INFUSION CENTERS:Opportunity for Financialand Personal Success

Ronnie J. Garner MD, FCAPInfusion Center

Presbyterian HospitalAlbuquerque, New Mexico

Why Infusion Centers?

Why Pathologists?

Why now?

Seminal changes in the delivery of health care

• Hospitalist• Internist & Primary care in transition• Managed Care with productivity goals• Government regulation• Prior Authorizations now the norm• Increased overhead• Overuse of Emergency rooms• Shift to outpatient services

Hospitals Have Competition

• Heart Centers• Surgical Centers• Eye Centers• Endoscopy Centers• Revenue sources are altered

Current Outpatient Infusion Centers

• Oncology or Rheumatology• Services own physician group• Limited services and hours• Physician not usually on site• Typically nurse managed

Many Underserved Providers for Outpatient Infusion Services

• Internal Medicine• Family Practice• Ob-Gyn• Gastroenterologist• Renal• Nurse Practitioner• Others

Limited Choices for Outpatient Services

• Rheumatology or Oncology clinics• Emergency Room• Admission to Hospital• Freestanding Commercial Providers• Home Health Care

Tremendous Opportunity

Hospitals and Clinical Pathology!

What is the Opportunity?

• Hospital Based Infusion Centers• Within the “footprint” of hospital• Managed by Clinical Pathology• Staffed by Clinical Pathologists• Provide suitable outpatient services for all

physician groups • Multiple referral options for physicians• Consultative Services essential & Unique

Why A Hospital Based Infusion Center?

• It fits the current model of integrated services

• Outpatient services emphasized• Reimbursement is better if hospital based• It consolidates a broad range of outpatient

services into a single unit.– Infusion Services– Donor services– Apheresis services

Why a Clinical Pathologist

• Hospital based• Contractual relationship already exists• Known entity• Pathologists already manage departments

needed to support an Infusion Center• We have or can acquire the required skills

Medical Skills for Success

• Medical Internship is essential• Clinical Pathology Residency• Knowledge to assist a variety of medical

specialists through patient consultation & management of therapy

• Comfort dealing with ill patients• Skills to evaluate and treat reactions to

therapy

Presbyterian Infusion Center

• Located in Professional building• 10,000 sq ft • 32 beds and chairs• 28 nurses• 4 physicians – all clinical Pathologists• 1 nurse practitioner

Strategy for Success• Admission services• Pre-authorizations for all patients• Pharmacy on site• Assess to laboratory and Transfusion

services & rapid laboratory turnaround immediately available

• Have your own charts and charting system• Create no barriers to service

Ancillary Services

• Tube system directly to laboratory• Tube system directly to Blood Bank• Resuscitative support from ER• Pulmonary services available• EKG available• Radiology available• ER admission available• Full gases available (O2, suction)

Hours of Operation

• Monday-Friday 7:00 am to 6:30 pm• Saturday 7:30 am to 5:30 pm• Sundays – usually in am 8:00 – 12:00• Apheresis in off hours if urgent• 24 hour call-back including holidays• Physician always available when patients

in unit.

Referring physician options• Referring physician writes orders and

infusion center provides services• Referring physician requests consult by

Infusion center physician & we develop therapy plan and treat

• We collaborate with referring physician to develop therapy plan & then we manage therapy.

• We evaluate & treat all reactions

Collaborative Medicine

• Rheumatologic diseases• Neurological diseases• Transplant rejection• Apheresis & photopheresis services• Profound fluid & electrolyte imbalance• Unusual endocrinology testing• Pediatric endocrinology testing

Coagulation referrals

• Hypercoagulable disorders• Bleeding diathesis• Factor deficiencies• Von Willebrands disease• Coumadin reversal• Acute ongoing blood loss

Hematology referrals

• Anemia – acute or chronic• Polycythemia-primary or secondary• Thrombocytopenia & Thrombocytosis• Hemochromatosis• IV Iron• Transfusions• Bone Marrow aspiration & biopsy

Specialized Services

• Immune function evaluation• Infertility immune evaluations• Maintenance of Pregnancy• Preoperative preparation-Jehovah’s

Witness• Preoperative preparation-high risk patients

& Pediatric patients• Antibiotic therapy 7 days weekly

Hospital Consults

• Post-operative or other bleeding• Hypercoagulable issues• SIRS patients• Heparin associated antibodies• IV Iron – Ob-gyn, GI, Pediatric, other• Pediatric Hematology & coagulation• Hemolysis • Immune workups

PINC Patient Visits 2000-2008

0

500

1000

1500

2000

2500

Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec

Month

Patie

nt V

isits

Year 2000Year 2001Year 2002Year 2003Year 2004Year 2005Year 2006Year 2007Year 2008

Christmas + 3 snow days

Presbyterian Infusion Center Patient Visits

• 2000-2200 patients per month• 85-100 each week day• 65-75 on Saturday• 10-15 on Sunday• We serve patients from every area of New

Mexico

How to build the business

• No barriers to access• Advertise the service• Always have a physician available• Communicate with the referring physician

about problems or issues• Make helpful suggestions-share your

knowledge – help solve their problem• Develop easy forms for physician use

• Communicate to referring physician about all relevant issues

• Be open to any new service• Save a few “emergency” beds• Know the patient’s medical history

– Recent history from referring physician– Consult with the patient – Some patients need admitted to hospital

Helpful Hints if Medicare• History & Diagnosis should justify therapy

and must be documented in the chart.• Diagnosis code for Medicare must justify

therapy. CMS may audit Infusion Centers• Recent Medical history must be in chart• Use different colored charts for different

patient types• Pre-authorizations recommended

The Reward for Hospitals

• Excellent Revenue stream• Patients enthusiastic about outpatient

service• Hospital based Infusion Center has better

reimbursement than a free standing center• All services are pre-authorized & losses

are minimal

Reward for Pathologists

• A fascinating patient mix• Practice is across many specialties• Develop an expansive knowledge base• The service is in demand & needed• You can make a difference • job opportunities enhanced

DO YOU SEE OPPORTUNITY?

ARE YOU FEELING REINCARNATED?

TRANSFORMING PATHOLOGY:Emerging technology driving practice

innovation