Upstate grows referral base through contracts

UTICA, N.Y. - Now that its vascular management access program (VAMP) has succeeded here, Upstate Home Care plans to extend its home infusion services to doctors and hospitals statewide. Through VAMP, Upstate partners with referrals outside the homecare venue to identify patients who could benefit from a proactive approach to IV therapy. This saves time and money, and is better for the patient, says Greg Lopresti, vice president and COO. "We're taking the headache off them," said Lopresti. "We provide the nurses, we insert the lines, we case manage these patients to get them out of the hospital sooner." Upstate trains hospitals on how to screen potential candidates, using a criteria template that can be modified in conjunction with the hospital. An Upstate infusion nurse then performs a physical assessment before making a recommendation. "What we're doing is looking at disease states that are high-risk," said Lopresti. "It's not just the diagnosis. We look at their veins, their access points, how many times they've been readmitted." Once approved by the treating physician, a peripherally inserted central catheter (PICC) line is placed with the aid of a portable ultrasound, charted and confirmed with an X-ray. The process takes about an hour. "About half of the assessments end up in placements of PICC lines," said Lopresti. Last year, in one hospital alone, Upstate did over 1,200 assessments and 600 insertions. Regular peripheral IVs might be changed 12 times before a PICC line is put in, increasing cost and risk of infection--a major reason for hospital readmissions, said Lopresti. "It's about being seen as other than an equipment or service provider," said Lopresti. "These physicians we work with in the hospital--when we go into their office, they're going to know us, know we provide a good service." Upstate earns over $10 million in sales annually and infusion comprises about half of that. Managed care and private insurance comprises about 60% of the business and Medicare and Medicaid the rest.