Marissa Shackleton, Executive Director of The Elliot Lewis Center, shares her experience navigating changes in the management of an infusion center. The Elliot Lewis Center is one of the largest multiple sclerosis centers in the New England. To learn more, visit www.elliotlewisms.com.
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Transcript: Interview with Marissa Shackleton, Executive Director of the Elliot Lewis Center
Dylan McCabe: 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 landscape, whether it’s an ambulatory infusion center or provider office or healthcare organization that has infusion suites. Our goal is to provide you tips and tactics so that you can grow a successful business and give patients the best care possible. And this week, we have a really interesting podcast because we interviewed Marissa Shackleton and she’s the executive director of the Elliot Lewis Center. They have one of the largest, multiple sclerosis centers in the New England area. And she’s at, she has helped navigate multiple changes in that organization, even going from using a management company to manage their infusion center, to them leaving that management company and managing it all on their own. You will hear that and much more in this episode. So let’s jump right into it. All right, as I stated, I have with me a very special guest Marissa Shackleton from the Elliott Lewis Center. She’s the executive director of the center and has been with the Elliot Lewis Center for seven years?
Marissa Shackleton: Yeah, approaching eight years.
Dylan McCabe: Okay, great. Well, thank you for being with us on the WeInfuse podcast.
Marissa Shackleton: Thank you for having me.
Dylan McCabe: Okay. And for those of you listening in you know, I’m always excited to have different guests and with Marissa specifically, she’s experienced different phases of an infusion practice and in a hospital setting and you know, the setting that they have now. And so she’s going to kind of share that journey with us as well. So, Marissa, for those listening, just kind of take a minute and share your background with the Elliot Lewis center. And for those of us that don’t know what the Elliot Lewis Center is, it’s kind of a big deal. So just share a little bit about that.
Marissa Shackleton: Sure, so I’ve been with the Elliot Lewis Center since 2011. We are a comprehensive care center for patients with multiple sclerosis. I’m located in Wellesley Mazda, just outside of Boston. We have two MS Specialists who are very focused on patient care. They spend a lot of time with their patients. We have a research team, an onsite infusion center, and some dedicated nursing and administrative staff.
Dylan McCabe: That’s great. And so you guys, I know you mentioned before we started this about going through different phases and kind of what it takes to start an infusion practice and stuff like that. So kind of share that journey with our listeners, because we get, I mean, we interact with people a lot that are already in different phases, but it’s kind of rare to talk to somebody that’s been through multiple phases into just the different business model, the different clinical setting. So share that journey with us.
Marissa Shackleton: So our practice has always been private, but was previously located in a hospital setting. So our first experience with infusions was in this hospital setting. Patients, our ms. patients were infused on an oncology suite and it was like that for many years and the hospital made some changes. And we’re no longer going to infuse ms. patients in the oncology suite. So we had to make a decision on how we were going to continue treating our infusion patients. And we decided to work with an infusion management company, and we worked with them for about four years. We learned a lot from working with them. And then about two years ago, we parted ways with the management company and have been on our own managing the infusion center. So I’ve seen it in three different phases and it was challenging to get our infusion center up and running under our roof but definitely rewarding.
Dylan McCabe: And so for people listening, when you say you had a private practice that was part of the hospital, and then the hospital decided to not see patients for infusion, was that something that was pushed by the payers or was that just a hospital policy? How did that come about?
Marissa Shackleton: It came about with an oncology Dana Farber came in and bought out the oncology department and it was exclusively oncology. So, the ms. patients needed to be treated elsewhere. And at the time only Tysabri was on the market for an infusible ms medication. So we had quite a number of ms. patients that we needed to switch over to our own infusion suite in a short amount of time because those patients are coming in once a month.
Dylan McCabe: Got you. And so now what all do you guys infuse? And you see specifically neurology patients, right?
Marissa Shackleton: Specifically neurology patients and nearly exclusively multiple sclerosis patients. And so WeInfuse all the approved products for multiple sclerosis, Tysabri, Ocrevus, Lemtrada. We do have some patients where WeInfuse Rituxan or IVAG some [inaudible] infusions. But the bulk of our infusions are the three main ms. Infusion medications.
