Adding Allergy as an Ancillary Service Aeroallergen and Drug Allergy

Transcription

1 Adding Allergy as an Ancillary Service Aeroallergen and Drug Allergy Jay Bates 1 Date Initials

2 Agenda Prevalence of Allergies Types of Allergy Services Practice Considerations/Implementation Measuring success 2

3 Introduction/Disclosures Jay Bates Director of Sales Operations, ALK, Inc. Have been with ALK for 11 years in Sales, Business Development and Management BS in Health and Exercise Science from Wake Forest University Member of the Corporate Advisory Board for the AOA 3

4 Prevalence of Allergy

5 Allergies are Everywhere 20% ~65 million people suffer from allergies Allergic rhinitis is the 6 th most common chronic disease 94% of patients who report as penicillin allergic are not. 40% of children with tubes have positive allergy tests

6 Overview of ENT Allergists vs. Traditional Allergists 3,615 Allergists with fewer new Allergists coming out of Fellowship programs each year. In % of ENT s offered allergy services. Today it is closer to 70% There are approximately new ENT physicians starting every year out of 110 Residency Programs Allergy training is now required at all ENT Residency Programs ENT s should either build strong referral relationships with Allergists or offer services within their practice.

7 Allergies in Your Practice It is estimated that 50% of patients visiting ENT offices suffer from allergies. It has been suggested, the relationship between allergic disease and many head and neck diseases is crucial. This could present in a variety of ways and may affect the diagnosis due to overlapping symptoms.

8 Continuity of Care Allergy, as a part of a complete evaluation, becomes a key in a variety of factors: Is allergy a differential diagnosis from the patient s original complaint? Are patient concerns being neglected by not thoroughly evaluating an allergy diagnosis? Would identifying and treating specific allergies optimize results? Drug allergy: Could treatment options be limited for the patient without a proper evaluation of potential penicillin allergy?

9 Allergy Services

10 What should I offer? Allergy Testing Allergy Treatment Drug Allergy Testing

11 Allergy Testing Proper diagnosis with skin testing can confirm the suspicion of allergies by correctly identifying the most problematic allergens and determine the severity. Percutaneous (prick) test introduces antigen into the skin to illicit an allergic response in the form of a wheel and flare (bump and redness) Intradermal test further helps to quantify the severity of the allergic reaction Panel of allergens can include pollens, molds, animals, epidermals, and food Typically test between allergens Extract manufactures can help you design your panel to match regionally significant allergens Testing may take between 20 minutes - 2 hours Can be performed by MA and above in most states **Patients must be off anti-histamine medications for several days before test**

12 Allergy Treatment (Immunotherapy) Allergy immunotherapy is a clinically documented treatment that may reduce or completely remove allergy symptoms Patients see a dramatic decrease in their need for traditional symptom-relieving medication. Produces results by challenging the immune system with allergens in a controlled up-dosing manner Represents the largest start-up investment and space requirements

13 Penicillin Allergy Testing Penicillin allergy skin testing is a simple step in adding allergy services to your practice. Studies have shown, when following the suggested protocol, the test has a 99% success rate Chance of anaphylaxis is very small Testing time: hours (mostly waiting time) Easy diagnostic to implement and supplies are easy to manage

14 Penicillin Allergy Testing (cont.) Process 1. Skin prick test with controls and derivatives of Penicillin (least sensitive) 2. Intradermal test with controls and derivatives (more sensitive) 3. Graded oral challenge with 250mg of penicillin (confirmation) Benefits Patient removes inaccurate diagnosis from health record, opens up entire class of broad-spectrum antibiotics Practice additional revenue stream and new source of referrals Healthcare lower cost for beta-lactums (Mayo Study) Fight antibiotic resistance 14

15 Practice Considerations and Implementation

16 Essentials to be Successful Staff and Space Patient Recruitment Supplies Getting Started Billing Training Protocols

17 Staff Physician: oversees all allergy protocols and ensures that office procedures follow recommended guidelines and the clinic complies with all federal, state and local regulations. Nurse: one or more nurses (techs) to perform allergy skin tests, administer immunotherapy injections and prepare all allergenic extracts for testing and treatment. Office Staff: observes patients for adverse reactions in the waiting room following their injections. Also reviews records to determine whether patients are compliant with treatment. Office Manager/Biller: Ensure all coding practices comply with procedure and payer requirements

