Dr. Stein and Dr. Roteman of CIVIC Infusion Center in Wilton, CT join us to discuss how standalone infusion centers are continuing to provide safe, affordable care for infusion patients during the COVID-19 crisis. For more COVID-19 resources and guidance, visit the National Infusion Center Association’s (NICA) website to download their toolkit.
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Transcript: How the infusion center is the optimal site of care during COVID-19
Dylan McCabe: WeInfuse Podcast episode number 25. Welcome to the WeInfuse Podcast and my name is Dylan McCabe but in every episode we give you a behind the scenes look at the operations of the infusion center, whether it’s a standalone infusion center or a provider’s office who has an infusion suite and our goal is really just to equip you so that you can have the best tips, tactics, and a road map to offer excellent services to your patients and grow a thriving infusion center. I think you’re really going to like this episode because I’m interviewing Civic Infusion Center, I’m interviewing their Executive Director, Debbie I’m also interviewing Dr. Stein and Dr. Roteman and they’re going to talk about how they pursue excellence in the midst of COVID-19 compared to a typical hospital setting. They’re going to really get into the details of why it’s such a positive thing for their patients to come to them versus going to the typical provider office or especially a hospital setting. So whether you’re thinking of starting an infusion center or having already, you’re going to get some nuggets of gold as we go into this interview. So let’s jump right in.
Dr. Stein: So basically Dr. Roteman and I are a board certified anaesthesiologists, and essentially we recognize that there was a need for a facility in this area that was focused on an affordable high quality and convenient alternative for patients with chronic conditions that require IV infusion therapy. This was something we felt very strongly about based on our own personal experience with friends and family and we understood that the hospital environment was not ideal because basically it was not as affordable and these types of patients that require these therapies are particularly vulnerable to infections and viruses that naturally spread within the hospital environment. So that’s sort of how we started off and we felt that this was a unique opportunity for this area and for the patients that really don’t have an option in this area for that kind of treatment.
Dylan McCabe:That’s great and for those listening, as I mentioned in the intro, we’ve got Dr. Stein, Dr. Roteman and Debbie, the Executive Director of Civic Infusion Center and so kind of give our listeners kind of a snapshot, a 90 second snapshot on what Civic Infusion Center is and why you guys are located in the place that you are and kind of the value that you offer.
Dr. Roteman: So Dylan, we’re basically a freestanding multi-specialty infusion center. We give practically every drug imaginable now, biologics, when we started out we were looking to see obviously what our patient population was. We chose the Wilton area up in Connecticut because Connecticut and the Northeast in general really doesn’t have a lot of options for these chronic disease patients and so like in anything everything has its risks rewards and we weren’t really sure even if this was the right location, but we thought that the hospitals were charging such incredible fees for this. We were told that we saw patient ELBs. People were really upset at what was going on at the hospital setting and we thought we can provide from our background as anaesthesiologists, we’ve done and managed a lot of these type of centers in ambulatory surgery and so we thought, okay, we have that kind of experience and background, how do we do it in the infusion business and that’s really how it kind of originated.
Dr. Stein: And just to add on that basically as anaesthesiologists we’re very experienced with IV therapies, IV treatments as basically critical care doctors in the operating room. So to be able to treat patients in this type of environment, we felt we were ideally suited to do that given our background and experience.
Dylan McCabe: Okay. So I’ve got to ask the question here, because WeInfuse does a lot of consulting and we’ve talked to healthcare providers around the US what was the big difference business-wise and talking about the workflow and just managing all the moving parts in the practice of going from anaesthesiology to infusing biologics in these patients with chronic diseases and I’ll let you know Debbie answer or Dr. Roteman or Dr. Stein, whoever wants to answer that, go for it.
Dr. Roteman: I mean, I’ll take it. I think so the biggest difference probably is these patients are, it’s not anaesthesia obviously, but these patients come with some of the same comorbidities and problems that we have in the OR, the difference here from a business standpoint is that this is obviously a very difficult sort of negotiable thing with insurance carriers. So it’s not easy as in other words, most of the carriers understand all the other businesses in medicine. We found that our carriers, at least here in the Northeast, we’re pretty blind to what outpatient infusion services were and so we had to do a lot of educating, we educated ourselves and then when I negotiated all these rates and just to get contracts with insurance carriers, just to be honest here and look they really don’t know, they don’t have people that are very experienced with dealing with outpatient office based infusion. They do know an aspect of the home infusion environment, but they really don’t know a lot about what we do and so again, we educated ourselves, we educated them. We started working very hard on all our contracts and so from a business aspect, I think that was the toughest part.
