Republished with permission from AISHealth.com
With numerous hospitals focused on the COVID-19 pandemic and many areas under stay-at-home mandates, home infusion is more important than ever. Changes within the industry already have been seen, and the current situation is likely to result in permanent shifts within the home infusion space.
“If you can do infusion at home, you need to do it there,” maintains Ashraf Shehata, KPMG national sector leader for Healthcare & Life Sciences. “This is about controlling infection risk in the near term, and many home infusion candidates are in a high-risk category. Longer term, there has been a shift toward delivering care in the most economical and clinically appropriate setting, largely driven by payers.”
“We have seen an increase in some home infusion utilization of select therapies in certain markets where patient administration sites of care are shifting from the acute care or hospital outpatient setting to the home, related to the pandemic,” says Drew Walk, CEO of Soleo Health. “We have also seen a significant reduction in other therapies due to the postponement of non-COVID-related procedures in health systems and provider offices.”
Walk tells AIS Health that while the types of drugs being administered at home have been fairly consistent with what were administered before the pandemic, he’s seen “a broader opportunity to provide first dosing in the home, which may have been offered only in a controlled setting previously.”
“Antibiotics/antivirals, pain management, total parenteral nutrition and [intravenous immune globulin] are currently the most common treatments given through home infusion,” says Shehata, adding that other therapies may be administered at home but “that depends upon the circumstances, such as the medication and the risk to the patient.”
Lee Newcomer, M.D., principal at Lee N. Newcomer Consulting LLC, says a shift to home infusion “will be relatively small” and would be done for two main reasons: avoiding exposure to people who may be infected and bringing down the overhead cost of hospitals or clinics. “The shift is limited by the small number of medications that don’t require physician proximity for side effect management,” he says.
According to Harriet Booker, chief operating officer of Option Care Health, Inc., “Option Care Health’s business model, built around a national network of compounding pharmacies, is designed to bring care to patients right when they need it — which often means delivering complex care with compounded pharmacy medications within hours of a patient discharging from a hospital. And the pandemic really has changed nothing about that, other than our need to ensure we are prepared to meet changing demand and variability in referral volumes.”
She says that the company’s standard operating processes “include comprehensive network and business continuity plans, which ensure our ability to provide infusion pharmacy and nursing care to patients on a consistent and reliable basis nationwide, especially during this pandemic. This real-time agility employs added shifts, remote staffing rotations and expanded pharmacy hours to compound and administer vital medications.”
Option Care Health has been working with hospitals to help them “free up beds in advance of an influx of COVID-19 patients or simply when and where they need it,” Booker says, including identifying conditions that may be treated at home or in an infusion suite and coordinating ongoing care for patients who may be discharged safely.
“Our network of compounding pharmacies allows us to develop care plans personalized to each patient, providing customized medications and supplies that are sent right to their home or administered in the infusion suite,” Booker tells AIS Health. “Our efforts are not only freeing up beds for COVID-19 patients but are getting infusion patients safely and efficiently into more comfortable settings and even preventing hospital admissions from the start.”
Some Services Moved to Virtual Setting
The company also has moved some of its services to a virtual setting, including “remote triaging, patient education and teaching, nurse oversight and assistance to discharge planners and patients.” And Option Care Health has reallocated some of its 2,900 infusion nurses and pharmacy clinicians to places with the greatest need, such as New York, New Jersey and Connecticut.
In such a highly contagious environment, the company is taking numerous precautions to help reduce the potential for COVID infections in both its employees and patients. “We are closely following CDC guidelines and are updating our plans, policies and guidelines as often as needed to ensure our employees’ safety and that of our patients, especially during this time of COVID-19 where conditions are changing rapidly,” says Booker. “We have a standing call daily to assess new COVID-19 related data and discuss how to adapt our PPE [i.e., personal protective equipment] supply accordingly. Due to our national network and a long-standing relationship with suppliers, we have an ample PPE supply and are constantly monitoring it to make sure our employees have everything they need to deliver safe treatment to patients.”
Shift to Home Has Been in Place
Some plans already have been shifting administration of certain therapies to patient homes and provider offices, which are more cost-effective settings than hospitals, points out Elan Rubinstein, Pharm.D., EB Rubinstein Associates. The 10th edition of Magellan Rx Management’s Medical Pharmacy Trend Report found that among 54 payer respondents, 39% had a mandatory site-of-service program in place in 2019. Among the members shifted into such a program, 34% were shifted into the home infusion setting.
