Operational Issues for Hospital-Based Home Infusion Pharmacies

Abstract

This article focuses on a nonprofit, hospital-based comprehensive home infusion service in which all intravenous (IV) drugs or nutritional admixtures, professional services, supplies, and reimbursement services are performed solely by inpatient pharmacists, IV therapy nurses, and pharmacy assistants. By modifying an inpatient work load measurement system, additional staff are justified by total time for home infusion service work units. Twenty-four-hour back-up by cross-trained inpatient pharmacists and IV therapy nurses has contributed to the number of patients served by the home infusion service, which has grown steadily. A permanent and complete outpatient medical record is maintained for each patient (separate from inpatient records) in the infusion service and is available for 24-hour easy access for after-hour calls. All multidisciplinary team members participate in formal, weekly patient-care case conferences to review and update all patient therapies. Services covered, billing procedures, procedure codes, allowable charges, prior approval requirements, copayment arrangements, claims processing schedules, and related billing arrangements were first identified. The overall success of the program's reimbursement remains at 85% of charges when combining all patients. Structure, process, and outcome criteria unique to a comprehensive home care quality assurance program evolved from our high volume (total parenteral nutrition [TPN]), high risk (pain management, antibiotics), and problem-prone (TPN, pain management) therapies. Reimbursement remains the most troublesome aspect of initiating a successful hospital-based program. The success of our program depends heavily on the ability to attract and retain a highly motivated professional staff and to maintain strong referral networks with local physicians, hospital discharge planners, and other health care professionals.