As allergy service providers, we are often asked to differentiate our Allerscripts program from other programs in our field. However, direct comparisons can be difficult given the variety of available business models. Whether a practice has had many years of experience with allergy treatment, or is just now considering options for an allergy program, the following information should prove helpful when deciding how to proceed.
There are 3 viable ways to incorporate allergy services into a medical practice:
1. Become an Allergist
The most straight-forward option is to purchase all the necessary supplies directly from the various manufacturers and begin offering allergy skin testing and immunotherapy. Doing everything in house can decrease costs for each patient test and treatment vial while generating the most profit for the practice.
The obvious downside is the large, up-front capital investment required to (a) procure a full inventory of allergenic extracts, ancillary supplies, a high-quality refrigerator, and alarm system (b) establish the appropriate clinical protocols, testing panels, and treatment formulations for the practice, and (c) hire & train competent staff to perform skin tests, compound sterile vials for subcutaneous immunotherapy (SCIT) and administer treatment.
Other headaches include: negotiating prices with suppliers, monitoring allergen expiration dating & backorders, while staying compliant with the ever-changing regulatory guidelines on sterile compounding.
2. Contract with a Service Provider
We sometimes refer to this as the “chauffeur” option, in which a company handles most, if not all, the allergy-related work in exchange for a contracted service fee. This arrangement can be pretty attractive, especially since most companies do not claim startup costs or make exaggerated profit projections. However, some find that these relationships sour quickly, and are given few options to opt out of contracts or improve the quality of service.
Here are just some of the frustrations we hear from practices that have contracted with Fee-4-Service allergy companies:
- Restrictive, misleading, & unfair contracts prevent the practice from opting out without excessive proof of cause or offering allergy for a period of time (e.g. 2 years) after termination of contract; all medical liability is owned by the practice.
- Allergy technicians, even those with “Certified” or “Specialist” in their title, do not necessarily have formal clinical training, nor are they qualified to make decisions regarding patient care, much less recognize and manage severe systemic reactions like anaphylaxis.
- Clinical support from medical professionals is not readily available for curbside consult or is simply non-existent.
- Providers are discouraged from clinical decision making or deviating from clinical protocols; technicians will often determine which patients qualify for testing and/or treatment without consulting the provider.
- Unconventional or inappropriate testing & treatment protocols have patients self-administer SCIT every other day, allergen concentrations made well below published guidelines, or patients held in never-ending build-up schedule to continue excessive billing of CPT codes.
- Improper (& sometimes fraudulent) billing practices push patients with favorable insurance plans into testing and treatment, bill the maximum amount allowed under a plan despite misalignment with clinical protocols, or violate/misinterpret the CMS allowable for CPT 95165.
- Obscure or unnamed pharmacies often mismanage prescription orders, taking 4-6 weeks (or longer) to prepare and ship patients’ treatments, writing illegal prescription paperwork, or using questionable sterile compounding procedures.
- Reimbursement is delayed or rejected due to billing and coding beyond contracted rates or allowable parameters, failed or incorrectly submitted prior authorization, and blatant overbilling.
- Improper billing arrangements (e.g. fee splitting) result in service fees based on percentage of reimbursement, joint accounts being required to draw service fees, as well as service fees and/or retained reimbursements based on patient quotas.
3. Do Some, Outsource Some
A happy medium can be found when the practice assumes the day-to-day responsibilities of providing appropriate allergy care, while allowing a service company to handle the more cumbersome aspects of preparing allergy immunotherapy.
If the contracted allergy service provider is also a licensed and experienced compounding pharmacy, all parties stand to benefit:
- The Practice can outsource the labor that comes with the most daunting regulatory challenges: sterile compounding of a black-box warning drug/biologic.
- The Provider can focus on patient care and is empowered with the knowledge of proper allergy testing & immunotherapy protocols.
- The Patient receives an immunotherapy formulation that (a) follows the highest quality standards and (b) provides allergen dosing aligned with published guidelines for optimal therapeutic outcomes.
- The Pharmacy eliminates the “middle man” in the typical allergy service model, thereby streamlining patient care and moderating healthcare costs.
It’s never too late to switch!
Innovation Compounding has built a roadmap for any practice hoping to offer the highest-level allergy care. Email firstname.lastname@example.org to learn how to get started with Allerscripts!