The Changing Landscape of Infusion Therapy for Neurology Practices

Office-based infusion centers have been a part of oncology practices for many years. As new medications become available, there has been increased demand for infusion-delivered therapies in several additional clinical specialties. One of the first in-office neurology-focused infusion centers, The MIND, started in 1989. It is a freestanding, privately owned, all-inclusive neurologic facility located in Farmington Hills, Michigan. According to Medical Director, Howard S. Rossman, they included an infusion facility early on to provide methylprednisolone treatment for multiple sclerosis (MS) relapses during a time when hospital outpatient intravenous administration was not fully developed. [1]

Infusion for MS Treatment

Nearly 1 million people have multiple sclerosis in the United States. [2] In November 2004, Tysabri (Natalizumab) was approved in the United States for treatment of relapsing forms of MS. According to a Psychiatric Times article, “Natalizumab and other biologic agents in development, such as the antileukocyte antibody alemtuzumab (MabCampath, Schering, AG), could have a major influence on treatment decisions for patients with MS.” As a result, the landscape for MS drug therapy is quickly transitioning from mostly self-injectables to a combination of self injectables and infusion based medication.

Prior to the 2004 approval of Tysabri, infusion medications were primarily used to manage either MS exacerbations or progressive disease. The need for neurologists to have in-office infusion capabilities was very small and not worth the investment. The approval of Tysabri to treat MS kickstarted a huge shift from currently an estimated 78% of neurologists not having in-office infusion capabilities [3], to many now looking to add this offering to their clinics. In 2017, Ocrevus was approved for use in the US to treat both severe and common forms MS. This drug, too, is administered intravenously. [4]

Referrals Come with Challenges

In the past and currently, neurologists treat MS patients with infusion therapy by referring them to hospitals, stand-alone clinics, or to hematologist/oncologist offices. Staff at The MIND, decided to expand their facility as a result of several challenges they faced when referring patients out for infusion treatment.

Primary Challenges [5]

Dependency on referral site for patient dosing information, patient reports, patient status, and laboratory results.
Failure to obtain informed consent.
Lack of monitoring for infusion complications.
Inability to provide consistent follow-up.
Late or absent patient reports made patient follow-up visits difficult, resulting in treatment delays.

The Switch to Outsourced In-Office Infusion

It’s clear that moving infusion treatment into your office is a better fit in terms of treating patients. The follow up, the care, it’s all under your roof and can be properly managed. However, trying to incorporate infusion on your own is like adding a start-up business to your practice. There is a much better, more fluid, and safer financial option to creating in office infusion: outsourcing the management. By outsourcing the management piece, you and your staff can focus on what really matters - patient care.

Treatment Benefits [6]

High-quality care in a comfortable and familiar setting
Allows for direct drug side-effect surveillance and supervision by their neurologist
Allows of optimized follow-up care
Ability to educate both nurses and patients on the infusion drugs being used