“There could be more home infusion, with drugs that pose low risk of serious adverse events during or immediately after infusion or where a patient tolerated prior infusions of these drugs with no or minimal difficulty,” says Rubinstein. “With respect to patients receiving chemotherapy, a move to home infusion would require a way to manage performance and evaluation of laboratory tests to assess the safety and appropriateness of the intended drug therapy and a decision prior to infusion to change dosage, change drugs, go ahead or hold off.”
Lisa Kennedy, Ph.D., chief economist and managing principal at Innopiphany LLC, points out that while CMS has changed some policies in support of home infusion, “not everyone is on board.” She notes that the Community Oncology Alliance “has raised safety concerns about home infusion centered on a lack of training of those in the community administering treatment at home versus trained oncology nurses.”
Conversely, the National Home Infusion Association “is strongly supportive of home infusion as a viable option for keeping patients safe,” says Kennedy. She also points out that guidelines from the American Society of Clinical Oncology (ASCO) say that providers should “consider whether home infusion of chemotherapy drugs is medically and logistically feasible for the patient, medical team and caregivers.”
In these guidelines, she says, “ASCO raises the key challenge here, which is how to take a system, process and resource designed to be administered in one setting and then move it to a home setting. It may not be feasible because of training of new staff, available resources, travel constraints, insurance and other logistics that mean that it just can’t be scaled properly. So it really depends on the situation, geography and capability of the center.”
Patients May Like Convenience
“Going forward there will be a lot of candidates for home infusion, and some customers/patients may like the convenience of getting care at home,” says Shehata. Investor respondents to the survey on which the 2020 KPMG Healthcare and Life Sciences Investment Outlook was based “saw a good opportunity in home health care, and that survey was taken before COVID-19. The burden on health systems is going to test new care models and open up more possibilities tied to home health care, including infusion.”
Alternative Care Models May Be Option
“The use of home infusion will also depend upon the nature of the medications used and the amount of time it takes to infuse the drug — anywhere from a half hour to four hours — and any specific handling requirements,” Shehata says. “There might be opportunities for alternative care models to be introduced here. The ability for nurses to teach patients how to self-administer the medicines is an important facet to this.
“However, some patients undergoing infusions of certain medications need to have vital signs tracked and need monitoring for adverse reactions,” he continues. “One option is to use telehealth with telemetry to remotely track a patient’s vital signs to ensure that patients are not suffering from adverse events while undergoing infusion. Another option is the nurse administering the drug can also leave the patient with a cell phone to call if there is any problem with a medication that requires several hours of infusion time. The response time has to be acceptable, and clinical risk has to be appropriate in these matters.”
Steven F. Robins, managing partner and principal at The New England Consulting Group, says while most infusions will still be administered in traditional sites such as hospitals and outpatient clinics, “there will be an evolution towards moving a number of chronic treatments to the home,” including dialysis, a shift that he says already was occurring before the pandemic. “In order for this shift to be significant, however, there will need to be improvements across the integration of smart technologies, including HIPAA-compliant integration of remote equipment and patient monitoring. It is important to remember that during the COVID-19 crisis, some of these requirements have been relaxed.”
Robins tells AIS Health that “we also expect to see a number of diagnostic procedures that are conducted by labs or in providers’ offices move into the home setting. This will result from a combination of emerging technologies integrated with smartphones, as well as providers starting to offer in-home options like mobile imaging stations that can be easily cleaned as they move from patient home to patient home.”
“The outpatient or infusion center-based model is great, but it is going to need multiple approaches tied to the complexity of treatment and also the consistency of treatment. The problem is that the current model is based on convenience for the health system,” asserts Shehata. “This could require some changes in the pharmaceutical supply chain to have the medications delivered at home rather than the infusion center or hospital, but a number of specialty pharmacies manage this process. Home delivery also can help patients who have transportation issues. Having care delivered at the home may also have the net effect of improving medication adherence.”
Contact Booker through Jonathan Durrbeck at JDurrbeck@pcipr.com, Kennedy at email@example.com, Newcomer at firstname.lastname@example.org, Robins via Renee E. Paul at email@example.com, Rubinstein at firstname.lastname@example.org, Shehata through Bill Borden at email@example.com and Walk through Susan Turkell at firstname.lastname@example.org.
by Angela Maas
How are you updating Option Care Health’s Highly Infectious Disease (HID) policy in light of the COVID-19 outbreak?
Option Care Health has always had a robust emergency management plan and HID policy in place. This policy outlines our response to all highly infectious diseases based on information provided by the Centers for Disease Control (CDC). Furthermore, we maintain a task force consisting of multiple clinical and operational leaders, which meets with our infectious disease consultant frequently to review and update our response plans related to the COVID-19 pandemic.
