Infusion Providers Alliance
The Infusion Providers Alliance is the leading voice for in-office and freestanding ambulatory facility providers of drug infusion services. Alliance members are committed to preserving the integrity of the provider-patient relationship in a manner that delivers exceptional care to patients at a value to the health care system.
Our members have facilities located in communities across the nation, each of which offers a more convenient, more efficient and less expensive alternative for patients than receiving their infusions in the hospital setting. These facilities serve as critical access points of care for patients and save tremendous dollars for commercial and government payers alike while also lowering out of pocket costs for beneficiaries.
The Infusion Providers Alliance mission is to serve as a thought leader and to educate on issues critical to safeguarding, supporting, and strengthening provider directed, patient-focused access to in-office and freestanding ambulatory facility infusion services.
The Clinic-Based Approach Results in Substantial Savings and Better Outcomes
Administering infused and injected specialty drugs in the in-office or ambulatory infusion facility setting rather than the hospital setting can result in substantial prescription drug cost savings. In-office and freestanding ambulatory facilities can reduce administration costs of specialty medications by at least 50 percent for the top 10 HCPS codes—which account for approximately half of overall specialty medical spending–compared to the hospital setting.1,2,3 As a result, in 2017 and 2018 total drug costs were 5 to 7 percent lower than the hospital setting for Medicare patients, and one-third to two-thirds lower for Medicaid.4
Medicare pays hospitals substantially more for infusion of identical drugs using identical staff time and skills as physician offices and freestanding ambulatory infusion centers, which are paid on the Physician Fee Schedule. For example, our infusion centers and practices regularly bill CPT code 96413 for the first hour of infusions of complex drugs such as Remicade, Ocrevus, and Entyvio for patients with a variety of diseases including Crohn’s disease, Multiple Sclerosis, and ulcerative colitis; for this particular CPT code, we are paid approximately 45 percent of the hospital rate: $309.56 vs $142.55. The payment differential widens more under CPT 96415 for additional hours of infusion: hospitals receive nearly double the physician office rate ($60.46 vs. $30.68). The contrast is even greater for CPT code 96372 for therapeutic, prophylactic or diagnostic injections such as for administering Boniva, Xolair, and Prolia for osteoporosis and arthritis: $60.46 in the hospital versus just $14.44 in the physician’s office, or 25 percent of the hospital cost.