Dylan McCabe: Absolutely and for those listening, we are recording this at the time of the Corona virus and so we’ve got principles to share here as well, but we’ve also got the fact that there are a lot of people working remotely. So if anybody here has kids or dogs or anything happening in the background, we are all dealing with it. So tell me this now. So you guys have a very successful standalone infusion center. You are strategically located in between some major health systems there in Connecticut. You guys have a great website. I looked over it and you’ve got really helpful resources, whether it’s a patient or provider who wants to send referrals, you’ve got forms of what has it been like dealing with the outbreak of COVID-19? Debbie, do you want to take it from the desk point of view?
Debbie Roland: Sure. So we certainly have had protocols in place before COVID-19 started but we have upped our protocols. For example, now we’re calling every patient before they come and asking them, did you experience a fever, a cough, shortness of breath? The questions that were set up by the CDC, this is something we hadn’t done before. Our patients don’t come here if they’re not feeling well anyway, because they’re not going to want to get an infusion if they’re ill on a regular basis. But certainly before they walk in the door here, they are screened, their temperature is taken, masks are worn. We’re cleaning down the office top to bottom three times a day. So we’re doing everything in our power in order to ensure that our patients who need their medication on a regular basis are going to be able to receive it, that we’re going to stay open, we’re all going to stay healthy on our end and we’re doing our best to keep our patients healthy as well.
Dr. Stein: Yeah. If I could just add to that, I think people actually are very relieved that there is an option available outside of the hospital because today, if you’re going to go to the hospital, you’re going to see at least in this area and probably all over the country. It’s pretty much a disaster area and so people are relieved that they have an option to go to that’s high quality and affordable still and it doesn’t interrupt with their regular treatment.
Dylan McCabe: So piggybacking off of that, what can you guys do or what are you doing that might be helpful to other infusion center operators listening to this, to reach out to those hospitals saying, hey, help us or we can help you alleviate that burden and we have a place patients may feel safer, better at this time coming to our standalone infusion center?
Dr. Roteman: So we have done that in some ways with our marketing staff, but Dylan as you know, the hospital systems really are very much to themselves and of course they worry about what they’re doing and we as a private center I think struggle a little bit with that. But what we have done is we’ve had our marketer go to all the doctor’s offices, even though she cannot even get in at this point, but she has her liaison, she’s emailing, she’s calling and we all have tried to put out the word of course, that we are open, we’re treating and we’re following all these protocols and fortuitously, obviously in this situation, we’ve been getting patients from hospital settings from all over because the patients themselves obviously are now saying, hey, wait a minute, am I going to go into a big, crazy hospital situation and sit in that chair where God knows who’s been in there and what’s going on and we see all the problems, everybody’s watching the news. Unfortunately, this is bombarded to everybody and it’s really such a stressful time in medicine and I think that’s where our infusion suites really come in at such the right time, because we provide a very relaxing and calm atmosphere. I think as Dr. Stein was mentioning, once we get these calls that our patients were being transferred actually to our facility from, I mean, whether it’s an insurance carrier calling, whether it’s a patient calling themselves, some of the even drug reps are looking for their patients’ places that they can go. So obviously this time for, I guess, all the freestanding infusion centers, this is a good thing, but again, we have to be really careful. I mean, my biggest fear and Dr. Stein’s biggest fear and Ms. Roland’s biggest fear is that if somebody gets sick in our center, okay, what do we do? Do we close for a week? Is it 14 days? I mean, as providers, we get updates almost on a day, I would say on a daily basis in New York and Connecticut, we get these provider alerts and updates and everything has changed, now as you may know, the whole world should be wearing masks, yesterday they shouldn’t have been wearing masks. It’s really a crazy time and so we do our very best for when we get these phone calls, Debbie and I, we really have a nice staff and they all know how to treat the patients really well. We tell them to not only allay their fears, but it’s the truth, we are doing everything that the hospitals cannot do just because strictly by spacing patients out we do have a private room, we have some semi-private areas for patients. Even in the snack area and the refreshment area we have our nurses going with gloves and sterilely giving them out to patients to avoid them coming to the snack area. So I think we are really bending over backwards and it’s really working and we’ve been kind of flooded with more calls due to this.
