Joseph Williams, Practice Manager at Birmingham ID & Infusion, shares his experience as an infusion nurse and practice administrator. With 15 years of industry knowledge he brings a wealth of insight to the discussion. To learn more about Birmingham ID & Infusion, visit bhminfusion.com.
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Transcript: How an AL practice went from 0 to 500 infusions per month in just 18 months
Dylan McCabe: WeInfuse podcast episode number 17. Welcome to the WeInfuse podcast, where we take the confusion out of infusion. And each week we give you a behind the scenes, look at the infusion industry from the business side and the clinical side. And I think you’re really going to like this particular episode because I interviewed Joe Williams from Birmingham ID and infusion. He’s the practice administrator there. He’s got about 15 years of experience in healthcare. Actually, on the episode, I think I say he has 20 but it’s closer to 15, but he has a unique take on it as a practice administrator who is personally involved in the growth of a practice from zero infusions a month to about 500 infusions a month, all in the span of about 18 months. Very interesting story, definitely some growing pains there, but a lot of really neat tips and tactics that you can hear from Joe today, so let’s jump right into it. Joe thanks for being on the show, man.
Joe Williams: Thanks for having me.
Dylan McCabe: Now, I do want to kind of take a quick step back to just brag on Joe a little bit. He’s got over 20 years’ experience in healthcare and he is the practice administrator, Birmingham ID like I mentioned, and they have a large and growing infusion practice, a multispecialty infusion practice. And he really has just brings a lot of experience to the table when it comes to the in-office infusion practice, especially from the standpoint of a practice administrator. So, Joe, I’d love to just let you have the chance to kind of fill in the gaps of your story. You know, what you’ve done up until this point and what it’s like being a practice administrator in your role today?
Joe Williams: Well I guess the short version would be I started out in the air force and really did nothing in either field related to what I’m doing now, but I feel like, you know, some of the groundwork that the air force or in the military set really helps with any line of work you end up in. But after that worked for a mergers and acquisitions company for quite a few years until 2008 happened and that along with many other people out there, I guess was a turning point to decide, what else could I do that I don’t have to worry about the economy affecting my job. And so I decided to go into healthcare and went back to school for nursing, with the intention of becoming a CRN or nurse anesthetist at the end of a five-year plan. After becoming a nurse, I really focused on cardiac ICU and pediatric ICU for years, that was my specialty. And decided to kind of go in more of a management direction as opposed back to school again for anesthesia. And ended up getting hired at this, my current practice, Birmingham ID, and Infusion as the clinical manager slash additional infusion nurse. And my job then was to oversee the infusion center. They needed somebody that was going to kind of streamline things, work out the kinks. They had only had the infusion center up and running for about a year at the time and no one really had any experience with running an infusion center. They were just doing antibiotics. And so, immediately had to deal with the distributors and the manufacturers kind of getting up to speed on how the contracts and the pricing and everything work along with the billing and collecting, and so, just front to back all aspects of the infusion business. And after about eight months I was offered the practice administrative role. And so I left the, I guess, frontline part of the infusion center and took over more of the oversight of the entire practice, but still heavily focused on the infusion center. And that’s kind of where we are today. We’ve since added probably 20 or so specialty infusions to our formulary, which was at the time just antibiotics and really just saw the need in the area probably mid-2017, the lack of infusion centers out there. Hospitals being really the only place that any patients had to go around here that needed rheumatology or GI or neurology type drugs. And so based on our physicians’ relationships with other physicians in the hospitals and just talking to other practice administrators in the area to find out what are you guys looking for? We really tried to focus on speaking to some of the outside referring nurses and see what difficulties they have trying to find somewhere to send their patients and tried to set up our process, to streamline the referral coming in and make it as easy as possible on those referring nurses. And we had probably 19 or 20 patients referred here within the first few months. And we’re probably over 450 now over the last year and a half.
Dylan McCabe: Wow. And so just so I’m clear the timeline there, how, what’s the timeline there? When did you guys start seeing patients for infusion up until today?
Joe Williams: So let’s, our infusion center originally opened February of 2016 with antibiotics. September of 2017 I took over as practice administrator and immediately worked with a large GI practice here in town that I knew was in desperate need of somewhere to send their patients. And so we started out with just your basic Remicade Entyvio GI Crohn’s type medications. And through that practice, along with one other practice that I knew needed those same medications ended up with about 19 referrals between September of 17 and January of 2018. And then by December, you know, through meeting with multiple other specialties and finding out what else was needed out there and adding those drugs to our formulary along with the fact that two of the hospital infusion centers in the area had shut down. So we took a big load of patients from both of those locations by the end of 2018, we had over 400. So I’d say within about 18 months, we went from zero to 60, you know?