Dylan McCabe: Okay, got it. And so when you guys had to move and figure out what to do with all of your patients and have the right setup and all of that, did you go into like a stand-alone infusion suite that was only for infusion, or did you have a regular practice with an infusion suite built-in?
Marissa Shackleton: So initially we converted an office to an infusion suite. We had three chairs when we first started and that was maybe four or five years ago. Now our office has relocated and our infusion model has changed to being a private infusion center. And we have a seven chair infusion suite with full time and a half time, and a couple [inaudible]. We have a full-time infusion coordinator and in-house billing. I think all of those components building those up from the beginning have helped us be really successful.
Dylan McCabe: Sure. And that’s a lot, I mean, that’s a lot of moving parts. I mean, you guys must be pretty busy. So with that said, and you’re going on almost eight years now. What would you say has been one of the biggest challenges you guys faced managing this on your own? Having the staff that you have in place and the processes and the patients and everything happening, all the moving parts, what would you say has been one of the biggest challenges you guys have dealt with?
Marissa Shackleton: Opening an infusion center is perceived as a risk and it is a risk, but it can be a calculated risk. One of our challenges was getting all of our ducks in a row before terminating our management contract, making sure that we had an infusion coordinator who could process the authorizations. And understood how to manage appeals and referrals and run a benefits investigation, check the insurance a few times before the patient’s sitting in the chair and which WeInfuse helps us with as well, making sure that we’re not infusing any patients with terminated insurance. We hired in house billing. It was something we’d always sent out before and having someone in the office who communicates regularly with our infusion coordinator. So, the two of them worked closely on making sure that everything is set on the front end. You have your authorization and your referral before you ship it out to bill, or you might have a problem. So I say a lot that no one cares about your patients like you do. So our team of 15 is really passionate about our patients and caring for them and making things happen quickly. So we’ve seen a great decrease in the amount of time between prescription and patient in the chair doing, with this model.
Dylan McCabe: That’s great. And for some of the people listening, I mean, we have a pretty broad audience from investors to physicians to practice administrators that listen to this podcast. So for, I’m just thinking specifically for practice administrators who have made that decision to outsource the billing, but now we’re thinking about bringing it in house. How would you say, I mean, what are some good ways to navigate that process? Because for most people that I talk to that’s one of the scariest things, is going from outsourcing to billing to bring it in house.
Marissa Shackleton: I agree. it’s scary. But things happen so much quicker in-house. When you’re dealing with an outsourced billing company, you’re one of many clients, you may have multiple people working on your account and they don’t have the turnaround time that someone in your own office would. So denial may sit on someone’s desk for weeks. You have to be cognizant of timely filing and timely appeals for denials. And those things can get, they can get lost and they can get written off. When you have a biller in house and something gets denied or requests for medical records, the medical records are at their fingertips. And the appeal can go out the same day. I feel like that is very unusual to happen with an outsource billing company.
Dylan McCabe: Yeah. You just have a lot more control over the process. We talked to people, especially people that are starting an infusion practice, that a lot of times it really is a good idea to outsource that billing. Especially, if you don’t have people trained in house that can do that. The last thing you want to do is get somebody in for them to learn through their own mistakes and making really costly mistakes in the practice. But I also talked to quite a few practice administrators and just people at infusion practices that are navigating that process. And it sounds like you guys definitely have some of the pros. I mean, there’s pros and cons, obviously in both scenarios, but that’s interesting to hear. So will tell me this with what you’ve been through and where you’re at today, what would you say is your main area of expertise today and your role there at the Elliot Lewis Center?
Marissa Shackleton: I think that I’ve learned a lot in the course of building this infusion practice that is solely managed by the Elliot Lewis Center. It’s something you often only do once and you learn so much along the way. So I’m trying to share some of my knowledge with others who are in similar situations. What I’ve learned is how important all of these different moving parts are in getting a patient in the chair and getting claims paid successfully. The intrusion coordinator, the biller, the infusion nurse, and the prescriber all work very closely together to make this happen. You really need to be a well-oiled machine for it to be successful.
Dylan McCabe: Okay, good. And that was going to be my next question is what, I mean, what’s one big key takeaway that you would want to share? And what would it be, just to make sure you’ve got your processes down?
