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IVIG payment changes put hospitals in tough spot

Pharmacy Regulation Resource, September 14, 2005

Hospitals may have to brace for an influx of patients needing intravenous immunoglobulin (IVIG) treatments while receiving less federal money due to reimbursement changes, industry observers say.

IVIG is an infusion of immunoglobulins, or a protein found in blood that helps fight off infections and viruses. IVIG patients typically have immune deficiencies or neuromuscular disorders.

With Medicare changing its payment structure from average wholesale price to average sales price (ASP) in the private-practice setting, physicians saw a drop in reimbursement for IVIG treatments, causing many to start sending patients to the hospital to cut their losses, says John Dehart, a managing partner with the educational company CMESolutions of Tucson, AZ.

The newsletter Medicare & Reimbursement Advisor Weekly reported that the change to ASP dropped IVIG reimbursement to $10 less than its actual cost. Nearly 90% of physicians have decreased the number of infusions at their offices as a result, the newsletter reported.

But the problem is, many hospitals scaled back their ability to administer IVIG treatments years ago when Medicare restructured reimbursement to move the treatments into the physician setting, Dehart says. Now many hospitals do not have the capability to handle the increased capacity.

A recent HCPro survey of hospital officials found that 75% are unsure how Medicare reimbursement will affect their IVIG services, something that doesn't surprise Dehart.

The pharmacy department is directly responsible for purchasing IVIG at most hospitals-75%-surveyed, meaning that pharmacy directors need to keep an eye on the reimbursement situation.

Few alternatives exist for hospitals, Dehart says. They may look for lower-cost treatments, but some patients can only receive IVIG because of their condition, he says.

Some patients could go on plasma exchange, which removes plasma fluid from the blood and replaces it with new fluid to replace antibodies and help the immune system.

The federal government has not touched the plasma exchange reimbursement system, Dehart says, although it could still be targeted in the future.

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