We Need Non-Oncology Infusion Centers & Infusion Suites
You may find it surprising that there is a $100+ billion dollar healthcare delivery model that you have never heard of. That’s right, “Billion” with a “B”. Unless you or someone you know has a rare chronic disease, you likely have never heard of this amazing (and expensive) group of specialty biologic medications delivered primarily by intravenous infusion or injection.
Even if you have never heard the term: “autoimmune disease” (AD for short), you likely are familiar with Multiple Sclerosis, Crohn’s Disease, Lupus, Rheumatoid Arthritis, and Psoriasis. It’s less likely you have heard of many other AD diseases: CIDP (Chronic Inflammatory Demyelinating Polyneuritis), Ulcerative Colitis, Hypogammaglobinemia, or other less known chronic disorders. These AD diseases are considered “rare” by most, but if you group the incidence of them all together, the numbers are unsettlingly large.
The National Institutes of Health estimates that over *23.5 million people in the US currently live with an autoimmune disease of some kind. The American Autoimmune Disease Association estimates that this number may be as high as 50 million and growing. (https://www.aarda.org/news-information/statistics/)
To put those numbers in perspective, cancer affects up to 9 million and heart disease up to 22 million. Looking at these statistics, autoimmune disorders as a group hardly qualifies as “rare”. (https://www.aarda.org/news-information/statistics/)
What do Autoimmune Disorders have to do with Infusion Centers?
Most of the medications that treat AD are large molecule biologic or intravenous immune globulin (IVIG) products. Without going into all the science here, just know that many these specialty medications are not available in a pill you can swallow at home.
That means that most of the treatments for AD must be administered by either intravenous (IV) or injectable methods. These treatments are not a one-time dose or a cure; instead, most of these specialty meds manage the disease and must be administered chronically over frequent intervals (every week, 2 weeks, 6 weeks, 6 months, etc.) for long durations and some, for a lifetime, or at least until a cure for the disease is discovered.
Some of these medications are self-administered, meaning that they have been formulated in a way that allows the patient to administer the injection to themselves, once the patient is trained in the proper technique.
That still leaves many of these medications, especially the intravenous-only ones, as requiring a registered nurse (RN), to safely and effectively administer the infusion treatment.
The specific requirements for proper medication preparation, patient safety, and the current economics of our healthcare situation dictate that sending a single nurse to each patient’s home to give these medications is not a workable solution.
This means that most AD patients who need intravenous or non-self-administered injectable medications will receive them in a facility setting of some kind. Facility options include hospitals, doctor’s offices with infusion suites, or stand-alone Infusion Centers.
Don’t cancer patients receive chemotherapy infusions all the time? Why is this problem any different?
For starters, cancer is typically not a “chronic” disease. Most chemotherapy regimens are meant to be started and stopped in short (less than a year) intervals. AD patient’s medications have longer frequencies and progressive treatment process that can last decades or longer.
Because the treatment approaches are different, the facilities, processes and economics are too. Some AD patients are receiving their treatments in oncology Infusion Centers, but these situations are usually a means to an end due to a lack of appropriate access in other preferable settings. The possible oncology solution to this problem is more complex than I want to dive into here, but I can say that if you do your own research, you will find that Oncology Infusion Centers are not a likely or effective solution to the medication access problem for AD patients.
AD Patient Access Options
Every year, millions of AD patients receive their medications in hospitals, doctor’s offices, and stand-alone Infusion Centers across the country. NIH estimates annual direct health care costs for AD to be in the range of $100 billion. (https://www.aarda.org/news-information/statistics/ – source: NIH presentation by Dr. Fauci, NIAID)
You would think that with these kinds of statistics there would now be a streamlined and efficient delivery model to help these patients – and you would be wrong. How we got here is probably worth exploring in another article, but I believe that some investigative work would reveal that the recent advances in biologic medications have simply outpaced the healthcare markets ability to react to, and create an efficient delivery model for these drugs.
The Hospital Option
Most hospitals will have some form of outpatient option for both the oncology and non-oncology patient needing specialty infusions. In most cases, the hospital option exists due to a lack of any other alternative. Yes, there are indeed some very nice hospital Infusion Centers that focus on the non-oncology patient, but many of these locations are also used for the hospital’s oncology and short stay needs. The major issue with a hospital outpatient Infusion Center (HOPD) is that it typically cost twice as much as the other, non-hospital outpatient options. Remember, we are not talking about costs of $10 to $20, these drugs are much more expensive…
“For commercial, medical benefit drug cost is often more than double in the hospital outpatient setting versus the physician office”
“…despite the physician office being the most cost-effective site of care, the trend is shifting away from the physician office and toward the hospital outpatient. Several reasons may be contributors: practice consolidation, decreased reimbursement to physician offices, and large health systems continuing to expand and acquire groups and services.”
– Magellan Pharmacy Trends Report 2016
Read the full article at WeInfuse.com