Marissa Shackleton: To make sure that everything is in line on the front end before putting the patient in the chair? It’s a lot easier to do the work in advance than try to back up.
Dylan McCabe: Yeah. And we agree, obviously, I mean, with WeInfuse that’s the whole point of our software solution is just to make sure you’ve got every I dotted and every T crossed before you, even before you even schedule the patient for an infusion. So that’s good. So let me ask you this with what you guys have gone through and where you’re at today. I mean, you’ve got a well-oiled machine now, but like you said, it took a lot of work to build that and to go through those three phases, what’s maybe one of the biggest light bulb moments or aha moments that you guys have had, that really kind of changed the way you do things at the Elliot Lewis enter?
Marissa Shackleton: I’m not sure if there’s one moment that I can point out. I feel like it was a learning experience over a period of time. We learned from being in the hospital setting, we learned from being with the management company, we’ve learned a bit from our colleagues and their processes, and it’s brought us to this well-oiled machine that we have now. So I think it was a steep learning curve, but it was a constant learning process all along the way.
Dylan McCabe: But I, yeah, and I like what you said at the beginning, it’s a risk, but it’s a calculated risk. And it seems like you guys have really gone into it with that mindset to just analyze the process and make sure you’re doing things the best way that you can.
Marissa Shackleton: It’s the best for the patients. You know, like I said, we have really minimized the amount of time to get a patient in the chair. And we’re also seeing that a lot of patients who are infused at hospital centers are seeing sites of care issues. And as a private center, we can take these patients, and we’re happy to see the ms patients in our area. There aren’t many private infusion centers because it is a calculated risk. But having this option for patients I think is really important.
Dylan McCabe: And that’s so good. I mean, that’s our heartbeat as well. Anytime we talk to a new potential customer, a lot of times we schedule a discovery call and the whole point of the call is to analyze the workflow. And it’s just, analyzing the patient’s journey. What happens when that patient gets up an order for an infusion? What does the office do then? How do they manage the workflow? And we are, our heartbeat is that if you have an efficient, streamlined workflow, you can focus more on the patient. The patient gets better care because the back-office staff, the nurses, everybody is, has a better process. They’re less stressed. The nurses are more focused on the patient and on the patient experience. And we kind of took cues from the dental world because when you go get your teeth cleaned, the dental hygienist is solely focused on you. They have everything around them that they need. They’re not getting up and leaving and coming back multiple times. They really have it down. They have a process down to where you just get the best–. You should get the best service possible. And so we’re trying to do what we can with our customers that are on, WeInfuse to kind of bring about the same experience to where the office can really focus on the patient. Of course, there’s a lot, there’s so many moving parts of the process like you described, but that’s the goal. So it’s really neat to hear you share those same values. And I know one of the things you mentioned was that you’ve also recently been really passionate about patient access issues and insurance issues. And so, share, just share some of that; some of the things that are on your heart about that.
Marissa Shackleton: I think that patients and providers find health insurance and financial assistance challenging. It is a very difficult world to navigate. So I’m trying to find ways to educate patients about their health insurance and also about financial assistance options. So first on the health insurance piece, I think many patients don’t understand their primary, secondary pharmacy plan. There are different benefits and that can cause a delay in the process. We do our best to try to navigate that with them. But I think, across the country, this is an issue where patients don’t understand insurance. They don’t know what a deductible or an out of pocket might mean for them and what it means for their plan. Where their drug might be tiered and how that affects the process. And part of that is our job to figure that out with them. Something that we do is the ms medications all have copay assistance programs, which the term itself is confusing. It sounds like it helps you pay for your co-pay when you come to the office, but it actually is financial assistance towards the cost of the medication and potentially the administration as well. So it can really make any of the infusible medications affordable for everyone. I don’t think that every patient knows about that and they should. They shouldn’t have large out of pocket costs to be on these medications. They shouldn’t make decisions about which medication is best for them based on the cost. Copay assistance programs make it affordable for patients with government insurance. There are third party financial assistance programs that can be very helpful. So we provide this information to our patients when we run the benefits. And when we speak with them about what their potential out of pocket cost is.
