Episode 004: Reducing Risks in Infusion Therapy with John Long, Altus Infusion

Transcript: How to reduce risk in infusions with John Long from Altus Infusion

Dylan McCabe: Welcome to the WeInfuse Podcast episode number four. Welcome to WeInfuse Podcast. My name is Dylan McCabe, and each week we give you a behind the scenes look at the infusion industry, and we just want to provide tips, tools, and a roadmap for all of you involved in the infusion space so that you can have a thriving, successful practice and today we have a special guest John Long with Altus infusion. John thanks for being on the show, man.

John Long: Thank you.

Dylan McCabe: We also have our famous co-host, Mr. Reece Norris with us today.

Reece Norris: Hey, good morning, Dylan.

Dylan McCabe: The whole goal of today’s podcast as always is to equip you guys. Since we have John here with Altus infusion, he’s going to be able to share about Altus things that are the latest and greatest insights from Altus. What alters the value that Altus can bring to provider offices? That’s unique from other situations that are available or other opportunities that are available out there for those of you looking for help to run your infusion practice. Let’s just dive right into that. John, before we jump into all that I know I’ve seen you at several trade shows. I know you’re the VP of clinical operations with Altus infusion, but just kind of share for our listeners a little bit of the background of your business journey up to this point, and what got you into the infusion space?

John Long: I’ve been a nurse for about 28 years. I started off, not really in healthcare, actually. I was a financial planner, a broker back in the late eighties, early nineties. Kind of moved away from that and made an opportunity to go back to nursing school, get my degree in nursing. I was a flight nurse with airlines back in the early nineties. Kind of moved more away from nursing in the mid-nineties, moved into the managed care arena to kind of start working with providers to help kind of rebuild their practices, turn them into financially viable entities. From there I kind of moved on to become the VP of contracting for Human for a few years. Then, I decided to get tired of working for large corporations, and created my own company. So I’ve owned and operated six or seven of my own companies from billing companies, practice management, consulting, management, service organizations, healthcare, just general healthcare practices. What I used to do before I actually joined Altus was, I had an MSO that would go in and identify failing your distress medical facilities from physicians who either in bankruptcy on the verge of bankruptcy, their trustees would come to me or make me an offer to buy out the assets that the physician worked for me to put them on a salary. After a five year investing period would go to allow the physician to buy back up to 60% ownership in that LP. So they can be their own boss again. But our management company would ensure that they would not go back into the same rut they were in when they first got to us. I sold that company in 2007 and retired up until I met these guys Altus in 2012 and then bought into Altus and it’s been a great ride ever since. I’ve been in the infusion arena now since probably even before that I was consulting for some other rheumatologists, but for about 11 years now. It’s been quite a ride just to see the progression of different biologics of the arsenal of physicians, used to have to treat rheumatoid arthritis to what they have now. It’s just trying to quite a drastic increase in the use of drugs and biologic agents.

Reece Norris: When you started, there was probably just Remicade.

John Long: Remicade was just coming to market. Of course, there was gold, there was methotrexate steroids, the highest utilizers for most physicians. I wanted to treat rheumatoid arthritis.

Reece Norris: Today we have Actemra.

John Long: Orencia, you have the toxin and MAB. You’ve got a bunch of oral DMARDs as well. But it runs a gamut, Cimzia.

Reece Norris: Yes, lots of change in just a few years. It’s awesome.

John Long: It’s Crazy.

Dylan McCabe: Yes, and what I hear really unique about you is, you’ve got the clinical training as a nurse, but then you also have a lot of skills in the area of business and finance and entrepreneurship. That’s like we talked about in our latest podcast episode, Brian, Nyquist was the infusion practice is so unique because you got a situation where obviously you have the clinical side, the doctor, the patients, but it’s so dependent on business acumen. You’ve got a multimillion, not from a business side, maybe a multimillion-dollar practice. That’s usually run by people that have not had a lot of training in business skills and business strategy, business best practices. So that’s just really neat. What I hear about your background is you’ve got both of those coming out. So, out of all that, everything that you’ve been through and learned, and your experience in business and the clinical side. What would you say today is your main area of expertise?

