GRAND RAPIDS, Mich. — As infusion centers have grown in complexity throughout the years, so too has the patient experience in these suites, with individuals often asked to take on a greater understanding of the clinical and financial impacts of their treatment, according to a presenter at the National Organization of Rheumatology Managers Annual Conference.
“On the surface level, it’s simple — the patient needs to get infused, and we need to get paid for that infusion,” Christine Mann, MBA, CMOM, chief operations officer for DENT Neurologic Institute & Infusion Center, in Buffalo, New York, and managing partner with NeuroNet GPO, told attendees. “However, what people don’t see is there are more complex infusion therapies, particularly with most centers doing rituximab now — which is a black-box warning drug — where you have to really be aware of what’s required for that. In addition, we now have vendor and specialty pharmacy logistics, where certain patients need to be registered before they can get a drug, and even before it ships.”
“You have to be aware of single-source distribution, and how the purchase price changes every quarter, as well as keeping up with average sale price and making sure your billers know that they’re billing correctly,” she added. “And, of course, you have payer mandates.”
Infusion center staffing has also grown more complex, Mann said. She described how when her infusion center first began, there was “just a few of us” assisting patients. However, now infusion center teams often require a services and support manager, a prior authorization specialist, a clinical nursing manager and a pre-registration specialist.
In addition, this team must remain vigilant in informing patients of their financial obligations, according to Mann. This includes a services and support manager providing insurance benefit education, copay assistance and foundation access; a prior-authorization specialist explaining guidelines, expected costs and overall coverage; and a pre-registration specialist who guides patients through high-deductible plans and calculating out-of-pocket costs.
“The patient experience has become more reliant on understanding both clinical and financial impacts of infusion,” Mann said. “We really have evolved from calling a patient and telling them they are coming in, and that patient saying, ‘OK, I’m really excited. The doctor said this is going to make me feel better.’ Now, the patient has to understand what that means, how often are they coming, what are their out-of-pocket costs and what is going to be paid up front.”
“We do try to help people a lot more with the copay card programs and the savings programs that the manufacturers offer,” she added. “It is getting to the point where we are helping them get set up before they leave the office, because we have found that giving them a pamphlet and sending them home doesn’t do much — until of course they get a bill in the mail for $2,000 and they don’t understand. Part of the patient experience is helping patients understand our coverage and insurance language.” – by Jason Laday
Mann C. Re-imaging your infusion suite and ancillary; Presented at: National Organization of Rheumatology Managers Annual Conference; Sept. 13-14, 2019; Grand Rapids, Michigan.
Disclosure: Mann reports no relevant financial disclosures.