An allergy practice may refer an IVIG patient to a hospital when the practice cannot cover the costs of providing the infusion under its reimbursement. Historical reports also describe patients moving between sites as payment rules and out-of-pocket costs changed, while access to some IVIG products can vary by site.
The practice may be losing money on office infusions
A physician office survey presented at a U.S. Department of Health and Human Services meeting found that many physicians referred IVIG patients to hospitals to avoid financial losses. The meeting summary said some patients had to travel long distances to reach hospital treatment. That account describes a financial reason for referral, not a judgment about whether a hospital is clinically better for every patient.
At the same meeting, a speaker said reimbursement did not cover some of the costs involved in administering IVIG, including billing and inventory. The speaker compared a hospital outpatient visit costing $17,000 with a comparable doctor's office visit costing $4,000. Those figures were reported in the meeting summary and should be understood in that context, not as a current price quote for a particular practice or patient. For a small practice, the relevant issue is whether payment covers the full cost of acquiring and administering the drug.
Payment changes have shifted patients between settings
A federal report found that after physician reimbursement rules changed in 2005, 42 percent of Medicare patients receiving IVIG in physician offices in late 2004 had moved to other locations by early 2006. The report also cited an Immune Deficiency Foundation survey in which 32 percent of hospitals said they had turned away IVIG patients at some point in 2006. Together, these figures show that a hospital referral did not guarantee that a hospital could accept the patient.
A separate HHS meeting summary described patients moving from doctors' offices to hospital outpatient clinics after office reimbursement fell, then to home care under Part D as payment changed. It said many later returned to hospitals because of Part D copays. This is a historical account of how reimbursement and patient cost sharing affected site of care. It does not establish that the same payment pattern applies to a patient's coverage today.
Payer rules and product access can affect the referral
The Academy of Managed Care Pharmacy reported that its managed care panel considered the hospital outpatient department the most expensive IVIG setting for commercial payers. The panel attributed that cost to payment commonly based on a percentage of billed charges plus a facility fee. This payer perspective helps explain why site-of-care policies may influence where an infusion is covered, even when an office or another site can provide it.
Product availability can also differ. The chief executive of FFF Enterprises said that some products from medium and smaller manufacturers are not available at every site of care. A practice may need to account for whether the prescribed product can be obtained at the location under consideration.
Make the reason clear in the referral
For practice owners, a useful step is to document the specific operational reason for each referral, such as reimbursement shortfalls, uncovered administration or inventory costs, a payer's site policy, or product availability. That gives the receiving center and the patient a clear explanation of why the office is referring the infusion. It also helps the practice distinguish a financial or access constraint from a clinical decision about where a particular patient should receive treatment.
Patients considering a change in infusion setting should discuss the plan with their own doctor.
This page is general education only. It is not medical advice. Talk with your own doctor about your health.
Frequently asked questions
Are hospital outpatient departments the only place patients receive IVIG?
No. In a survey reported in Allergy, Asthma, and Clinical Immunology, 47% of surveyed IVIG patients received infusions at home, 37% at an infusion center, and 11% in a hospital. Those percentages describe the surveyed patients, not every IVIG population.
Can infection risk be part of a site-of-care discussion?
A study of patients with primary immunodeficiency reported lower pneumonia and bronchitis rates among those receiving home IVIG than among those treated in hospital outpatient infusion settings. Its authors suggested infection risk may matter when selecting a site of care.
Does a hospital referral mean a practice has judged hospital care to be clinically necessary?
Not by itself. The physician office survey summarized by HHS described referrals made to avoid financial losses, so a referral can reflect practice economics. The clinical reason for an individual patient's setting should be discussed with that patient's doctor.
Sources
- SUMMARY REPORT OF THE PUBLIC MEETING ON PATIENT AND PHYSICIAN CONCERNS WITH ACCESS TO INTRAVENOUS IMMUNOGLOBULIN (IVIG) (U.S. Department of Health and Human Services, Office of the Assistant Secretary )
- EXECUTIVE SUMMARY FINAL (U.S. Department of Health and Human Services, Office of the Assistant Secretary )
- MARKET INSIGHTS Immunoglobulin: Findings from the AMCP Market Insights Program (Academy of Managed Care Pharmacy)
- The Increased Demand for Immune Globulin Products and Its Effects on Patient Access (IG Living Advocate Podcast (IG Living magazine))
- Immunoglobulin replacement therapy in patients with primary and secondary immunodeficiencies: impact of infusion method on immunoglobulin-specific perceptions of quality of life... (Allergy, Asthma, and Clinical Immunology)
- Impact of Site of Care on Infection Rates Among Patients with Primary Immunodeficiency Diseases Receiving Intravenous Immunoglobulin Therapy (Journal of Clinical Immunology)
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