For these reasons, 2025 promises to be filled with M&A activity involving infusion providers and a proliferation of new market entrants. While there is a short list of national and regional infusion providers, demand for scaled assets is outpacing supply. Consequently, it is expected that PE firms will pursue tuck-in strategies to achieve scale and more varied and “omnichannel” offerings. The patchwork of state laws impacting infusion providers, such as licensure requirements and corporate ownership prohibitions, result in a complex legal landscape for infusion providers. Currently, ambulatory infusion centers (AICs) staffed by nurse practitioners and infusion suites that source drugs through pharmacy dispensing (AIS) are not largely regulated at a state level. However, there is an increase in state interest and awareness that will likely lead to increased regulation in the short term. Historically, most AIC providers have been relegated to payor contracts with regional and local payors. Additionally, the types of contracts accessible to AICs traditionally have looked more like physician practice or clinic agreements. Payors are still in the early stages of contracting with AIC providers on a national scale or having specific networks for AICs. It is expected that the breadth of payor offerings for infusion providers will increase in 2025. Specialty drug manufacturers have long recognized the value of enhanced service relationships with specialty pharmacies. However, this synergy is largely untapped with AICs. AICs have access to patients for a duration and in a manner well beyond the reach of specialty pharmacies. For infusion providers who also have home infusion capabilities, there is the ability to provide robust comparative and omnichannel data. In 2025 it is expected that manufacturer and infusion provider relationships will grow in volume and sophistication. Due to payor and consumer pressure to move infusions out of hospital-based infusion centers, there has been longstanding interest in joint venture or other partnership models with health systems for infusion offerings. Outside of management models, this puzzle remains largely unsolved. 2025 may see growth in innovative collaborative models between health systems and infusion providers. 3. On the Rail with Post-Acute Care BY DAVID COX, ANNA GRIZZLE, LARA FLATAU & JONATHAN STANLEY Private equity investment remains active in the post-acute sector, and navigating the uncertainties of potential changes in the landscape will be critical to investment success. Many of the key themes center on the upcoming change in administration and potential Congressional action, including: • Proposed Hospice Care Act. The Hospice Care Act, introduced as proposed legislation in late 2024, received substantial industry input and early support. If enacted, it promises to substantially alter the hospice landscape. The drafters contended key changes are designed to expand the benefit and reduce fraud, but the bill has a much broader impact. A temporary moratorium would prevent new hospice providers from enrolling in Medicare for at least five years, and the rule restricting multiple changes in control during any 36-month period would be expanded to cover a 60-month period. In addition, a change in control of a hospice would be required to be submitted to the Department of Health and Human Services (HHS) at least 90 days prior to the proposed change. The proposed legislation also proposes material changes in the payment structure, including new benefits for home respite and transitional inpatient respite, along with new reimbursement eligibility for costly palliative treatments, such as dialysis and blood transfusions. Hospice would be added to the list of designated health services, which means the physician self-referral, or Stark, law would apply to hospice services. This proposed change would significantly increase the stakes to ensure compliant physician referral source arrangements. Examples of other changes intended to modernize Medicare’s hospice approach include: nurse practitioners and physician assistants permitted to certify eligibility; increased survey frequency; tightened reporting and oversight requirements; and required quality data submissions as a condition of payment (rather than the current approach providing for a 4% penalty for failure to submit quality data).
2 | BASS, BERRY & SIMS
Powered by FlippingBook