neurology infusions

[scoopdaboop]

What things in neurology can you routinely do infusions for? just headaches and ms? Also, are infusions becoming more routine in private practice, and wouldn't more infusions equal more $$? I feel like i didn't learn much about infusion therapy for neurology. Also, will it ever reach the level of say heme onc for infusions?

---

Members don't see this ad.

 

[xenotype]

What things in neurology can you routinely do infusions for? just headaches and ms? Also, are infusions becoming more routine in private practice, and wouldn't more infusions equal more $$? I feel like i didn't learn much about infusion therapy for neurology. Also, will it ever reach the level of say heme onc for infusions?

Headache infusions are often cash, which means if one is good at business a significant portion of your practice can be outside of insurance and not subject to reimbursement cuts. Theoretically an entire boutique headache practice could be done completely outside of insurance successfully and quite profitably. As for MS, a high end MS practice is already very similar to heme onc in many ways in terms of drug monitoring and infusions. Alemtuzumab is really used by both heavily for example and is a very powerful drug with a lot of complexity. As for whether infusions are profitable generally yes but reimbursement cuts can ruin you quickly, even within a single year.

As for neurology in general- other areas do infusions as well. IVIG is the lifeblood of most practices in outpatient neurology for a wide variety of indications so one is either working with home IVIG companies or doing the infusions outpatient. Rituxan some neurologists use if you can get comfortable with it again for a wide variety of indications. Overall there are opportunities to build a practice and potentially have infusion as a profitable component of that practice, but there is risk in it.

 

[NEApplicant]

Out of curiosity, why is this considered profitable for neurology? Like how is a neurologist actually making more money through infusions than they would through regular practice? Is it the administration fee? Is there a markup on the drug? Or is it just the fact that it's another "procedure"?

If Medicare Part B compensation was restructured (there was talk of this during the Trump admin, looks to be on hold right now but may resurface in the future?), would that tank any future prospects for these fields?

 

[xenotype]

Out of curiosity, why is this considered profitable for neurology? Like how is a neurologist actually making more money through infusions than they would through regular practice? Is it the administration fee? Is there a markup on the drug? Or is it just the fact that it's another "procedure"?

If Medicare Part B compensation was restructured (there was talk of this during the Trump admin, looks to be on hold right now but may resurface in the future?), would that tank any future prospects for these fields?

Same way heme onc gets paid by infusion of the drug- the delta between drug cost and drug administration reimbursement from insurance/medicare. If medicare cuts the rate 2% like they have before, you start losing money very rapidly. Infusing a drug and later not getting paid is a classic drag on finances for this type of set up. There are a lot of ways you can get hosed.

 

[deathmerchant]

Out of curiosity, why is this considered profitable for neurology? Like how is a neurologist actually making more money through infusions than they would through regular practice? Is it the administration fee? Is there a markup on the drug? Or is it just the fact that it's another "procedure"?

If Medicare Part B compensation was restructured (there was talk of this during the Trump admin, looks to be on hold right now but may resurface in the future?), would that tank any future prospects for these fields?

I don't like to tell this to other physicians but the secret is Medicare's "Buy and Bill" and "White bagging" system. Thats what many oncology and other (MS) practices do. I found this out after i investigated a practice that was making insane amounts of money and doing shady stuff.

In short, you have a contract with a drug company/pharamacy who will sell you the drug for a steep discount (because you will prescribe a lot of it) and you keep it in your in-house pharmacy. Then you administer it to patients and get full reimbursement rates from Medicare and an additional 6% for infusion.
So if a drugs average cost is $10k, the company will sell it to you for $8k and medicare will reimburse $10k plus $600 infusion charge. Plus there are some other minor charges for facility and your regular visit charge. So you are making over $3000 on that one infusion. For some drugs like Lemtrada- the insurance price is over $80k/year. So depending on your contract with the company, you are looking at 10-15k or more per patient. In addition to regular billing.

In addition, many MS centers have their own PT/OT/ST services and MRI/EEG/EMG(which they read themselves). They do some pain management and Botox/baclofen as well.

Please DONT get any ideas and do this.

 

[xenotype]

I don't like to tell this to other physicians but the secret is Medicare's "Buy and Bill" and "White bagging" system. Thats what many oncology and other (MS) practices do. I found this out after i investigated a practice that was making insane amounts of money and doing shady stuff.

In short, you have a contract with a drug company/pharamacy who will sell you the drug for a steep discount (because you will prescribe a lot of it) and you keep it in your in-house pharmacy. Then you administer it to patients and get full reimbursement rates from Medicare and an additional 6% for infusion.
So if a drugs average cost is $10k, the company will sell it to you for $8k and medicare will reimburse $10k plus $600 infusion charge. Plus there are some other minor charges for facility and your regular visit charge. So you are making over $3000 on that one infusion. For some drugs like Lemtrada- the insurance price is over $80k/year. So depending on your contract with the company, you are looking at 10-15k or more per patient. In addition to regular billing.

In addition, many MS centers have their own PT/OT/ST services and MRI/EEG/EMG(which they read themselves). They do some pain management and Botox/baclofen as well.

Please DONT get any ideas and do this.

You are correct, but setting up this kind of practice is A) not illegal if structured carefully regarding stark law and B) hospitals essentially do exactly this, get paid more for all the visit fees just because all the practices they bought are 'hospital outpatient departments' and aren't subject to the stark law when essentially the name of the game is to keep the entire revenue stream in house from the PCP to the MRI and the eventual admission through the ED (hence hospitals building FSEDs in profitable neighborhoods with high % insured). If you build a successful practice that manages to have all of these resources (quite expensive, especially MRI and PT in house) and get/retain a lot of patients you deserve to do well financially. This doesn't excuse the slimy people that give MS drugs without good indications, order useless EEG/EMG just to bill, obvious fraud etc which I am sure the practice you investigated was sketchy about some of these elements.