John Long: I focus on a lot of different things. I look at, of course, the use of biologic agents ensuring that all of our providers are utilizing the step edits to make sure that the claims are dedicated the first time, every time. So that’s one of our primary focuses. I also build clinical processes. Any drug that we use, we ensure that we’re following the FDA label, make sure that the documentation is supportive. We also look at how physicians are documenting or how they’re using biologic agents in their practice, because sometimes they forget that in the step edits, they should be using the insets of course, then moving on to the DMARDs and the teen apps, and then the biologic agents. That’s where a lot of physicians kind of go wrong. You have a lot of physicians who think, okay, I want to put this patient right onto a biologic agent and wondering why those claims don’t get adjudicated, just because they’re not failing the step, but it’s as, as most of these payers are mandating, that’s where they kind of, again, as you talked about these, these office managers, sometimes their spouses, they don’t really know how the infusion business works. Until they get those claims denied and it gets stuck with hundreds of thousands of dollars in denials, then they’re like, okay, what did I do wrong? Why am I getting these claims denied? Who can help me?

Reece Norris: It’s awesome. Yes in our experience as a software company, always trying to put in best practices and processes to make sure claims actually get paid. As you just mentioned, it could be hundreds of thousands of dollars just in a few clients. It was 10 and you’re well over a hundred thousand dollars.

Dylan McCabe: Yes, and we do it to your point. When we ask physicians if they’re not infusing, when we ask them, why not first, their first response is too much risk. One Lemtrada claim, one Lemtrada patient, it’s over a hundred grand.

John Long: It’s $121,000.

Dylan McCabe: It’s just too much risk, right. You can’t make any mistakes and that’s great. So, what’s one thing you would want our listeners to hear or to learn from your main area of expertise today?

John Long: I think looking at, developing a plan if you’ve identified, you want to put infusion services in your practice, making sure that you have the right person who can do the billing collections aspect of it, making sure that you have a utilization team or individual who’s going to be looking at your documentation, make sure it’s supportive of the services that you’re providing, or at least at the very least take a look at what the payer websites are mandating so that you know where the pitfalls are going to be. Because that’s where a lot of physicians like I said, get into trouble and they just have no idea. They said, well, we tried to put this patient like Tamra and that patient claims never got paid. So they perceive Actemra as a bad drug because payers don’t want to pay it, not understanding that it’s truly something that your staff doesn’t understand and the process and they should be following.

Dylan McCabe: Why is that so hard? Is it because there are so many different drugs out there? Is it because they each have a different process you have to follow? In your opinion, with your expertise, why is that so challenging for the physician’s office?

John Long: Well, again, it’s all about education. It’s all about knowing what drugs you use, what specific requirements, for instance, you have symphony Aria. If you look at what the FDA label has for Simponi Aria, it’s only approved for, and used with methotrexate. So you have to have methotrexate and combination therapy with symphony Aria. If you use Simponi Aria, just by itself and now no can combine therapy, then all payers will come back and deny the claim, which is ridiculous. Because there are other drugs you can use. There are other DMARDs sulfasalazine or Plaquenil besides methotrexate. Some patients have severe hair loss, GI, nausea, vomiting, diarrhea, with methotrexate, so they refuse to use it. But it’s mandated because of the FDA label and the way that clinical trials were conducted. That’s the only way that payers are going to pay it. So how do you get around stuff like that? You can have a patient take 2.5 milligrams of methotrexate once a week, which is significantly nothing. When you document that, then the payers are going to see that, the patients on methotrexate and they’re in somebody’s RNs. So now approved.

Reece Norris: Wow. What insight just right there for our listeners.

Dylan McCabe: He knows a little bit about this. Just a little bit. Yes, it’s good grief. You better have somebody that’s incredibly detail-oriented managing this process. That’s what I take away from that, and you better have a process in place.

Reece Norris: I think when you and I did a podcast where we featured the innovative infusion story. John just alluded to, you’ve got to have a team. Everyone brings a different skill set in your practice, making sure that your billers are really very knowledgeable about these payer policies, shoot, it’s huge.

John Long: Payer policies sometimes change, quarter over quarter, year, over year, sometimes month over month. So you have to have a whole team, and we have hundreds of team members and artists that do nothing but that they go to all these classes that are being offered. They look at websites every single month looking for updates because the payers aren’t going to send you something saying, hey, by the way, Bill’s biologic agents that you’re using, don’t forget. We have a new payer policy that you have to follow. They don’t do that. They just look to deny your claim and you, and then when they get that claim denied, they come back and say, okay, well check our website. I’ll tell you exactly what you failed or why we’re not paying this claim.

Dylan McCabe: That’s great. Yes. Because, well, for the physician office, even if it’s a multi-provider office, how are they going to stay on top of all that they can’t. I mean, their focus is on patients. Just even for listeners of mine, it comes to my mind for people listening to his podcast who may not be familiar with Altus. Tell our listeners, who is Altus? What’s the main focus of Altus? What’s the main value that Altus offers to physician offices?

