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Past Issue
Volume 2, Issue 3 | November / December 2023

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Danell Haines, PhD, Research Consultant

Home infusion is a site of care (SOC) option for patients requiring intravenous (IV) or subcutaneous (SC) medications for treatment of acute and chronic medical conditions….
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Jennifer Zhao, Johns Hopkins Care at Home; Brian Sherman, RN, Johns Hopkins Care at Home; Ashley McCracken, PharmD, MBA, Johns Hopkins Care at Home; Stephanie Watkins, RN, Johns Hopkins Care at Home; Kristopher Rusinko, PharmD, PhD, MBA, MEd, MS, Johns Hopkins Care at Home

A productivity metric that infusion sites measure to gauge operations is chair capacity, which is a direct reflection of physical chair utilization based on the inputs of…
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Nicholas Panchak, PharmD, University of Minnesota Medical Center Fairview Health Services; Ryan McFarland, PharmD, University of Minnesota-Duluth College of Pharmacy; Jessica Das, PharmD, BCPS, Fairview Health Services; Alicia Zagel, PhD, MPH, Fairview Health Services; Jennifer Ross, PharmD, BCIDP, University of Minnesota Medical Center Fairview Health Services

Beta-lactam-induced neutropenia (BLIN) is a serious adverse reaction associated with extended treatment courses. For many severe infections, guideline-directed medical therapy frequently involves weeks or months…

from the editor

Michelle Simpson, PharmD, BCSCP, MWC | Editor-in-Chief, Infusion Journal

Understanding financial decisions for choosing the site of care for infusion therapy can leave patients and providers feeling like they are given limited options. Determining the proper site of care for infusion medication administration is a growing challenge with complex reimbursement decisions. Reimbursement for the same medication could be higher, lower, or not reimbursed due to where it was administered.1 Too often, insurance benefit design and the patient’s potential financial responsibility weigh heavily in the decision-making process.

When receiving a referral, home infusion providers are trained to assess the patient and treatment plan. The pharmacy and nursing team can evaluate the site of care based on clinical information and financial outcomes as part of coordinating care with the patient’s insurance. Based on payor restrictions and patient characteristics, one of these locations may be a better option, either financially or clinically.

The care coordination model in home infusion has been effective in providing explanations of financial responsibilities to patients and keeping patients involved in their site of care decisions. NHIF collected patient satisfaction survey data and established home infusion industry benchmarks for satisfaction. For the question, “I understood the explanation of my financial responsibilities for home infusion therapy,” the 2022 benchmark was 89.85% of patients who responded “yes” to understanding their financial responsibility for their home infusion therapy.2,3

As part of ongoing care coordination, the patient’s eligibility is verified, and the treatment plan is updated. Data collected on the status of patients discharged from home infusion services reported higher rates of the reasons “change in eligibility” and “change infusion provider” in patients who were discharged for therapy types that included specialty drugs.4,5 The increasing number of specialty medication approvals coupled with the high cost of these medications has become a target for reducing health care costs through site of care optimization.

Site of care costs will influence financial decisions. The article in this issue of Infusion Journal by Danell Haines, titled, Cost Savings: Home Versus Inpatient Infusion Therapy, A Review of the Literature, evaluated the current evidence available for cost comparison of infusion medications administered in the hospital setting compared to the home or alternate site. The literature review was specific to data collected in the United States since it would not be a balanced comparison to analyze U.S. health care cost results against other countries due to significant differences in the health care systems.

The author’s conclusions found consistent cost savings associated with home and outpatient infusion therapy compared to the inpatient SOC for a range of infused drugs. The author performed an extensive search with open search dates. From 1988 to 2023, only 6 articles met the inclusion criteria for the literature review. Four of the 6 compared outpatient anti-infective therapy (OPAT) to inpatient or hospital-based care. The author provided a count of excluded articles from outside the U.S., and it is worth noting that the amount of research available from single payor systems was more widely published.

While Haines’ findings do not come as a surprise for home and alternate site infusion professionals, there is an obvious need for research in reimbursement and cost analyses of health care by site of care.

Promoting evidence-based research is at the heart of our mission, and Infusion Journal is interested in publishing cost-related research in home infusion. As the pipeline of specialty infusion medications grows, it represents an area for large savings and an opportunity for site of care research. Infusion Journal maintains a list of suggestions for research in relevant areas of interest in home infusion.6

If you have a patient case or idea for writing a case report or questions about submitting a manuscript to Infusion Journal, contact: infusionjournal@nhia.org.

Learn more about the journal and review information on manuscript submission.

1. ASHP: Navigating and Optimizing Infusion Services when Hospital-based Care is Not an Option. American Society of Health-System Pharmacists. https://www.ashp.org/-/media/assets/ practice-management/docs/Site-of-Care-Challenges-81919.pdf (Accessed October 29, 2023).

2. National Home Infusion Foundation (NHIF). 2022 Annual Patient Satisfaction. Internal Report. Unpublished.

3. Sullivan C, Haines DJ. Uniform Patient Satisfaction Survey Questions for Home Infusion Providers. A Research Study. INFUSION. Mar/Apr. 2017;p.56.

4. National Home Infusion Foundation (NHIF). 2022 Annual Patient Status at Discharge. Internal Report. Unpublished.

5. Haines DJ. Reasons for Discontinuation of Home Infusion Services. A 2021 and 2022 Comparison. INFUSION. May/June. 2023.pp:22-25.

6. NHIF. (2023, May 17). Infusion Journal Research Topics. National Home Infusion Association. https://nhia.org/nhif/ infusion-journal/infusion-journal-research-topics/