As we learn more about this unprecedented pandemic, our HID policy is being referenced, monitored and updated as needed. Components of the policy include:
- Identifies the responsibility for monitoring the CDC website as well as applicable state and federal resources related to the HID
- Describes the collaboration between departments required for an effective response and the necessity for counsel with an infectious disease medical consultant to ensure appropriate actions that protect staff, families, and patients.
- Promptly secures adequate personal protective equipment (PPE) and medical supplies
- Implements screening tools for risk stratification
- Includes up-to-date information regarding vaccines and any other preemptive treatment
- Outlines responsibility for fulfillment of required tasks
- Summarizes tracking for both patient and employee infections and identifies those responsible for reporting
- Defines patient management principles
- Explains management of human resources, including the allowance for flexible attendance and telecommuting
- Specifies required training both upon hire and annually at a minimum
- Addresses patient prioritization, handling new referrals, and implementation of an emergency plan
- Identifies respiratory hygiene, handwashing, standard, and droplet precautions
- Describes PPE use, order of donning and doffing as well as patient education regarding PPE and overall infection control
- Communicates about the central repository for questions and concerns during a HID outbreak (including pandemic) that is monitored by senior members of the clinical services department
Are you experiencing any service issues/shortage of nurses?
At this time, we are not experiencing any major service issues or shortage of nurses. We are constantly monitoring CDC and WHO information and will provide what is needed to promote the health and safety of our team members, while delivering needed care to the community based on CDC guidelines.
What are you doing to keep your nurses safe?
The health and safety of all employees is our top priority. Our infectious disease prevention plan calls for PPE and education of our team members and patients on the following:
- Preventive actions that have been suggested to help prevent the spread of the virus:
- Wash your hands often with soap and water for at least 20 seconds (If soap and water are not available, use an alcohol-based hand sanitizer)
- Avoid touching your eyes, nose and mouth with unwashed hands
- Avoid close contact with people who are sick
- Stay home when you are sick
- Cover your cough or sneeze with a tissue, then throw the tissue in the trash
- Clean and disinfect frequently touched objects and surfaces
- Steer clear of crowds whenever possible
- Necessary PPE for our clinicians (including goggles, mask, and gowns if needed) in our cleanrooms as well as employees in contact with patients who have a HID
- Proper donning and doffing is vital to protect patients and employees
- Consider having the coughing/sneezing patient or caregiver wear a mask
- If an employee is sick, our HR policies are designed for additional PTO or remote work as needed
- Screening every patient in advance of a face to face encounter to identify patients with a potential risk and to ensure proper PPE is on hand for the visit
What are you doing to protect your patients?
The screening we do is intended to protect patients as well.
Prior to an infusion suite visit, patients additionally must complete an intake questionnaire before any appointment with an Option Care Health team member. Nurses and other care staff are using PPE in accordance with the CDC guidelines.
Above all, we want to assure you that we are taking active measures to help protect patients, our healthcare workers and employees from COVID-19. Our infusion suite network across the United States can help protect healthier or immunocompromised patients from the impacted COVID-19 population.
How are you maintaining the safety of your infusion suites?
Option Care Health follows HID and pandemic protocols for maintaining cleanliness of our infusion suites. On top of our infection prevention plans, we are also ensuring:
- Infusion suites will be re-stocked and cleaned on a frequent basis and will be maintained in a clean, patient-ready condition, at all times
- Manage patient flow into infusion suites by limiting points of entry to reduce foot traffic and maximize spacing
- Pre-screen patients by phone before their scheduled appointment and upon facility entry to minimize the chance for exposure
- Counter tops and work surfaces will remain clear of clutter and disinfected between each use, including prior to preparation of any medications or sterile supplies for patient use
- Patient and visitors’ chairs, diagnostic equipment, infusion room tables and non-disposable equipment used for patient care as well as all equipment used by a patient while in the treatment room, will be disinfected with an approved sanitizer (i.e. Sani wipes) between patients or when visibly soiled
- Waiting room chairs and floors in the infusion suite will be cleaned daily and after each patient visit
- Patient and guest restrooms shall be cleaned and disinfected weekly and after each use, if the individual has a known infection
- Additional cleaning precautions and procedures:
- Differentiated disinfecting protocols implemented based on levels of facility exposure
- CDC-approved cleaners for disinfection containing alcohol solutions with at least 70% alcohol
- Staff wears disposable gloves when cleaning and disinfecting surfaces and discards gloves after
- Scheduling patients at alternating times when possible and ensuring a minimum of 6 feet of space between chairs during concurrent appointments
How do you plan to service patients in the event a pharmacy branch closes?
