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  1. 1. INFUSION CENTERS: Opportunity for Financial and Personal SuccessRonnie J. Garner MD, FCAP Infusion Center Presbyterian Hospital Albuquerque, New Mexico
  2. 2. Why Infusion Centers? Why Pathologists? Why now?
  3. 3. 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
  4. 4. Hospitals Have Competition• Heart Centers• Surgical Centers• Eye Centers• Endoscopy Centers• Revenue sources are altered
  5. 5. Current Outpatient Infusion Centers• Oncology or Rheumatology• Services own physician group• Limited services and hours• Physician not usually on site• Typically nurse managed
  6. 6. Many Underserved Providers for Outpatient Infusion Services• Internal Medicine• Family Practice• Ob-Gyn• Gastroenterologist• Renal• Nurse Practitioner• Others
  7. 7. Limited Choices for Outpatient Services• Rheumatology or Oncology clinics• Emergency Room• Admission to Hospital• Freestanding Commercial Providers• Home Health Care
  8. 8. Tremendous Opportunity Hospitals and Clinical Pathology!
  9. 9. 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
  10. 10. 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
  11. 11. 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
  12. 12. 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
  13. 13. 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
  14. 14. 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
  15. 15. 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)
  16. 16. 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.
  17. 17. 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
  18. 18. Collaborative Medicine• Rheumatologic diseases• Neurological diseases• Transplant rejection• Apheresis & photopheresis services• Profound fluid & electrolyte imbalance• Unusual endocrinology testing• Pediatric endocrinology testing
  19. 19. Coagulation referrals• Hypercoagulable disorders• Bleeding diathesis• Factor deficiencies• Von Willebrands disease• Coumadin reversal• Acute ongoing blood loss
  20. 20. Hematology referrals• Anemia – acute or chronic• Polycythemia-primary or secondary• Thrombocytopenia & Thrombocytosis• Hemochromatosis• IV Iron• Transfusions• Bone Marrow aspiration & biopsy
  21. 21. 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
  22. 22. 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
  23. 23. PINC Patient Visits 2000-2008 2500 2000 Christmas + 3 snow days Year 2000 1500 Year 2001 Year 2002 Year 2003Patient Visits Year 2004 Year 2005 1000 Year 2006 Year 2007 Year 2008 500 0 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Month
  24. 24. 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
  25. 25. 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
  26. 26. • 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
  27. 27. 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
  28. 28. 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
  29. 29. 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
  31. 31. TRANSFORMING PATHOLOGY:Emerging technology driving practice innovation