Dr. Stein: Even before the COVID-19 crisis occurred our standards and our expectations were to exceed the hospital environment, not just to match the hospital environment. So I think this COVID-19 crisis is just highlighting what we can do and it’s brought to light the importance of just focusing on high quality patient care, accessibility for patients as well as understanding that people need to be able to afford their treatments. So I think this has really been an interesting time for us and I think people are really starting to learn about us as a result of this crisis as well.
Debbie Roland: Yeah and if I could piggyback on that, often people did not know that they had an option of going to a free standing infusion center and certainly there were a lot of physicians who wanted to keep their patients in their system, if you will. Once they come to us and realize what they have when they come to us and they experience what they have, it’s been remarkable. I mean, the patients so appreciate this type of environment and so we’re very happy to be able to be here to support the community and support the patients and make sure that they get their treatments.
Dr. Roteman: Right and Deb, I think you were just to maybe add a little bit here, Debbie was saying that when they come in and we really don’t even let them in now, there’s a locked door that temperature is taken outside, a nurse goes to see them and we do the evaluation and the appropriate screening questions, but they’ve been flabbergasted. I mean, they’ve been super surprised like, oh wow, you guys can really do this and we’re doing all the things that we’ve read about. So yeah, I mean, overall, we’re pretty happy right now with how we’re taking care of patients.
Dylan McCabe: Well, I think about that and I think about if my own mother or somebody in my family was going to get infusions, I would absolutely want them to go to a place like civic versus a hospital with the crowds and all the risk associated with that and you guys are clearly going the extra mile to provide a great setting for your patients, but also a safe setting. But let’s kind of shift gears here and you guys are doing so many things very well, and you bring a lot of obviously clinical expertise and business acumen to this situation, but let’s talk about what’s been one of the biggest challenges that you’ve had to navigate with this that’s kind of caught you off guard or caused you to put extra time and energy into dealing with that challenge? And then I’ll follow up with what’s been one of the things that you’ve learned that’s gone really well? But for other infusion centers listening that are wondering if other people are sharing their own experience, what’s been one of those biggest challenges you’ve been facing?
Debbie Roland: I can take that. So as we mentioned, the phone has been ringing and patients have been wanting to transfer to our center and that’s been great, but a lot of the physician offices, especially in New York City are working with either a skeleton staff or they’re working from home. So getting the information that is challenging has been more of a challenge lately. So that I would say is the biggest problem that we’re having and also on the other side is getting the authorizations are taking longer. We’re really pushing it to make it happen very quickly but it’s a tremendous amount of time spent gathering the information that we need and getting the authorization. We are turning things around very, very quickly, but certainly when people call us when they have an infusion scheduled for the next day and we want to get them in the next day. So we’re doing somersaults and backflips in order to make it happen and it’s stressful, but we’re getting it done.
Dr. Roteman: Right. As the medical director, I get calls from Debbie and the staff, because again, the communication, which we really, I think that’s one of the things we pride ourselves on, we have our nurses that really communicate with the office of the referring providers nurses and so if they’re not around and something they can’t write an order. So what’s been happening is we’ve been getting orders that really are, I don’t want to say unacceptable, but kind of not written in the right way or they forget a signature or the doses not written correctly. So then I’m looking at these trying to get approval from their office, trying to go over with our nurse, is this right? Can we do this patient, they want to be done this Saturday and so again, the communication, which again it was very smooth up until COVID-19. So yeah, that that’s been a real challenge for us.
Dr. Stein: I’ll add one another challenge, I think we saw a little bit early on, which I think we’ve overcome at this point is that we were busy doing a lot of education about infusion with insurance companies and why insurance and why patients want an alternative site for their care and why it’s critical for patients to be able to have this and why it’s a win, win for both patients and insurance companies to have an alternative high quality location like us around. Initially we kind of had a lot of misunderstanding about what’s involved and who’s there but eventually they sort of understood, and we were at a place now where they actually very much appreciate what we’re doing and realize the value that we’re bringing to the community.
Dylan McCabe: That’s good and your website does a good job of communicating that too. I think something on your homepage says it’s about half the cost per patient to get an infusion at a standalone infusion center versus the hospital.
