this growing need.

Although most widely associated with cancer treatment, infusion therapy also plays a critical role in the treatment of many other illnesses. Today, there are numerous specialty intravenous (IV) drugs on the market with several more in the pipeline, targeting rheumatoid arthritis, multiple sclerosis, Crohn disease, osteoporosis and anemia, as well as various neurologic, gastrointestinal, and other conditions.

Some of these ailments are strongly associated with age, so as the population of elderly “baby boomers” continues to grow, the need for infusion therapy to treat these diseases will only increase. More people will need access to these treatments as additional IV therapies become available as well. Additionally, payer steerage to non-hospital, lower-cost sites of care for infusion administration is driving demand for alternate sites of care, as it is more cost-effective to administer infused therapies in an ambulatory setting than in a hospital.

For many oncology practices, adding specialty infusion services may be a prudent choice. But it is not something that should be undertaken without extensive research and careful planning. Examining some of the critical factors to consider, as well as strategies to employ when expanding into this service area, may provide necessary insight for practices considering this business model.

Patients and Providers Gain Advantages

When oncology practices add specialty infusion services, both patients and providers reap the benefits. For instance, patients have the convenience of only dealing with 1 facility for all their infusion needs, including oncology. If they are being treated for other conditions that require IV specialty infusions, patients often find it difficult to juggle these appointments with their oncology treatments. Having the oncology clinic schedule, manage, administer, and provide centralized billing for all infusions delivers a 1-stop comprehensive care approach that makes the treatment journey simpler and helps provide the best possible patient experience.

Another aspect of patient convenience is the closeness to home that community-based oncology centers provide. Other infusion centers could be hours away, requiring the patient to travel to seek care, adding to the fatigue and stress that can make treatment more difficult.

Additionally, patients have a level of familiarity with their cancer clinic and confidence in the professional staff they see on a regular basis. Receiving their other IV infusions in a familiar environment with trusted staff members can significantly reduce the stress and anxiety that often accompany medical procedures, especially if they are receiving a new infusion. Likewise, the clinic staff members are very familiar with the patient and know their complete medical history. This type of information could prevent any issues with a new medication.

Practices also gain many benefits when adding specialty infusion services. By expanding outside of the oncology space, they are diversifying their services while simultaneously increasing their revenue. Additionally, these practices are not only adding a valued service, but they are also enhancing their ability to provide comprehensive care—a critical component of value-based care—by supporting patients with treatments for other chronic diseases in one convenient location.

Finally, exposure to more products outside of oncology leads to an increase in the overall knowledge of the clinical staff. The addition of more products outside of the oncology space requires staff to do more education and learning, helping to keep them current and fresh.

Key Considerations

There are several factors an oncology practice should carefully examine when deciding whether it makes sense to add infusion services. Foremost among them is determining the exact need for such a service based on current competitors in the market space and the patient/referring provider satisfaction level with existing services.

If the market is not saturated and referring providers are experiencing delays and frustration because their requests are not being met in a timely manner, there may be an opening for another specialty infusion provider. If so, adding these services might make sense from a return-on-investment perspective. If the market is already overloaded and there is no way to separate the practice from competitors through an enhanced experience for the patient or referring provider, it might be best to forego expanding and just focus on oncology patients.

Examining overall population trends in the target market, especially for baby boomers, is also important. Geographic areas that have a large retirement population may offer good potential if other infusion providers have not already saturated the market. If there is a decrease in population because of out-migration, infusion services could be impacted just like any other service sector. It is important to realize the need for infusion services can vary greatly based on geography, and what is needed in a metropolitan area may look a lot different than what is needed in a rural or suburban region.

Practices should determine the number of potential referring providers and network with those who would be crucial for the success of the new service. Holding receptions and gatherings after hours with key providers can be invaluable, as they offer the opportunity to identify the types of medications these providers are interested in giving and whether they feel there is a need for the new service.

Additionally, information may be learned by talking with current patients about what other infusions they are currently receiving at other treatment centers. This point demonstrates why it is important to have buy-in from the practice staff about adding new services, as they are the ones who spend the most time with patients and can have direct conversations with them about additional care they are receiving.

Strategies for Success

Once a practice has done its due diligence and made the decision to add infusion services, there are some best practices that can be employed to help ensure success for the new service. First and foremost, a task force should be created within the clinic. Expanding the practice’s infusion services requires collaboration and buy-in from multiple stakeholders across the organization, and a task force could likely be the most efficient way to accomplish that goal.

The task force’s responsibilities include critical projects such as: evaluating market conditions and capacity; defining roles and responsibilities of each stakeholder in the process; creating workflows and standard operation procedures (SOPs); and training and educating staff. It is important to make sure each member of the task force is a willing participant and a supporter of the added service.

If done thoroughly and correctly, the process of collecting the required information and developing SOPs can take anywhere from 3 to 6 months depending on how ready the group is and how adept everyone is at gathering information. Timelines should be developed to keep members focused on their tasks so they know what the expectations are and what should be prepared for each meeting.

Practices should also seek out and utilize resources from various organizations and companies that have expertise in this area. For instance, McKesson has developed a comprehensive proprietary handbook to assist oncology customers. Developed by subject matter experts, it helps practices identify and implement step-by-step strategies and activities that are critical to ensure success and long-term growth for this new business line. Resources like this are invaluable, as adding infusion services is a complex process, and it is very easy to overlook something that can become a costly headache down the road.

About the Author

Bob Zutaut, RPh, is director of clinical services at McKesson.

Avoiding Potential Pitfalls

Practices that decide to offer specialty infusion services must first confirm the drugs are available from their distributor. Some of the products requested from referring providers may not be obtainable, and it is important to know that ahead of time so other plans can be made. Initially, it might be beneficial to create a limited formulary that contains products that are positive from an economic standpoint and are covered by most commercial payers in addition to Medicare.

It is also very important to have the oncology clinic take responsibility for obtaining prior authorization instead of relying on the referring physician’s office to complete it. Prior authorization should be obtained before a patient is scheduled for an appointment with the physician and the infusion center. This ensures the practice has the proper documentation before administration of the drug, as well as later if any issues arise with the claim.

If the clinic does not control the approval process, economically unfavorable or non-covered products ordered for patients could end up creating chaos for the practice, as well as patients. Perceptions of confusion or issues patients experience with the infusion process can lead to dissatisfaction and negative overall views of the oncology practice.

Success Depends on Careful Preparation

Oncology practices are in a perfect position to offer specialty infusions. They already have the necessary environment to provide these treatments, and their staff knows how to handle these complex types of therapies which are very similar to oncology infusions.

The key to success when expanding into this new business line is to be deliberate and proactive, rather than reactive. Carefully identify, create, and implement all the critical processes necessary to be successful when offering this type of service. Have a good understanding of the referrals that are potentially available, the products to be infused, and the economics for each drug. Most importantly, clearly define and control the prior authorization process. The creation of a task force and the use of resources outlining best practices will help ensure success and long-term growth while developing a robust new service everyone can take pride in offering to the community.