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Beyond the Bed: Transitioning Cancer Care From Hospitals to Outpatient Infusion Centers
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Specialty pharmacists are critical for enhanced management of clinical and logistical aspects of treatment.
Cancer therapy has advanced significantly beyond surgical resection with the introduction of chemotherapy, targeted therapy, and immunotherapies, delivered orally, subcutaneously, or through intravenous (IV) infusion, providing patients with less invasive treatment options. IV infusion is one of the primary methods of cancer drug delivery and allows for rapid and controlled delivery of medication directly into the bloodstream, ensuring systemic distribution. Patients traditionally receive infusion treatments at hospitals; however, this yields a multitude of disadvantages, such as cost inefficiencies, resource constraints, and a poorer patient experience.
Pharmacist adjusting IV for patient with cancer | Image Credit: © Halfpoint - stock.adobe.com
At the Association of Cancer Care Centers 51st Annual Meeting & Cancer Center Business Summit in Washington, DC, Jorge J. Garcia, PharmD, MS, MHA, MBA, FACHE, FACCC, assistant vice president of Infusion, Oncology, and Investigational Drug & Research Pharmacy Services at Baptist Health South Florida, discussed how dedicated infusion centers can provide more efficient, patient-friendly, and cost-effective alternatives to hospital-based infusions. He also highlights the importance of specialty pharmacies in managing the clinical and logistical aspects of treatment.
The demand for treatment often exceeds availability, especially in hospital-based settings where costs are high, resources are limited, and operational efficiency needs improvement. Hospitals often have expensive bed utilization rates, and many have more patients waiting in the emergency department to be admitted than there are beds available. There is also inflexible scheduling, limited capacity to effectively manage multiple patients at once, potential treatment delays, lending to longer wait times, and less favorable experiences for patients.
“We also have patients standing by in sister facilities waiting to go to our main hospital for a service that is only offered in the main hospital, and when those patients are standing by in the other hospitals, we cannot bill because they’re not being serviced for the service that they need,” explained Garcia. “So, it just creates this snowball effect. It's not good for anyone. And the infusion centers really help transaction the patients in a better way.”
Dedicated infusion centers can provide solutions to many of the challenges seen in hospital-based settings. For instance, these centers offer numerous patient care benefits, including convenient access to specialized treatments and shorter wait times. With a more personalized care environment, infusion centers can better accommodate diverse patient populations, including those covered by Medicare, Medicaid, and commercial insurance plans. They may also provide convenient access to specialized treatments that are not available in the hospital setting.
Beyond patient care, infusion centers offer substantial operational benefits for health care systems. By allowing patients to transition to an outpatient setting for continued treatment, they help reduce hospital length of stay, freeing up inpatient beds for those in critical need. Additionally, infusion centers enhance patient flow and alleviate emergency department congestion by providing a designated space for patients requiring ongoing infusion therapies rather than occupying emergency or inpatient resources. This leads to a more streamlined care process, improved efficiency, and a better overall patient experience.
Infusion centers also offer specialized medical oversight, ensuring patients receive expert care in a controlled environment. Standardized drug protocol management helps maintain consistency in treatment, reducing the risk of medication errors, while proactive toxicity monitoring allows clinicians to identify and address adverse reactions early. These capabilities make infusion centers well-equipped to handle complex treatments, including those for rare diseases and specialty medications.
However, infusion centers face their own unique financial, clinical, and operational challenges. Garcia placed great emphasis on the crucial role of specialty pharmacies in supporting infusion centers to overcome these obstacles and help carry out a comprehensive, patient-centered approach to treatment. Their expertise, skills, and training make them essential for navigating complex payer authorization processes, managing high-cost medication logistics, and supporting patient access to treatments.
“We felt that they didn't know the drug space as well, and we wanted that to be known by pharmacy professionals that knew how to do it consistently, that know the right words to pair [together] to be able to get that authorization,” Garcia explained. “That was key. Today, we do get about a 99% rate of success with getting those authorizations in the hospital.”
Clinically, specialty pharmacies can provide specialized medication management and close monitoring for patients with complex or unique treatment regimens. Close and consistent interaction with patients during treatment creates more opportunities to identify and manage toxicities, as well as any need for medication or dose adjustments. This can improve treatment continuity, helping patients stay on their therapy for longer periods of time.
As the demand for outpatient infusion services continues to grow, health care systems must focus on building sustainable models that integrate specialty pharmacy support, optimize operational workflows, and enhance patient access to life-saving therapies. By addressing these key factors, infusion centers can fulfill their potential as a cost-effective, patient-centered solution to the challenges of hospital-based infusion care, ultimately improving outcomes for both patients and providers.
“We practice in a very fast, evolving marketplace,” concluded Garcia. “I think it's important for us to understand and have a clear vision of those internal and external factors that are impacting access for the patients that we care for. Pharmacy can have a strategy that really helps inform overall organization strategy, and we are positioned to leverage and expand access in our entities.”
