Today, infusion center business makes up approximately half of the typical health system’s drug spend. The majority of medically billed pharmaceutical infusion treatments have historically been administered in hospital outpatient settings.
However, prone to high overhead and billing inefficiencies, costs for these treatments can vary by 100%, depending upon the care setting. As a result, there is a seismic shift away from hospital outpatient infusion services.
This shift is being further accelerated due to three main reasons:
1. Health insurers are pushing patients away from hospitals.
In early 2018, Blue Cross Blue Shield began expanding their Place of Service for Medical Infusions to limit infusion services to non-hospital environments, because they identified as well that “Costs for drug infusions are significantly higher at a hospital’s outpatient facility than other settings.” Many insurers have followed suite and are increasingly requiring patients to seek treatment via home health or physician office infusion centers in order to qualify for reimbursement.
2. Fast Rising Drug Prices
Constantly rising drug costs affect everyone involved in patient care - hospitals, clinics, pharmacies, and insurers.
With the growing population of infusion patients, the hospital referral model is more and more difficult to keep up. It is clear a change is needed. Specialty practices are spending too much time dealing with complicated reimbursement processes, scheduling and staffing challenges and prior authorizations that prevent them from focusing on their patients’ outcomes and overall treatment.
New breakthrough treatment options are becoming available in rapid succession. However, obtaining authorizations and receiving payment for these treatments is becoming increasingly complicated.
3. New Treatment Options
The availability of new treatment options is driving and accelerating these changes. New, breakthrough drugs such as Ocrevus and Orencia have increased the need for these non-hospital infusion options, and have forced payers to quickly react in order to manage costs and ensure there are enough seats for patients to receive their infusion therapy. With new drugs coming down the pipeline, there has been a strong push to ensure there are sufficient cost-effective treatment options.
Some specialty practices have chosen to bring infusion services in-house as a solution while others are in the process of figuring out how to navigate this landscape in a way that works for them. Some choose to manage this process themselves. Others outsource management to a 3rd party. Likewise, all infusion management companies are not offering the same solutions either. Not all have experience with specific specialty practices, or cover the same breadth of management services and offerings.
The key to choosing the right infusion management partner, is to identify a company that is looking to be a partner in your growth and support both your current and future needs.
Interested in learning more about outsourcing your in-office infusion center management? Click below for a free consultation.
 Blue Cross NC