The financial advantage of billing as a hospital outpatient department (HOPD) is steadily deteriorating for infusion centers due to site neutrality, changes to the 340B drug pricing program, and private payers' site-of-care policies.

To help you determine the best billing strategy, our Infusion Center Billing Strategy Playbook walks you through five key steps.

Use these additional tools and guides to help:

• The Executive's Guide to Infusion Center Business Strategy is designed to help executives quickly get up to speed on the infusion center business, why it increasingly demands their attention, and how program leaders can respond.
• Our FAQs about the differences between HOPD and freestanding infusion centers will help you consider some of the operational differences in billing status.
• The Infusion Center Business Strategy Reference Guide gives an explanation of key infusion center terms, programs, and policies.
• Our annual Oncology Medicare Reimbursement Updates provide an overview of changes impacting infusion center reimbursement in the 2023 Medicare HOPPS and MPFS Final Rules.
• Understand what payer site-of-care policies mean for different stakeholders and potential strategies to respond.
• This blog discusses study data on the difference in Medicare chemotherapy costs between hospital-based and freestanding settings.

To maximize productivity and improve patient experience, it’s important to have the right staffing mix in place. Use the following steps to optimize your staffing structure:

1. Compare your current staffing mix to peer organizations. Read our key insights from the benchmark data for chemo nurse, clinical trial nurse, advanced practitioner, clinical support staff, and pharmacy staffing from our infusion center benchmarking surveys.

2. Maximize the efficiency of your current staffing model. Ensure that your program can accommodate growing workloads and escalating treatment complexity with our Three-Step Cancer Staffing Makeover. And make the most of pharmacists' knowledge and skillset to help increase nurse and physician capacity.

3. Determine your current and future staffing needs. Use the Infusion Center Staffing Profiler to evaluate your current staffing in relation to your patient volumes and number of chairs, while anticipating how your staffing mix will need to change as your program grows.

With many moving parts and unpredictable patient needs, the infusion center is susceptible to delays and breakdowns. In addition, growing volumes and expanding treatment options mean that many infusion centers are running at or above capacity. We’ve mapped out our best practice resources to help you improve your infusion center throughput:

1. Increase your infusion center capacity and reduce appointment wait times.

• Redesigning Workflows: Infusion Center will walk you through three tactics to help you address and even eliminate common infusion center throughput bottlenecks.
• Increase efficiency and provide patients more reliable care by optimizing patient throughput.
• Learn how more than 100 infusion centers offer access to lab and pharmacy services and the impact that can have on patient wait times.
• Review our survey insights on chair utilization, patient wait times, and extended hours at infusion centers.

2. Improve infusion center scheduling

• Redesigning the clinic schedule helps you evaluate your current performance, optimize your scheduling process, and improve patient communication so you can see patients sooner.
• See data from more than 250 infusion centers on how they schedule patients.
• For more information on how to improve your cancer center scheduling, check out our Scheduling Improvement Toolkit and UVA's approach to creating a centralized call line.

Rising drug prices, declining reimbursement, and increasing prior authorization requirements have left many cancer programs concerned about the financial health of their infusion centers. The following strategies are essential to ensure financial sustainability, while also improving the patient experience:

1. Make sure you're getting every dollar you're owed.

• Understand financial performance and identify opportunities through financial reporting. To get started, download a sample denials report from Avera.
• Review our survey data to understand how pharmacy leaders feel about infusion center revenue cycle and opportunities for improvement.
• Use our survey data to benchmark your organization's experiences with revenue cycle for provider-administered drugs and identify opportunities to strengthen your revenue cycle processes.
• Prior Authorization for Physician-Administered Drugs provides best practices for staffing, process redesign, improving information flow, and working with payers to reduce prior authorization requirements.
• Finding the right staffing model for the prior authorization team can be particularly challenging. See how two organizations reorganized their teams and saw significant returns.

2. Mitigate the risk of increasingly expensive drugs.

Understand why programs are investing in clinical pathways and how they're implementing them:

• Learn about stakeholder perspectives on controlling infusion care costs, including UNC’s approach to helping providers utilize drug cost data.
• Download our research report, Reduce Unwarranted Care Variation in Oncology.
  

See how Memorial Healthcare and others are working with pharmacy to better understand drug profitability.

As drug costs soar, organizations need to systematize how they assess drug "value." See how Mount Sinai and Christiana Care are starting these conversations.

Review our 2021 Oncology State of the Union for examples of how cancer programs can leverage partnerships with a variety of stakeholders to respond to increasing financial pressure from purchasers.

Health plans are increasingly requiring that provider-administered drugs be sourced from an external pharmacy, often referred to as "white bagging." Develop a comprehensive strategy to respond to white bagging requirements and minimize impacts on patient safety, logistics, and finances:

• Learn how to overcome white bagging challenges to protect patient safety and minimize logistical hurdles.
• Read key insights from our workshop on strategies for responding to payer white bagging requirements, featuring panelists from Penn Medicine, Mount Sinai, and Vanderbilt University Medical Center.
• Use data from our Pharmacy Reimbursement and White Bagging Survey and Trending Now in Cancer Care Survey to benchmark your organization's experiences with white bagging, specialty pharmacy, and oral chemotherapy. to benchmark your organization's experiences with white bagging, specialty pharmacy, and oral chemotherapy.
• Understand what clear bagging is and how some health systems are using it to offset the challenges brought on by white bagging requirements.
• See how Smilow Cancer Hospital at Yale New Haven decreased time to fill oral chemo prescriptions and drove revenues through its internal specialty pharmacy.
  

Monitor the home infusion landscape and assess whether developing a home infusion program could be an effective strategy for your organization to maintain continuity of care and minimize infusion revenue gaps in the face of increasing site-of-care pressure from payers:

• Learn about Medicare's new home infusion benefit for CY 2021.
• Understand what oncology home infusion is and why it's gaining traction.
• Learn six things you need to know if you're considering investing in home infusion.
• Read about how Penn Medicine delivers high-quality home infusion therapy to its patients.
  

3. Improve patient care and your bottom line through financial navigation.

With growing evidence that financial toxicity impacts patient quality of life and even survival, cancer programs must find a way to address patients' financial needs.

• Cancer Patient Financial Navigation includes 17 best practices plus six downloadable templates and worksheets to help patients understand and manage their financial responsibilities, in turn improving your program's revenue capture.
• Review two different sample business cases to help make the case for cancer financial navigation at your own organization.
• Make sure patients understand what they owe using these strategies and this customizable form.
• See how St. Alphonsus and Anne Arundel are going above and beyond to make sure they connect patients to all available financial assistance.
• Check out our survey results to learn how more than 200 cancer programs are addressing patients' financial needs and other barriers to care.