Scott Soefje, PharmD: Take a Site-Specific Approach to Optimize Care Delivery, Finances
According to Scott Soefje, PharmD, understanding nuances across sites of care can help health care providers optimize patient care delivery while ensuring financial viability across all settings.
Conducting a comprehensive financial analysis in health care requires a thorough understanding of cost structures, reimbursement models, payer-mandated limitations, and more, all of which vary significantly depending on the site of care.
In his presentation titled “The Great Financial Debate: Cost vs Margin for Cancer Care Drugs” at the Hematology/Oncology Pharmacy Association Annual Conference 2024 in Tampa, Florida, Scott Soefje, PharmD, addressed how these factors affect financial decision-making across inpatient care, hospital-based infusion centers, physician-based infusion centers, and home care settings.
“Knowing what each side is doing, knowing what each payer is doing at each site is very beneficial in making your financial [decision] and doing your financial analysis,” said Soefje.
When it comes to cost, hospital and hospital-based infusion centers usually pay the most while physician offices typically receive discounts. What’s more, different care types have different reimbursement structures: inpatient care uses a fixed payment model, so lowering costs is key. But for fee-for-service or percentage-based models, there should be a balance between cost and maximizing reimbursement. Understanding these nuances, Soefje said, is crucial to make tailored financial decisions at each site.
“[As more] payers [make demands] about specific sites of care, you have to be able to understand how that’s going to impact your analysis,” said Soefje. “If the payer is not going to pay you to [provide care] at the hospital, then that’s zero revenue. [That means] you can’t [provide care] it in the hospital, you got to take it somewhere else.
By understanding the interplay between cost structures, reimbursement models, payer preferences, and sites of care, Soefje concluded, health care providers can optimize patient care delivery while ensuring financial viability across all settings.
Read more of our coverage from the HOPA 2024 Annual Conference here.
