What’s all the Excitement over Home Infusion and Alternate Site of Care?
The administration of infused drugs in the outpatient setting has traditionally been provided to patients in hospital-based and provider-based outpatient centers. While home infusion and alternate infusion centers existed previously, these options were mainly operated by independent companies and reserved for a select group of therapies and patients. But these dynamics are changing due to payer requirements, COVID-19's impact on patient care and new drug approvals from the Food and Drug Administration (FDA).
Let's first review what home infusion and alternate infusion centers are.
Home infusion: traditional vs. specialty
Home infusion involves the preparation, dispensing, delivery, administration and monitoring of intravenous and infused medications in the patient's home.
Traditional home infusion therapies include antibiotics, parenteral nutrition, pain management and hydration. Traditional therapies are generally continuations of a patient's inpatient infusion medications or are transitioned directly from the emergency department to the home. These patients traditionally receive 2-3 training sessions from a nurse and then weekly lab and catheter dressing visits. Medications are generally administered via a central line, port-a-catheter or PICC line.
Specialty medications include immune globulin, anti-tissue necrosis factors and monoclonal antibodies that treat various chronic conditions such as rheumatoid arthritis, immune deficiency and multiple sclerosis. Specialty medication administration has moved out of the more expensive hospital setting and into the home where reimbursement is lower. This change has largely been driven by payer mandates due to the increase in costly biologics over the past several years. Specialty medications usually start in the outpatient area and are prescribed by a specialist. These patients may only receive their treatment once per week or month, so their nursing services vary, but the overall frequency of administration for specialty medications is generally less.
Due to their high cost, specialty medications have become a major revenue source and focus for home infusion pharmacies. When discussing home infusion services, it is important to consider both traditional and specialty therapies, because each requires a different business strategy.
Alternate infusion centers on the rise
Alternate infusion centers are non-provider-based infusion centers that look and feel like a hospital or provider-based centers. They are staffed by registered nurses, but services are billed to the patient's insurance provider.
Over the last few years, we have seen an increase in home infusion and alternate infusion center utilization and an increased number of health system-owned home infusion and alternate infusion centers. A few of the factors spurring this growth include:
- Payer site of care requirements shifting specialty medication administration away from hospital-based outpatient infusion centers to lower cost sites of care. Non-hospital-based infusion care cost payers significantly less money.
- COVID-19 pandemic pushing treatment to non-healthcare facilities to minimize the spread of disease.
- A continued increase of new infused drug approvals by the FDA. Many medications in the new drug pipeline are administered as infusions or injectables rather than administered orally.
- Health systems' focus on improved transition of care, decreased hospital length of stay and readmissions by gaining control over a fragmented process, mainly due to the lack of home infusion software communication and integration with electronic medical records.
- Medicare changes that support expanding the current limited coverage of therapies to a greater number of therapies.
- Patient preference for increased convenience and comfort.
All of this indicates that home infusion and alternate infusion center services are here to stay. While providing these services may make sense as a part of your hospital's overall growth strategy, there are many factors to consider, such as whether you should use internal operational resources, contract with a pharmacy-managed services vendor or partially outsource certain functions.
Keep an eye out for my next blog where I take a deeper dive into this topic and discuss challenges in setting up and operating your own home infusion and alternate infusion center services.