1. INFUSION CENTERS: Opportunity for Financial and Personal Success Ronnie J. Garner MD, FCAP Infusion Center Presbyterian Hospital Albuquerque, New Mexico

2. Why Infusion Centers? Why Pathologists? Why now?

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. Hospitals Have Competition Heart Centers Surgical Centers Eye Centers Endoscopy Centers Revenue sources are altered

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. Many Underserved Providers for Outpatient Infusion Services Internal Medicine Family Practice Ob-Gyn Gastroenterologist Renal Nurse Practitioner Others

7. Limited Choices for Outpatient Services Rheumatology or Oncology clinics Emergency Room Admission to Hospital Freestanding Commercial Providers Home Health Care

8. Tremendous Opportunity Hospitals and Clinical Pathology!

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. 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. 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. 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. 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. 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. 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. 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. 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. Collaborative Medicine Rheumatologic diseases Neurological diseases Transplant rejection Apheresis & photopheresis services Profound fluid & electrolyte imbalance Unusual endocrinology testing Pediatric endocrinology testing

19. Coagulation referrals Hypercoagulable disorders Bleeding diathesis Factor deficiencies Von Willebrands disease Coumadin reversal Acute ongoing blood loss

20. Hematology referrals Anemia – acute or chronic Polycythemia-primary or secondary Thrombocytopenia & Thrombocytosis Hemochromatosis IV Iron Transfusions Bone Marrow aspiration & biopsy

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. 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

25. 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

26. 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

27. 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

28. 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

29. 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

30. 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. DO YOU SEE OPPORTUNITY? ARE YOU FEELING REINCARNATED?

33. TRANSFORMING PATHOLOGY: Emerging technology driving practice innovation