John Long: When Mark and Clint founded Altus back in June of 2010, the whole reason it was founded was that there was a physician that came to them and said, hey, look, I’ve got a need. I’ve known you guys for a long time. I trust you guys. They needed to partner with somebody that they had. Number one that had a good understanding of the medical market. Number two that they could place their trust in. Because remember, these are a lot of expensive drugs and they don’t have the time to allocate for those types of services. They created a management service organization or a management company, an infusion management company that could serve those needs of those physicians and put the physician first. That’s what we kind of pride ourselves in, we are their business partners. We are not actually a vendor for you. We’re your business partner. So hand in hand, we’re going to look at opportunities to better your practice. We’re looking for revenue enhancement within your practice, but looking for the opportunity for you as a physician to actually practice the art of medicine, which is what you do best, we take care of the business act, aspect of it for you. We’re going to go in, and there are three major components for you as a physician that you have to do, which is number one, provide us medically appropriate patients. Number two, you actually have to make sure that you are using our EMR. Then lastly, we want to make sure that you are ensuring that these patients coming to us have this space that we need in order to conduct those infusions. We do everything else from A to Z. We do all the billing collections. We do the appeals process. We do the prior authorizations. We do foundation assistance. We do copay assistance for your patients. If there are any peer-to-peers, we’ll set those up for you, anything and everything that you’re going to need, we’re going to make sure that we take care of that. We make sure that our nurses are fully trained and qualified. We provide staffing at no cost to you. We provide all the medical supplies and the acquisition of all the drugs. So essentially there’s no risk for you whatsoever. The only thing you should do is again, show up with those patients in that space, use our EMR, and the rest we do for you.

Dylan McCabe: Clearly, you guys take a lot of the risk away from the physician because you guys are actually buying the drugs. You’re making sure the claims are filed appropriately. You’re taking care of all the details that could be a huge risk financially. Right?

John Long: Absolutely. The great thing about that is that we kind of put our money where our mouth is because if those claims don’t get paid, because we did something wrong, we take the losses on that. You don’t take any losses whatsoever. We’re a hundred percent at risk for the drug.

Dylan McCabe: Yes. That’s great, with Altus infusion, you guys have that expertise. You come in, you’re like you said, and you’re going to be a partner with that office. You’re going to provide the business practices. You’re going to really free the physician up to focus on the patients and not worry about this stuff. Like we talked about earlier, the risk of that brings a lot of anxiety. With everything you clearly know, you guys are in a lot of offices, you have a lot of clinical and business experience up to this point, share a story of one of the biggest challenges you guys have faced. I mean, there’s successes and failures in business and in these practices, we hear stories. We talked to practices all over the US. Some are thriving. We’ve talked to a couple that is closing their doors. Tell us one story of where you guys faced a big challenge that all just kind of pushed through and learned from.

John Long: There’s so much space here in the rheumatology market. We have actually picked up clients from our competitors, very large super groups, I’m thinking of one in particular. They actually came to us and said, hey, look, what can you guys do? Currently, I can’t buy any more drugs. I was just cut off from my distributor because I owe them $600,000. I don’t know how I’m going to pay them back and don’t have, I don’t have infusion services to pay that I have no other way of generating revenue, but they won’t send me the drug. What can you all do?

Dylan McCabe: Wow.

John Long: There’s an opportunity there for us. Since we’re buying all the drugs. It’s, in our name, not in yours, essentially what we’re going to be able to do, because we’re acquiring that drug is we’re going to be able to buy that under your DEA, but at the same time where we’re at risk for that. The manufacturer for those distributors actually will allow us to acquire that drug. What we did is we negotiated a term for this individual to pay back that money. We took all their revenue that was generated from the infusion and created a payment plan to allow this physician to pay back that revenue, over 21 months. That’s $600,000. It actually paid back to that distributor within 21 months completely debt free in less than two years.

Reece Norris: That’s great. Great story.

Dylan McCabe: That is a good story. I love that. I love the detail, that story that somebody came to you with a need and you guys provided a very real solution because what, yes, go ahead.

Reece Norris: No, and you just mentioned competitors, and some people view WeInfuse as a competitor. That’s what’s great about this podcast is we can come and bring quote, unquote competitors. WeInfuse, Altus, and take that hat off. Right now just provide best practices and stories and business strategy for infusion centers. I think that’s our whole goal and man kudos to Altus for what you guys have done in the space. As Dylan mentioned, we run into you guys everywhere, so it’s great.