At Option Care Health, providing extraordinary care for our patients is at the center of everything we do – and this has never been more important than right now. As the nation’s largest infusion provider, Option Care Health is uniquely positioned to treat patients in all 50 states, due to our nationwide pharmacy network.
Each of our pharmacies has updated an emergency dispensing and compounding plan, which includes back up plans based on adequate staffing and appropriate licensure. At least one back up compounding pharmacy has been identified for each existing site. Our technology platforms and multi-state licenses will allow us to transfer prescriptions as needed in the event of a partial or complete shutdown of a particular pharmacy.
- As the nation’s largest infusion provider, we are uniquely positioned to treat patients in the safe environment of their own homes and our alternate infusion suites (AIS), which reduces their exposure to further risk in more public settings.
- We’ve always had an Infectious Disease Prevention Plan, which calls for Personal Protective Equipment (PPE) and education of our staff and patients. In light of the coronavirus outbreak, we are actively monitoring CDC guidelines and working with Infectious Disease experts and updating our plans, policies and guidelines as appropriate. We continue to accept and service referrals to care for patients.
- In the event of an employee exposure, including travel to countries that are determined by the CDC to be “Widespread Sustained (ongoing) Transmission,” we have asked employees to please alert Human Resources so that we can determine a go forward plan that may include staying home or working from home for at least 14 days upon their exposure or return from travel.
- Option Care Health, in conjunction with our Infectious Disease expert and in accordance with CDC guidelines, is currently screening all new and existing patients prior to in-person contact. For patients determined to be at risk (due to travel or known exposure), a registered nurse will follow up with both the patient and the prescriber for next steps.
- We are providing updated education and information to our teams on an almost daily basis.
- Our Supply Chain team is working with our vendors to make sure that Option Care Health has adequate supplies available for both patient care and PPE for our employees to maintain continuity of care.
As Vice President, Chief Information Security Officer for Option Care Health, Jill Rhodes is passionate about protecting patients’ health information. That starts with fostering a culture of security, a mission that, for her, extends far beyond her job.
Jill compares information security to seatbelts. When laws were first enacted many people grumbled about the hassle. Today, most wouldn’t think of driving off without first putting on the seatbelt. It’s become ingrained in our culture.
“We need to build a very similar culture for information security so that everyone in their daily lives thinks, ‘Am I going to give everyone my credit card over the phone? Did I check that I’m sending the information to the right person? Should I email that personal information?” she said.
Earning industry recognition
Her efforts to create a culture of security at Option Care Health have not gone unnoticed. She was named 2019 Chief Information Security Officer of the Year in Chicago by the Association of Information Technology Professionals, ISACA, FBI-InfraGard, Information Systems Security Association (ISSA) and the Society for Information Management (SIM). She believes she was chosen due to her strategic and holistic (including governance, process, technology and people) approach to health information security.
For example, at Option Care Health, Jill and her team built an ambassador program, in which every Option Care Health location has an information ambassador. These are not IT folks, but infusion therapy nurses, pharmacists and office managers; in other words, those who don’t work in the world of IT, but are affected by it.
“They’re in the field providing infusion services and the more my team and I can share with them, the more we can get this vital information about protecting ourselves and our patients out there to everyone,” she said.
The ambassadors speak monthly to other employees at their locations to provide tips and advice. It’s a grassroots trainer-trainee model that has been successful at Option Care Health. Jill saw benefits of this model in the past as well when she was working with the federal government supporting democratic development in other countries. As a Foreign Service Officer, she educated students about multiparty elections and how to vote. The students would then tell their parents, spreading the knowledge and value of voting.
From national security to patients’ private health information
Her holistic worldview and commitment to creating a culture of security comes from an astounding breadth and depth of life experiences. She worked in international development in Bolivia and Russia as a diplomat and helped people transition to multiparty democracy in Eastern and Southern Africa. Jill has worked for the State Department, Department of Homeland Security, the Department of Defense and the CIA. She was a member of the Senior National Intelligence Service, has a law degree, volunteers with the American Bar Association, and runs the security committee at her temple. Jill has also written for and edited several books on security.
During her work with the federal government, she saw the data and security perils firsthand, but realized the biggest risk lay in the economic risk to the private sector created by cyber incidents. As a result, she resigned from federal service and moved to the private sector.