Dylan McCabe: Yeah, that’s what I was listening to. I mean, with a rough timeline there, it sounds like in about a year and a half; you guys went from a handful of infusion patients to close to 500 a month. That is a massive increase in volumes. So that is such a neat story. And I had no idea you were in the air force, so thank you for your service.
Joe Williams: Yes sir.
Dylan McCabe: And I think we both sound a little hoarse for those of you listening, you can tell that we’re, you know, I don’t know what it’s like for you guys in Birmingham right now, but in Dallas, Texas, our people with allergies are just, you know, under the weather right now with everything coming back to life after the winter. But, for those of you listening, to be patient with us as we swallow and try not to cough into the mics.
Joe Williams: It’s like a yellow cloud in Alabama right now.
Dylan McCabe: Well, Joe, with what you’ve learned, what you’ve been through the different skills that you’ve acquired, being a nurse, and so forth. What would you say is your main area of expertise today?
Joe Williams: I think having a nursing background has helped me, I would say focus on the nursing and patient care side of things more so than some of the experiences I had as a nurse in the hospital where your supervision maybe never took care of a patient, held a hand at the bedside. And so, a lot of the things that they would do or implement it was just too much disconnect from what actually needed to be done. And so I think that’s one of the areas that we have been able to excel in is that I am able to see things from the nurse’s side of it; whether it’s our nurses in the office taking care of the patients or the nurses from the outside provider’s office, referring those patients here. I know what it’s like to try to find somewhere to send a referral and the headaches and the red tape sometimes that are required to make that happen. And the time the man-hours that are spent at the end of the day, scheduling this, or getting benefits checked, or getting a prior authorization done before you send that referral. Just all these little items that, a lot of times a CFO or CEO that has never actually taken care of a patient may not understand.
Dylan McCabe: That’s interesting. And I know with your position, I know from talking to you, you know, we’ve been talking for several months now, and we’ve talked a lot about numbers, and you’ve kind of given me a behind the scenes, look at the practice to help understand how WeInfuse can add value. So I know you are in the numbers a lot. And to hear you say that you can, as somebody with experience as a nurse, you can kind of look at things a little differently. What’s one big thing, one big takeaway you would want our listeners to have from your expertise today because I can tell you right now there are many people listening to the podcast that are thinking about either acquiring an infusion center or starting one, or partnering with a provider that has an infusion practice. I mean, I just got off the phone before this podcast with a couple of guys that are pharmacists that are looking to partner with a neurologist who already has infusion suite, but is not seeing patients for infusion. So if they were listening, what’s one big thing you would want them to take away from your area of expertise today?
Joe Williams: I think you said it, I mean, it is a numbers game. So you can’t, there’s so many moving parts to an infusion center to the infusion industry your drug prices and your drug reimbursements, they’re changing quarterly, the new drugs coming out every month. But also the operational side of things and your processes and everything. I mean, there’s, we’re tweaking something constantly trying to make it better for everyone involved. And whether you’re going from no patients to 400 patients over 12 months, or you’re just trying to maintain a current census, I think, you have to stay on top of all of it all of the time and be flexible. I don’t think this is an industry that you can get set in your ways. There’s just too much changing all the time.
Dylan McCabe: That’s really good. And I know that you know, guys have a very successful practice because we’ve talked enough about it. So I know that to hear you say, there’s a lot of moving parts. There’s that’s a weighty statement because there are, but you guys obviously have your processes down and you’re using the software to help with the process. And you guys have, I mean, I know just from dealing with you, I know how long it took, how many questions you asked. I mean, I do demos every day with practices all over the US and I can honestly say, Joe, I think you asked me more questions about the software, about what it can do and can’t do, what it would look like to implement it, what it would look like for the nurses, for the billers for everybody. I really think you probably asked me more questions than anybody. And I say that as a huge compliment because it just shows that you took the time to look into the future and see what would it look like if we were actually on WeInfuse software. How would it change our processes? How would it change our timelines? How would it change how many tools that we use to manage the process? How would it change the roles of the people that are doing the things that they’re doing? And you really took the time to analyze it as much as you could. So that by the time you guys made a decision to bring this new process in place you had gotten buy-in from your team. You thought through the potential hurdles, potential pitfalls, you’d really done your due diligence to make sure it was a winning situation. So I know, just to hear you say that there’s a lot of moving parts and you have to really think through it, you know, I know what that really means coming from you. Now let’s switch gears a little bit and look at some of the different aspects of the infusion practice. Now from a business model standpoint, we know there are wonderful things about it, and there are also big challenges. So let’s talk about one of the challenges with what you’ve been through and witnessing the intense growth of a practice. What would you say has been one of your biggest challenges in the infusion practice? And if you have a specific story, you can tell us without getting too specific or whatever. That’s great, if not that’s fine too, but just kind of pull back the curtains and let us have a kind of a behind the scene look. What it looks like as far as one of the challenges goes for a practice administrator.