Dylan McCabe: That’s great. I mean, you guys are really taking the extra step to make sure the patient has what they need and how–. Do you just do that case by case, depending on the payer and their particular type of insurance, you let them know, Hey, here’s what your estimate out of pocket is. And you go through all the details with them?
Marissa Shackleton: Correct.
Dylan McCabe: Or do you have like specific resources you send them to?
Marissa Shackleton: So for, in our process, we run our own benefit investigation in conjunction with the pharmaceutical company benefit investigation, and that lets us know what the patient’s responsibility would be. If the patient has an out-of-pocket cost, we talk to them and help them enroll in a copay assistance or financial assistance program, depending on what their insurance is.
Dylan McCabe: Well, I can just tell you, I mean, we talked to three or four practices a day, five days a week, and it’s very rare to hear of a practice running their own benefits investigation and using the services of a pharmaceutical company as well. So you guys have this redundant system in place, and that just shows that you guys are really taking an extra step for the patients. So that’s awesome. I mean, I don’t think I’ve ever heard that before. Have you? Just for those listening, I know you can’t see us, but we’re in a meeting room and our other account executive Princeton King is listening in. So he’s our silent cohost in the background. So that’s great. I mean, that’s really impressive. So that was the first piece and then what was the second thing that you were going to talk about?
Marissa Shackleton: I kind of navigated into that with the financial assistance and copay assistance piece. And I do agree that most centers are not doing all of this together and patients should be informed that these options are available because their provider or infusion center may not be discussing that with them and not–. In our center, our providers and infusion center are together. We’re in the same office; they are down the hall from each other. So our providers see patients in the infusion center every day. And they’re very well connected and we work together as a team, but I know a lot of centers are offsite. So having that team approach and connection is a little bit more challenging when you’re not in the same room.
Dylan McCabe: That’s a great point. And I’m thinking back to a number of episodes back on our podcast where Reece Norris was on the podcast as well and said one of the critical components to grow a great infusion practice is the team you have in place. And that’s what you just spoke to. So I think that’s great. I mean, you guys are clearly doing something special and unique. And a lot of people we have on the podcast, their heart is in it. They really care about the patients and that comes across with you as well. And, but you guys, you clearly have a heart for the patients, but it’s just from what I gather, you’ve got some pretty detailed processes in place as well to make sure that patients have access to these life-changing drugs. And I think that’s key because it’s like navigating a maze for these patients, navigating insurance. I mean, it’s confusing to me and this is the world I live in and it confuses me daily, just things that change with payers and reimbursement and access to drugs and step programs and all these other things that happen. So that’s really neat that you guys are helping the patients with that. Well, what would you say is one last piece of advice to anybody listening to this particular episode?
Marissa Shackleton: It’s tough to pick one piece of advice. I think to learn from your experiences and ask for advice from others, you know, we have learned a lot by asking for advice from others.
Dylan McCabe: That’s a great point because there’s not a lot of infusion practices talking to one another saying, Hey, how can we learn from one another so that is a great point. And of course, this podcast can help that, help with that. So, well, thank you so much for joining us for the show. And for those of you listening, if you haven’t done so before Elliot Lewis Center is a customer of WeInfuse as well. So please, sure to check out our website at weinfuse.com and request a demo of the software if you haven’t done so before. We are really passionate about partnering with infusion practices to put a powerful process in place so that you can give the best patient care possible. Now, before we finish this, I want to say, you can find Marissa Shackleton on LinkedIn as well, and you can see some of her backgrounds there. And if you want to reach out to her, you can definitely connect with her there as well.
Marissa Shackleton: Thank you.
Dylan McCabe: So, yeah, Marissa thanks for being on the show.
Marissa Shackleton: Thanks so much.
Guest Speaker:
Marissa Shackleton is Executive Director at The Elliot Lewis Center, a state-of-the-art medical center specializing in multiple sclerosis. Marissa began to focus on MS when she worked at the ELC Foundation, a nonprofit organization that supports MS patients. When she began at the Elliot Lewis Center, Marissa served as Senior Clinical Research Coordinator, using her background in Health Communication from Boston University.
