DO YOU KNOW INO N E W S L E T T E R
W
elcome to the inaugural edition of the Do You Know INO newsletter. The Option Care Heart Failure team has compiled current and relevant information related to our Heart Failure Program. We hope this information will help you as you continue to meet with INO referral sources on a consistent and frequent basis. We welcome your suggestions for topics and other information you would like to see in future editions. Spring is a time of renewal and growth. We want to encourage and support you to grow the INO business. When you have questions or concerns please reach out to us. Thanks for your continued support of the Heart Failure Program and the patients and families we serve!
If you have any questions or would like to contribute content, please contact Tess, Stephanie and Jessica, your Heart Failure team at: OC-HF-TEAM@optioncare.com
Check out our video to see how our specialized heart failure team helps patients meet their therapy goals. This newsletter is for internal distribution only.
What the Cures Act Means for Home Infusion Therapy The 21st Century Cures Act has had a great impact on Home Infusion therapy. Not only the way we do business, but most importantly, the impact it has had on patients. Since the CURES Act was enacted January 1, 2017, our INO census has taken a bit of a hit, but we still continue to bring new patients on service. We are now into the 2nd quarter and it’s up in the air as to how our competitors will service these patients. Remember our statistics of a few weeks ago – 26 new referrals of which only 4 were Medicare B. So encourage your referral sources to send you their patients so that we can do a complete analysis of their insurance. Let them know that many of the Medicare population have adequate reimbursement because of Medicare advantage, replacement, or HMO plans. We have also seen Medicare patients with true secondary coverage or access to commercial insurance.
Patients have different goals when they are discharged home on inotropic therapy. Let’s take a look at the different types of goals. We want to continue to bring these patients home and also grow our existing business. PALLIATIVE CARE – nearly half of our patients on service today are home for symptom management. These are Stage D/Class IV patients that have chosen not to have advanced therapy such as a heart transplant or VAD, or they are patients who do not qualify for these treatments. Our palliative care patients can be on service as little as a few days or as long as 12 months or more. Remember that our statistics show that
The Cures Act has impacted those patients with just Medicare Part to learn more about how the Cures Act B population greatly. impacts home infusion care, go to We have seen patients http://www.keepmyinfusioncareathome.org weaned from therapy and discharged to home. many Medicare patients have adequate We have also witnessed patients remain in reimbursement for home inotropic therapy. the hospital and transitioned to a ventricular Encourage your referral sources to send you assist device (VAD) sooner than originally these patients! scheduled. We need to be vigilant in talking BRIDGE THERAPY –patients receive inotropic to our referral sources about advocacy medications as they await a heart transefforts and a Provider Services Agreement. plant, ventricular assist device, or until a Continued on next page
Do You Know INO Newsletter is designed to bring you timely information on heart failure, initiatives, and industry developments.
Cures Act continued
decision is made about what advanced treatment option is most appropriate. We have heard from transplant centers that they often require their Medicare patients to get additional insurance coverage before being listed. This coverage often allows us to take patients home on therapy.
Below is a summary of inotropic referrals in Q1. New referrals are coming in daily from all over the country. We need to make these numbers go up and up! With your commitment to these patients, our referral Q1 Summary sources and Option Care, growth is inevitable!
Q1 SUMMARY
5
VA
Our comprehensive program allows patients to be home and help them meet their treatment goals.
57
8
Hospice Medicaid
46
Commercial
46
164
59
Replacement Plan
57
Medicare B 0
10
20
30
40
50
60
Non Medicare B Medicare B Referrals
First quarter summary shows that overall, patients with payers other than Medicare B are referred 3 times more than the Medicare B population. We have also seen an increase in the average length of therapy from 88-89 days to just over 100 days. Source: Corporate Medicare Referral Logs from 2017 fiscal year.
The Cures Act and the Impact on our Inotrope Referral Process Since January 1st and the implementation of the Cures Act, our process has changed in working up our new inotropic referrals. The most important change when working up referrals is the need for insurance benefits to be fully verified prior to sending up the inotrope referrals to our corporate team for processing. While Option Care’s policy now stands that we are not accepting any new Medicare B inotrope referrals, there have been a handful of cases we have been able to accept even if Medicare was the primary payor. Sometimes it is discovered that a true secondary payor may be able to come into play when billing these claims, and we are able to fully bypass billing Medicare for payment. Please note that a supplemental policy would not allow for this option and we would need to determine if the patient has a true secondary insurance policy.
Please continue to share with your referral sources our ability to accept these referrals. Congratulations to our Minneapolis Care Management Center for securing our first inotropic service cost sharing contract agreement with Allina Health System! Our Minneapolis location now has a standing contract to continue accepting and servicing all Medicare B beneficiaries needing home inotropic therapy coming out of these facilities. Our clinical
To help expedite the referral process it will be necessary to fully verify benefits and communicate to the corporate team the insurance(s) we are dealing with in order to exhaust all our options to bill for this therapy.
The most important change when working up referrals is the need for insurance benefits to be fully verified prior to sending up the inotrope referrals to our corporate team for processing.
The updated Corporate Inotrope Referral Form is a step by step guide to help with this new process and is available on OC Net.
excellence and trust has been proven and our partnership with Allina Health System will continue. Way to go!!
Keep in mind, we are still seeing a good number of INO referrals from other payors as well: Medicare Replacement Plans (managed Medicare, Medicare HMO, etc.), commercial payors, VA, Medicaid and hospice contracts.
Keep an eye out for monthly calls that will be scheduled and held on the 2nd Monday of every month. These calls will be held by Jessica McNish, Medicare Clinical Coordinator
Š2017 Option Care Enterprises, Inc. All rights reserved. 170C0086
to review and provide clarity on our referral process, answer any questions regarding our referral process and our Heart Failure Program in general. All new team members should make a point to attend and experienced team members are welcome to join the call to discuss issues, concerns, share stories, and stay up to date on changes.