Joe Williams: I think like a lot of your current customers or clients have experienced for the longest time everybody’s using Excel spreadsheets to keep up with inventory. You’ve got a different payer portal for every drug out there to check benefits. You’ve got prior authorizations that may expire every six months or every 12 months that you’re trying to keep track of. And when you get to a specific volume of patients, and I think we really started feeling it around that one fifty-two hundred marks. I mean, these patients are coming every four weeks, every six weeks, some every eight weeks, some every six months trying to keep track of all of that and keep track of your inventory and keep track of your prior authorizations. So that patient doesn’t come in six months from now and their PA expired yesterday and keeps your scheduling. I guess, moving to where you’re not having people waiting in the waiting area. It’s just you need more than a spreadsheet to do that. And you need I definitely sound like I’m marketing for WeInfuse right now, but I asked all these questions for a reason. We have gone through two different EHR implementations prior to WeInfuse and just really had a bad taste in my mouth after both of those because I didn’t ask enough questions. Because I didn’t, you know, there’s certain things that you don’t even think to ask until you’re in the middle of using the software now. And you’re like wow; I didn’t realize this was even going to be an issue. But you need a way to coordinate all of that and minimize as many extra steps as possible to be efficient and not make the mistakes that can cost you thousands and thousands of dollars.
Dylan McCabe: That’s so good. You know, we talk with a lot of practices and talk through their workflow. I mean, that’s always one of our first steps is doing a discovery call. I want to understand your workflow. Tell me about what happens from the moment of an initial order, who gets the order, what do they do with it? Okay. They load it into the EMR, then what happens? And then it gets sent off to somebody who’s in charge of handling all the prior [inaudible 16:43] referrals and calling the insurance company and updating information. And how are they handling that? And I was in, I was on a trip to Houston a couple of weeks ago at the time of the recording of this podcast anyway. And I talked to one particular location that was managing their own in-office infusion suite. And they were tracking the details of each patient’s status, whether they had authorization that was approved or not, approval date, expiration date, number of treatments, all those details on this one-page template that they printed out. And then they would handwrite and updated status on the template and the gal that was managing all these patients had a stack of these templates on her desk and sure enough, they lost one. So they had this patient coming in for infusion. They don’t know their authorization number. They don’t know whether the office still, you know, whether it’s expired or not. They don’t know how many treatments the patient’s been approved for. And everybody in the office is like combing the office, looking for this incredibly important information. And it’s just crazy. But like you said, and you know, more better than I do, they’re so many balls that you have in the air that you’re juggling for all these patients. And it’s really hard. And by the way, we’re fine if you want to market for, WeInfuse on this podcast.
Joe Williams: Yeah, I’m sure.
Dylan McCabe: So let’s mine some gold from that. I mean, what would you want our listeners to take away from that experience?