Dr. Stein: Yes and the reason for that is because I think a lot of patients realize this only after they received their bill for their infusion, but there’s something called the facility fee that hospitals are able to charge. So in addition to the professional fee, that’s charged to patients, the hospital itself charges a facility fee and these costs add up. So as a free standing independent center, we don’t charge a facility fee and that significantly reduces the amount that patients have to pay and insurances have to reimburse for our services.
Dylan McCabe: To me that’s a huge value add. I mean, you’re helping patients to really provide a safer environment. There’s a lot less interaction and they don’t have to go to a crowded hospital. You’re saving them money, which is huge. So these are big things and then I think about the communication flow, just going back to Debbie’s comments about having to deal with all the different communication. I know Civic uses WeInfuse, which is huge because the software gives you a tool to put everybody on the same page in the insurance process, the scheduling, the charting and so forth. But I know that as you interact with other providers and they’re using a constellation of systems to manage that same workflow, it makes it really challenging especially when they’re using everything from sticky notes to handwritten notes, to one software for charting and another software for this, it just makes it hard for everybody to communicate effectively and I know that that’s been a challenge that you guys have had to deal with as well. Well, let’s talk about that and talk about the positive side of that as you’ve had to deal with that, what’s one really big thing that you guys have learned that’s going to make you a better infusion center?
Dr. Stein: Well, one thing that I’ve learned is that amazingly the standards in the hospital are quite low, so it really hasn’t taken us much to really stand out and sort of set the bar for what infusion therapy should be. I think people deserve a clean and inviting setting. That’s with high quality personnel experienced people to do that know what they’re doing and I think many times when people go for infusions, whether it’s in a doctor’s office or even in the hospital, they find themselves in what could be described as almost like a closet, dirty supplies and equipment. So I think we’ve really taken it to another level and we’re trying to set the bar in terms of what people should expect when they come for an infusion treatment.
Dr. Roteman: Yeah and I think one of the really important things that I learned and I guess this is true in all of medicine, but particularly in the infusion space with these kinds of patients, is that if you provide a great service and make people very happy and really understand what they’re going through, for example, there’s a huge multiple sclerosis population. I say huge because there are many people out there who have been on the outset of just being diagnosed, they don’t know. In MS particularly patients look good, they can look very athletic and healthy and work, but they’re suffering as we know. So it’s kind of a disease where it goes a little bit under the radar and of course as many of you know Acravis is a huge drug now for this and we see that providing these patients with that good care and understanding their illness, I mean, it’s almost like it’s really rewarding actually. So we’re finding that and at Civic, we take everybody, we hardly rarely if ever turn down an order for something that let’s say is not the most profitable or just not, we think we’ll get all of that will come back to us. Particularly in infusion, the word of mouth from patient to patient and patients to their doctor’s office, I think has really been a big plus for us. So those are some big takeaways.
Dr. Stein: And I also think this is sort of as anaesthesiologists, we’re not typically involved with patients other than sort of as an afterthought, when they come in for surgery, they kind of see us after, and then we’re kind of gone. But here we’re starting to appreciate just those patient interactions and getting to know patients and understand and they’re starting to develop relationships with us and our staff and I think that’s been very satisfying and rewarding for us as we’ve grown.
Dylan McCabe: Let’s talk about that for a minute and as you guys experienced an increase in patient volume and you’re in an opportunity to help other providers who maybe can’t see these patients like they normally would and I looked at your website, you guys are even open evenings and weekends, which is huge. It raises a question in my mind that we get asked a lot at WeInfuse, especially for people who want to open an infusion center and they say, why would another provider or a rheumatologist or gastroenterologist, why would they want to send us their patient for infusion? That doesn’t make sense. So what are some of the benefits of why a local provider would want to send a patient to you guys and kind of outsource that treatment?
Dr. Roteman: So we saw this early on and that’s a great question, because for anybody who’s thinking of opening a center out there, we understood very well that yes, there may be big practices doing IOI and some do it well, and some don’t do it well at all and honestly, the majority was in the not doing it well at all category and the reasons for this and we understood this is that if you remember in a doctor’s office and with their nursing staff and their other staff and their administration staff, there are so many things going on other than the infusion services. So they will try to characteristically we found out from speaking to a lot of our nurses that not only would they have to multitask by answering the phone and go seeing a patient in room two, then going, starting an IV in the back room where the infusion suite, as far away from where they were, they couldn’t really do this with a good flow in an organized manner and to this day I would say that there are many offices that still try to do this. So we understood, I think from the beginning by doing a lot of homework and that’s another thing if we, again, I don’t want to discourage anybody, but I think this is a very, very tough business and you have to have your eyes wide open when going into it. We did a lot of research to find out what was going on in our area, who should be doing what, and again, I think the offices, to your question, they just have a hard time coordinating all the other things that are going on and therefore not really prioritizing their infusion suite.