Dylan McCabe: Yes, with that experience, that story you just shared, I mean, let’s find some gold from that. Because it’s easy for that to just go, Oh wow. What a story. But I mean, what’s one thing you would want our listeners. What’s the biggest thing you’d want our listeners to take away from that story? Maybe it’s a provider who’s listening right now. Who’s thinking, I want to start infusing, but that story scares me away from it, or maybe it’s somebody listening right now. That’s thinking, man, I need to go talk to my office manager. As soon as I finished listening to this, make sure we got everything in here. What’s one big lesson you’d want them to take away from it?

John Long: I think planning for the goal, your goal is to have an additional revenue stream within your practice. How do you ensure that getting to that goal, that you have all the steps necessary to be successful? Because in order to do that, you have to have the right office manager. Maybe the office manager is your wife. Maybe the office manager is a longtime friend of yours. You have a hard time trying to ask them to do specific items because they perceive in their mind that this is the way it’s always been done. This is how some of their peers are doing it. You as a physician have to have some ownership in that. This is your practice. You work very hard to build this. You want to make sure that you are trusting, you’re entrusting the right people to do the right jobs. That I think for physicians is the hardest thing because you, as a physician, just want to treat the patient. You don’t have to worry about all of the minutiae behind the scenes in order to treat the patient. This is one of those steps, identifying the right person to find the right process and of course, making sure that they follow through on those things.

Dylan McCabe: That’s so good. That goes back to something that you talked about in the podcast where I interviewed you, constantly comes back to the team you have in place and is that a cohesive team? Do you have the people with the right skill sets running in the right lanes? It’s crystal clear after the story you share that you better have somebody that’s incredibly detail-oriented and has experience in this space. We’ve heard stories about practices that outsource their billing, but the billing companies didn’t really have expertise in infusion billing, which is so unique. Next thing, a year into it, the practices dealing with issues that are costing, like you said, hundreds of thousands of dollars. Let’s share another story with what you’ve experienced so far with you, and you have a unique lens. Somebody that helps manage infusion practices, what has somebody in your position, what’s one of the light bulb moments you’ve had as you’ve helped all these provider offices around the US.

John Long: I think for physicians sometimes that I run into, because again, I do Physician’s Education for most of our physicians across the country. One of the things that I identify is documentation. There are physicians who have been practicing the art of medicine for 25, 30, 40 years and are very set in their ways. I think what’s really hard is trying to evolve with the art of medicine over the years and transitioned into what healthcare is becoming or has become. Documentation is key. I still run into physicians who are not using EMR systems, very antiquated processes and wondering why their claims don’t get paid. That in itself, just finding a way to become more adaptable to situations that are happening within healthcare is going to help you as a physician grow and MB fiscally appropriate throughout the duration of your practice.

Dylan McCabe: Yes, Let’s talk about that for a minute. I talked to a practice a few weeks ago that is very high volume and infusions, and they were keeping track of their inventory and ordering for the following week in a spiral notebook. They’re doing over a thousand infusions a month and I think to myself, okay. I’m trying to picture myself if I’m on your team, what happens if somebody steals that spiral notebook, loses it, what happens if there’s a fire or a spill, whatever it might be, what’s going to happen to that next week? I mean, you just added another eight hours to your day of trying to recount redo, probably more than that, but yes, we run into that as well with an inch. There’s hesitation though because if you have a nurse that’s been charting on paper for 10 years and thinks, well, I don’t want to have to deal with this tricky EMR. That’s going to slow me down. I’m going to make mistakes and all this stuff. But I love that because we all know that if you can get a process, that’s up to date, especially if it’s electronic, it really reduces the risk significantly.

John Long: I’ve seen a lot of those practices. I have one in particular that just came on recently had 600 patients that are doing a month. Also, like you said, in a binder or spiral notebook, and you have, 10 Joneses, they order the drug for Miss Jones and low and behold, they ordered the wrong drug for the wrong Jones, administer the wrong drug because of course there’s no process in place. What happens in those scenarios where you actually administered the wrong direction to the patient, these insurance companies are not going to come back and reimburse that for the wrong patient? You’ve lost a drug for that wrong patient. Plus you may not get paid on that patient that actually needs to have the appropriate drug.

Dylan McCabe: That’s just a perfect segue for those of you listening. If you feel like you have your process down pretty good, you’ve got an office manager that’s developed some systems, but maybe that office managers using an Excel spreadsheet of the calendar, sticky notes, all the things we hear frequently check out, WeInfuse go to WeInfuse.com. You download our, blogs not download, but look at our blogs. We have resources available on our website, request a demo. If you want to see our software, that’s what WeInfuse software is really designed to take practice. It’s already got a pretty good hold on their infusion practice, but they know that there are some possible gaps. There are some, a few mistakes that are being made each year. We want to put that all in one place and streamline that process and that joy John said the documentation. We have an infusion nurse note that captures, all the drugs that are used, the billing time, all that. Definitely go to WeInfuse.com and request a demo today, if you have not done so before. That leads to another point with, with Altus knowing what experiencing what you’ve experienced with these different provider offices. Tell us about, we’ve talked about challenges, tell us about something you’re most excited about right now with Altus.