Joe Williams: I think the biggest, and I am going to use way infuse here as an example, and I promise I am not receiving any payment for this. The biggest change that I’ve noticed in our process and I have talked to lots of other practices across the country, some of the local practices, well, let me say this way, the successful infusion centers that I’ve talked to have the nurses taking care of the patients, and they have some other position that is in charge of managing the flow. If you want to use the, WeInfuse a portion of this. So the patient intake, we call them infusion coordinators. I have two of them now. We had to add a second one because it just got a little overwhelming for just one. But there are certain practices I’ve talked to and a couple in town here that have closed down. And we took a lot of those patients for them. And when I just called to talk to them, how are you guys doing things to see if I could tell what was causing issues in some of these other places I found out that their nurses were not only doing the intake and checking the benefits, getting the prior authorizations. But they were also doing the infusions and then submitting the charges for those infusions and then being, they were expected to keep track of the prior authorizations a year from now when they’re about to expire. And that explained it to me because there’s no way you can expect your nurses to do all of that and take care of the patients and do a good job taking care of the patients. And so prior to WeInfuse, even though I had an infusion coordinator doing the intake and my nurses doing the patient care, they were also submitting the charges at the end of the day. Which for anyone that has any infusion experience knows the billing part of the infusion is probably the most complicated part with all the different line items and the billing units and the wastage and everything else that goes into it. Expecting your nurses at the end of eight hours and 20-25 patients to sit down and focus on details like J codes billing units and wastage and not make mistakes is, that’s an impossible task. Eventually, there’s going to be costly mistakes. And so with the WeInfuse software, we’ve been able to streamline that process and know exactly where a referral is from the time it comes in through the time it’s scheduled. Know when they’re ready to schedule the second time around and know that the prior authorization is in place prior to that next appointment. The biggest benefit that I’ve seen out of it is I’m not getting calls anymore from people outside providers’ offices saying, we send a referral over, it’s been a few weeks just trying to check and see what the status is and not really being able to look it up immediately and tell them, here’s where it’s at. This is how long it’s been, awaiting a PA, or we’re still needing documents, whatever the case may be but it’s all one screen. Prior to that, we were having to bounce from portal to portal, trying to find the referral, looking in the EHR that we use for documents. There were just too many clicks. WeInfused has been at, we’ve been able to streamline that into one screen and see exactly how long a patient’s been ready to schedule or how long they’ve been waiting on benefits to be checked. And it not only helps the staff complete their jobs and the nurses not have to deal with the billing at the end of the day, so they can just focus on the patient care, but it also helps me have better oversight over the operations. I can with one screen, one-click look, and see how well are we doing? How fast are we processing these referrals? How fast are we getting these patients in here? I don’t have anybody waiting two or three weeks sometimes to get scheduled. I mean, 48 hours and we have benefits done and prior authorization started. And usually, within a week, we’ve got that back and ready to schedule. So turnaround time has been huge on the referrals. Time the nurses are spending in the back after the infusion center has done for the day has shortened by probably two or three hours on average. And then obviously the inventory management side of that, but that’s a whole other conversation.
Dylan McCabe: That’s so good. Well, I mean, you brought out two big things that I want to highlight there. And one is, you mentioned what the nurse goes through. And when I go to meet with a practice, I say, listen, we’ve got three primary goals and I’ll learn a lot of this from Carrie, from K2 health. So I got to give credit where credit’s due, but, you know when you have a strategic lean efficient approach, you’ve got three outcomes and you highlighted one of them. One of our goals here is to reduce physician and nurse burnout because it is something we hear about. And you just describe why you’ve got a nurse, somebody who’s clinically trained, passionate about taking care of people. And they also have all of these administrative duties and tasks that they really weren’t trained for. And probably didn’t, really didn’t want to do as have as part of their role. And so that’s what we believe too, is that we have nurses focus on nursing and that’s the goal. The software is a software that does a lot of things automatically like calculating dosage for the nurse. The software automatically updates the inventory as the nurse’s charting on that patient. So the nurse doesn’t have to go and update some kind of spreadsheet. The software does all kinds of things to make the nurses’ job a lot faster to where they can have more of a clinical role than an administrative role. And I really liked that you highlighted that. And then the other thing that you talked about was the process. And that’s one of the things we’re pretty passionate about too, is we want to make sure that we’re reducing burnout. We also want to make sure we’re reducing financial risk because you hit the nail on the head. If you have somebody that’s been taking care of patients all day, and then you expect them to go and, you know, create like a billing note or something like that with the proper J codes and modifiers and wastage and all this other stuff over the course of a year, it is absolutely impossible that somebody can do that perfectly. So I just love to hear you say that because that’s what we’re passionate about. And obviously, like you said, it makes your life better. You’re getting less calls, stress level overall is down and people’s stress levels are down. That means they can focus on patients even more and the patient gets a better experience too. So that’s just great to hear you comment on all of that. So with everything you’ve been through so far, you’ve been through some pretty intense growth at the practice there. You’ve gone through transitions to different EMR platforms and how to deal with all of that. You’ve gone through the onboarding of, WeInfuse, you guys have experienced a lot of change over the last two years, and I know it’s changed for the better, but it’s still change. But now that you’re here, tell us about what you’re most excited about right now today.