Dr. Stein: Right. And I think also just to tag onto that is that it is extremely hard to be successful in this and I think the reason is because you could easily start losing money. The drugs are very expensive, insurance doesn’t always reimburse appropriately in this constantly changing reimbursement and costs for the medications that constantly need to be tracked. So a lot of places don’t have the ability or desire to track this information and you could find yourself very quickly losing money. So we’ve taken great pains to be very careful on how we manage our medications and our contracts and I think it requires it, it’s very work intensive and I think that’s why it’s not done a lot at least in our area.
Dylan McCabe: Those are great points and those are the kinds of things we share with consulting clients for WeInfuse, but it’s great to hear it from you. You’re reducing the financial risk for the provider and really a lot of these providers, it’s almost like a, I hate to call it a side business, but it’s not their main area of expertise. It’s not their main focus and it is a whole new workflow and a whole new level of risk and reimbursement, like you said. So if everybody swims in their lane and we all do what we’re really good at, things will flow a lot better and that’s kind of what I hear you saying in that. We could talk on and on about the different things you guys are doing to kind of stand apart and offer excellence in different ways, but want to respect your time and wrap this up here in a few minutes. So what’s some parting advice you would have for other infusion centers as they navigate this current challenge of COVID-19?
Dr. Roteman: I would really say again, not to discourage of course, but really do your homework. As far as knowing all the aspects of the business, it’s not as Reese and the guys are always saying, it’s not a build it and they shall come business, you have to know, obviously your market, your area, what the hospitals around you are doing and patient demographics, things like that. I mean, it takes a lot of time to research. Again, I think that the biggest hurdles are with your insurance carriers and one of the things that I would say to people is really understand your particular insurance carrier market state to state, as we learned going to the great NICA meeting last year we had people from all over the country and meeting people and understanding how their States look at the infusion industry through their insurance companies is very different than another state. You would think that this would all be national, no brainer, but it’s not. So understand your environment, do your homework and put in the hard work. It’ll definitely be rewarding.
Dr. Stein: I would also, I agree completely with that and also I would say to understand that health care is hyper-local just because you’re able to do something in one market does not mean it will not translate into another market. So you have to be very careful in doing your research because it may not work out even though you can be successful somewhere else.
Debbie Roland: And what I would say to the other infusion centers who are dealing with COVID-19, take those extra safety precautions and treat your staff well, because know that they are working harder than ever and just everybody stays safe and continues to treat your patients because your patients need that medication. So you staying open and staying safe is incredibly important.
Dr. Roteman: Yup, agreed.
Dylan McCabe: Great points guys and so for those of you listening, I just want to say thanks to Debbie Roland. Thank you, Dr. Stein. Thank you, Dr. Roteman. We appreciate you guys, of course, as a WeInfuse customer and that we can partner with you and thank you just for providing excellent service to your patients.
Dr. Stein: Thank you.
Debbie Roland: Thank you.
Dr. Roteman: Thank you Dylan, thank you for having us.
Dylan McCabe: All right. I’m sure you got a lot from that interview. I really appreciate them being on the show and I love how they talk about why a provider would want to send them their patients or why their patients are really getting the best care possible compared to having going to a hospital, especially in the midst of COVID-19 and guys now is a time more than ever, where WeInfuse software really shines because when many people are working remotely, it puts everybody on the same page. Everything from the insurance workflow, navigating that whole process with prior auths, to the scheduling, to the nurse’s charting, and even a lot of billing information that billers need all of that in one place, even with very powerful features like appointment reminders, alerts, and ways of messaging those patients to stay on top of this process, go over to weinfuse.com to learn more and to request a demo schedule a time to talk through it with an account executive. You will be glad you did. There’s just no need to use a constellation of systems to manage this complex process and those of you that have listened. Thank you for listening. If this has been helpful, please share with others and also rate and review on iTunes. It’s just a great way to say thank you to us. We hope this was helpful. My name is Dylan McCabe, this is the WeInfuse Podcast, and we will catch you in the next episode.