Improving cyber security at the office and at home
The culture-building is working, says Jill, who notes people now regularly send her emails that don’t look right or tell her their stories of family members being scammed via a simple click of the mouse.
When people ask her what they can do to improve their own security, her standard advice is:
- Educate yourself about threats that exist and how to protect your (and your family member’s) information
- Know what to do when something happens – and it will. The right response is critical
- Talk about experience and technological issues – from phishing emails you’ve received to how to update your devices – with friends, family and coworkers
“Our team members work with patients daily and my role is to help us all protect this information and reduce our risk – not just at Option Care Health, but in every facet of our lives.”
BANNOCKBURN, Ill., May 30, 2018 — Option Care Enterprises, Inc., the nation’s largest provider of home and alternate treatment site infusion therapy services, recognizes 19 of its nurses for passing the Certified Registered Nurse Infusion (CRNI ®) examination this spring.
The bi-annual CRNI ® exam, facilitated through the Infusion Nurses Certification Corporation (INCC), is the only accredited and nationally recognized certification for infusion nursing. Option Care’s newly certified clinicians make up nearly 20 percent of the total number of nurses to receive the credential this March and will join an elite group of only 3,000 active CRNI ®s worldwide. Option Care bases its own policies and procedures on INCC standards to ensure clinicians are held to the industry’s leading best practices.
“The achievement of CRNI ® credentials by so many of our nurses demonstrates our team’s commitment to going above and beyond to deliver exceptional care, “ said Brenda Wright, Senior Vice President of Clinical Services at Option Care. “When a nurse passes the rigorous CRNI ® exam, we are confident that individual is qualified to support our patients at home, and that he or she knows the standards of practice for infusion regardless of site of care, has demonstrated critical thinking skills and understands the importance of adherence to evidence-based standards.”
The CRNI ® exam tests the knowledge and expertise of registered nurses in eight core areas of infusion therapy practice: technology and clinical applications; fluid and electrolyte balance; pharmacology; infection prevention and control; special populations; transfusion therapy; antineoplastic/biologic therapy; and parenteral nutrition.
The recognized Option Care nurses (listed alphabetically by last name) include:
- Karen Bucher (Tennessee)
- Jennifer Burcke (Missouri)
- Erin Birke (Missouri)
- Michelle Carmichael (Maine)
- Tracy Cashman (Montana)
- Karen Choate (Oregon)
- Carol Dearborn (Maine)
- Stephanie Ferrante (Maine)
- Kori Utter (Massachusetts)
- Patty Westcott (Minnesota)
- Kristen Harrison (Massachusetts)
- Deborah Langston (Washington)
- Jennifer Lee (Washington)
- Paige Luebbert (Missouri)
- Jessica McNish (Texas)
- Pamela Mull (Ohio)
- Melissa Sackett (Minnesota)
- Sheila Schreiber (Minnesota)
- Tammy Wright (Washington)
“The CRNI ® credential is invaluable as a measure of the infusion nurse’s professionalism and dedication. It demonstrates a commitment to the specialty and is an accomplishment that is widely recognized and respected,” said INCC Chair Lisa Gorski, MS, HHCNS-BC, CRNI ®, FAAN.
About Infusion Nurses Certification Corporation (INCC)
The Infusion Nurses Certification Corporation (INCC) was established in 1983 to develop a credentialing program to increase positive patient outcomes and to enhance the specialty of infusion nursing by recognizing and raising infusion nursing standards, policies, and procedures.
About Certified Registered Nurse Infusion (CRNI ®)
The Certified Registered Nurse Infusion (CRNI ®) credential is the only nationally accredited certification in infusion nursing. It assures employers, nurses, and, most important, patients that the infusion nurse with the credential meets the highest quality standards. The CRNI ® credential is also the only certification that evaluates the knowledge and clinical excellence of nurses working in the specialty of infusion nursing on an ongoing basis.
About Option Care
Option Care Enterprises, Inc. (Option Care) is the nation’s largest and most trusted provider of home and alternate treatment site infusion services. An industry leader, the company draws on nearly 40 years of clinical care experience to offer patient-centered therapy management. Option Care’s signature Home Infusion Plus services include the clinical management of infusion medicines, nursing support and care coordination. Option Care’s multidisciplinary team of more than 1,800 clinicians — including pharmacists, nurses and dietitians — are able to provide home infusion service coverage for nearly all patients across the United States needing treatment for complex and chronic conditions. Learn more at www.OptionCare.com.