Joe Williams: I think the most exciting part of this entire industry is just how fast it’s growing and the opportunities that are out there. I struggle focusing on one item at a time no matter what I’m doing. And so this is probably the first role or job that I’ve ever had, where that is a good thing because there are so many opportunities out there in so many areas that you can go with what we’re doing. The need and the areas is huge and so expanding that coverage is probably one of our main goals, offering locations for patients in the rural areas that are driving two hours to get here every four, every six weeks, knowing that there’s needs in other areas of the state and being able to cover that, you know, that’s probably our big goal right now that we’re working on.
Dylan McCabe: That’s great. Yep. There are a lot of opportunities out there to grow as far as the business goes to grow your business model, but also to help people and to get patients access to these life-changing therapies. That’s a great thing. Well, I know we could continue. We could talk about this stuff for hours, but to keep things concise and we’ll keep these, more questions maybe for a future episode, but what would one last parting piece of advice be for our listeners today?
Joe Williams: I think the biggest thing that I’ve learned in this industry is relationships are huge; having someone to talk to ask questions. There are not a lot of people in my area at least willing to share their knowledge or information about the infusion business, the infusion model, and the ones that are willing to talk may not necessarily know what they’re talking about. So between your distributors, your drug reps, people that WeInfuse the national infusion center association, and then there’s just so many different people that I’ve been able to meet over the last couple of years that have just have made a huge difference in what we’re doing. And the value of those relationships is worth more than any extra discount or rebate or whatever somebody else might offer you that you don’t have that relationship with. So I think using those relationships maintaining those relationships has been huge. And the other thing would just be awareness. There’s a guy you introduced me to actually Dylan, Charlie shadow walled at Wasatch that I had a long conversation with to just sit and chit chat about infusion a few weeks back. And he said it best by saying that awareness is his biggest competitor. And I think that is very true for anyone that’s in the infusion industry right now, office-based or ambulatory infusion centers. It’s still an unknown option for a lot of patients and a lot of physicians out there, home infusion have been the route or hospital infusion centers have been the only option for so long. Letting people know and get the word out about what we do and the benefit of the ambulatory or office-based infusion center is another big part of what we’re doing right now.
Dylan McCabe: That’s some good advice. Yeah. It’s not really the kind of industry where you can just call somebody up and say, Hey, I know you’re running an infusion center. I’d love to take you to lunch and learn about your business. You know, if you want to learn about real estate, there are a lot of realtors you could call, but it’s not the case in the infusion center. So it’s good that you highlighted that. I mean, it really is about relationships. We all stand on the shoulders of others and like you said, awareness, it’s so good. And I’m glad that you mentioned the resources there, the national infusion center association, for those of you listening, if you’ve never gone to their website, you can check out infusion center.org, that’s infusioncenter.org for lots of free resources to just educate and equip people that are connected to the infusion space. And then also, like you mentioned, Joe, just trying to find other practice administrators and you know, I was delighted to connect you guys. And when I asked if they, if Charlie be willing to talk, I was just delighted to see his response is a short email. He said, absolutely, I love to talk to Joe. And there’s just not a lot of that in this industry. And we need to see more of that. So I’m glad you mentioned those things. Well, Joe, thank you so much for being on the show. We’re thankful that you gave us a behind the scenes look at some of the things, the challenges you faced. Also some of the things you’re excited about and thank you for helping us to put together another podcast.
Joe Williams: I appreciate it anytime.
Dylan McCabe: Great. And for those of you listening, if you haven’t done so already like Joe mentioned, whether you have an in-office infusion center, an ambulatory infusion center, be sure to check out our website, weinfuse.com. And if you’re interested in how our software can help you manage your workflow and add a significant amount of efficiency and bring some pretty powerful safety checks and balances, feel free to just request a demo through our website. And one of our account executives will follow up with you ASAP and we can go from there. But for all of you listening, thank you for tuning in and we will catch you on the next episode.
Guest Speaker:
Joseph Williams, RN, Chief Financial Officer at Birmingham Infusion, and Managing Member at Infusion Concepts, has over 10 years of clinical experience. He worked as an Electronic Warfare Technician from 2001 to 2005, then went on to receive his Associate’s and Bachelor’s degrees as a Registered Nurse.