John Long: Looking at what the market’s doing. There are so many drugs again that are continuing to come to the market. Now you have biosimilars that are actually coming into the US that’s going to be a very challenging market. It’s a very exciting time for physicians. But again, you have to know how to manage those biosimilars within your practice. There are some doctors who want to develop a biosimilar strategy, which is something that we can do. Something actually I personally do with physicians. One-on-one so I’m pretty excited about that opportunity. Then I have other physicians who don’t want to have to manage that biosimilar strategy at all, because of course, when you look at reimbursement for biosimilars, some of them came to market recently just in the past a year and a half started off really, really strong, but I’ve already bought them out. So the reimbursement actually will be underwater probably by the next quarter. Looking at those, you know again, you don’t want to move patients from one drug to the next, because it’s not in the best interest of the patient at the same time. You as a physician who got into the infusion market, want to know how to manage that realistically. We have strategies for both doctors who want to do biosimilars and then those who do not, and we’ll develop a plan for them as well.

Dylan McCabe: That’s great.

John Long: Rebates are a big aspect of what’s going on now. When you look at when these biosimilars came to market, there were no rebates because they were just coming to market. Now everyone’s fighting for that opportunity for you to use their drug over another. All manufacturers now are offering these rebates. So again, maximizing efficiencies within your practice, work smarter, not harder. That’s what we share with our physicians all the time. There are opportunities for you to make these different choices that meet your patient’s needs that can fiscally be appropriate for you and an opportunity for your practice.

Dylan McCabe: It’s a constantly evolving landscape is what I hear you saying. You guys are staying on top of it. Just so there’s no confusion because sometimes people ask, WeInfuse people that haven’t taken the time to review our website and find out what we are. We are not a management company. We absolutely do not provide staff billing services. We don’t take the risk. We don’t buy the drugs for you. We don’t put a business model in place for you. So for those of you that, if there’s any confusion, WeInfuse is a software platform. It’s we believe the latest and greatest tool for those of you to help you manage the process manager, Altus infusion clearly provides something that’s completely different, which is completely managing that for you from a business perspective, providing staff, even supplies, chairs, am I right?

John Long: Everything basically.

Dylan McCabe: For those of you that are confused about, well, should I look in a way of the fuse, or should I look into Altus? The question is what’s your situation and what is your need? And obviously Altus offers a lot for those of you that are there, where Altus is the right fit. So this has all been great. There are so many questions I could ask this podcast could go on and on and on, but I won’t do that for the sake of our listeners and all of us here, but what’s one last piece of advice. I mean, if there’s one thing, if you had just 60 seconds with our audience, what’s one parting piece of advice you would give to them today.

John Long: Again, just develop your plan. Your plan is going to be completely appropriate, make sure you have the right people in the right positions to make sure that you’re fiscally appropriate.

Dylan McCabe: That’s so good. What’s the best way for people to get in touch with you if they’re listening and say, well, I want to talk to John?

John Long: My email address is jLong@autishealthsystem.com. I can also give my direct contact. My cell phone number is (210) 324-2300 (210) 324-2300. It’s my direct line and I’m pretty much working seven days a week.

Dylan McCabe: What’s the website address for Altus.

John Long: It’s Altusinfusion.com.

Dylan McCabe: Altusinfusion.com. Awesome. Well, thank you so much for joining us today.

John Long: Thanks for having me.

Dylan McCabe: Reece; Thanks for being a co-host again.

Reece Norris: Absolutely.

Dylan McCabe: For those of you listening, clearly, you heard a ton of value add from John at Altus. Again, for those of you that maybe you want to start an infusion practice and you think, listen I don’t want the risk. I need help with the staff. I need help with billing. I need help with supplies, call John at Altus today, and learn more. At least just do an exploratory phone call and you will get a ton of value just from that initial call. So, and again, that website one more time is?

John Long: Altusinfusion.com.

Dylan McCabe: Awesome. Thank you for joining us today. Another podcast of WeInfuses where we aim to take the confusion out of infusion. Hopefully, those of you listening are a little less confused today. If you want to contact us, definitely visit, WeInfuse.com. Other than that, we will catch you in the next episode.

Guest Speaker: John Long, RN is the Vice President at Altus Biologics, formerly Altus Infusion.