18 Staff (cont.) Allergy Nurse(s) Attributes to Consider: Focused individual with attention to detail Superior communication skills Works well with patients to build relationships Easily trained Existing Staff Member Promotion/new roll Additional Responsibility to current roll + : Knowledge of practice and physician(s) - : Can dilute man-hour resources New Hire Promotion/new roll Additional Responsibility to current roll + : Sufficient resources for new tasks - : Significant learning curve (IT and practice workings) 18

19 Space The ideal setup Could combine: Waiting rooms Testing/Mixing/ Injection Rooms Exam Room Considerations: Lines of sight Easy external access Creature Comforts

20 Supplies Clinical Usual and customary furnishing for exam rooms (upright exam chairs or flat benches) Waiting areas Medical Supplies: Usual and customary; such as Needles, syringes, gloves, sharps containers, etc. Anaphylaxis management: crash cart Skin testing Allergen extracts (aeroallergen, food, controls, penicillin) Allergen skin test devices (Percutaneous) Intradermal syringes Stainless steel utility cart. Mixing Lab Bulk allergens, empty vials, diluents Syringes, needles, sharps containers Trays/Organizers and labels for vials Refrigeration Unit** ** Refrigeration Units: Upright Stainless Steel Coolers (ideally with thermometer and alarm) Note: Estimated total start-up cost is $7-15K on average

21 Training On-Site (some extract companies offer this service) Cross-train staff Physician involvement Dedicate the time 100% to the training (closed office) On-going support Training manual and documentation Outside Meetings and Conferences AAOA (Basic and Advanced Courses) AOA Pan-Am Meeting Local/Regional Conferences

22 Protocol Development This could be your most important implementation step Proper protocols reduce risk to your patients and staff Protocols you will need include: Panels Standardized skin testing panel specific to region & practice Skin testing devices and techniques Administering allergy injections Emergency situations Extract preparation Steps for quality assurance, patient & staff safety Documentation and form creation If you have an EMR - custom clinical templates creation

23 Forms you may Need

24 Billing Appropriate CPT codes Testing Treatment Extract preparation Reimbursement rates BE SURE TO BILL CORRECTLY CPT ALLERGY TESTING Percutaneous (MQT) # Intradermal (MQT) # Intradermal (SET) # CPT ALLERGY INJECTION Single injection Multiple injections CPT ANTIGEN PREPARATION Multiple dose vial #doses Ea addit multi dose vial #doses CPT Penicillin Testing Percutaneous/Intradermal # Oral Challenge Mins (61+)

25 Patient Recruitment Current patient base Who has history of chronic rhinitis or sinusitis? Who is labeled penicillin allergic? Did you recommend referral to an allergist? Referral network Practice marketing Website and social media Community health fairs Advertising to promote continuum of care

26 Measuring Success

27 Start with goals Practice Objectives Understand all stakeholders expectations Set clear and measurable goals Agree on a timeline to evaluate success Clinical Objectives Represent diversification of services Provide continuum of care Enhance patient outcomes Business Objectives Elements of strategic planning & marketing strategies Offers opportunities for revenue/profit enhancement

28 Growth Metrics to Trend Improve Plan Monitor & Trend Stats: Review Do Total # of Patients per month/quarter/year/doctor # of New patients per doctor # of patients recommended to start IT but chose symptomatics Average Number of Patients Skin Tested per Month % of New Patients Started on IT Retention Rate Time from First Consult to Immunotherapy Start Total Number of Current Immunotherapy Patients IT billings as a % of total billings Referral Trends Wait time for appointment

29 Practice Growth Assume: 5 new patients/day Year 3 Year 2 50% of these most likely have allergies 50% of these elect to go on immunotherapy Treatment lasts 3-5 years with an estimated average of 50% compliance rate Year 1 Monitoring the patient s overall health for multiple years will allow for more continuity of care and possible enhanced patient outcomes

30 Revenue Model Allergy Testing Year 1 $252,000 Treatment Year 1 $468,000 Antigen $189,000 Shots Total 1 st Year: $909,000 CPT ALLERGY TESTING Nat l Medicare Fee Schedule Percutaneous (MQT) # Intradermal (MQT) # Intradermal (SET) # CPT ALLERGY INJECTION $6.50 $8.00 $ Single injection $ Multiple injections $10.50 CPT ANTIGEN PREPARATION Penicillin Testing Year 1 $69, Multiple dose vial #doses CPT Ea addit multi dose vial #doses Penicillin Testing Percutaneous/Intradermal # Oral Challenge Mins (61+) $13.00 $19.00 $

31 Questions/Open to the Floor Jay Bates