Starting a Blood Bank inside a Private Practice
Authors: Graham Evelyn M , Graham David Mark , Evans Molly J , Smith Daniel Lucas , Brinker Matthew Thomas , Pettijohn Erin M. , Gribbin Thomas Edward 
Published: December 2024

Problem: Cancer patients frequently require blood product transfusion. However, Centers for Medicare and Medicaid Services (CMS) restricts the reimbursement for the transfusion of blood products to hospital facilities and hospital outpatient departments. This eliminates non-hospital providers, such as private practice oncology centers, from providing transfusion services. The Cancer and Hematology Centers (CHC) is a large single-specialty practice (26 physician) providing comprehensive oncology services in West Michigan. CHC operates a highly-complex CLIA certified laboratory capable of functioning as a blood bank. We show here that transfusion of blood products in a non-hospital setting can be done safely and at significant savings, improving patient safety and quality of life.

Methods: The successful implementation of CHC Transfusion Services required obtaining all necessary components of a blood bank. We initially contacted the American Red Cross (ARC) to serve as our blood supplier, selected a testing methodology that aligned with our transfusion service objectives and experience, and selected a reagent supplier (Quidel Ortho). We developed our policy and procedure manual based on Quidel Ortho manufacturer instructions, American Association of Blood and Biotherapies (AABB) Standards and Technical Manual, and the ARC Hospital Resource guide. We recruited highly-trained staff, developed a record-keeping system and adapted our Laboratory Information System (LIS), Orchard Harvest, to report interpretive blood bank results. Examples of interpretive results that transmit to the patients' EMR include blood typing and antibody screening, compatibility testing, unit information, and transfusion information. Once testing is completed and results are accurately recorded in both the reaction book and the LIS, blood products within the CHC Transfusion Service can be couriered to any of our clinic sites for transfusion following AABB guidelines. Any suspected adverse reactions to transfusion are investigated by clinical and lab staff. Transfusion reaction work-up results are reviewed and signed by the laboratory medical director. The ARC provides blood bank reference testing and consultation as needed. We currently have a contract with a regional insurance provider, Priority Health, to permit billing and reimbursement for this service.

Clinical Outcomes: Since September 1, 2023 to June 30, 2024, these capabilities have enabled us to administer 309 psoralen-treated pheresis platelet units, 115 packed red blood cell (pRBC) units, and 452 irradiated, pRBC units. On average, we transfuse nearly 100 blood products monthly to an average of 32 unique patients. No hemolytic transfusion reactions have occurred in patients receiving blood products from The CHC Blood Bank.

Financial Outcomes: Cost analysis shows that CHC can transfuse one unit of pRBC's for $368. Publicly available data from a large local health system indicates a price of $570 per unit (55% higher). Our outpatient, clinic setting permits same-day or next-day transfusion. In contrast, in the event of unexpected blood results or a lack of capacity in a hospital-associated, outpatient setting, patients would previously need to be sent to the ED for transfusion or directly admitted to the hospital. The inpatient price is determined by DRG which bundles comorbidities and usually results in a charge exceeding $10,000. Thus, avoiding the hospital substantially reduces the cost of care for this patient population.

Conclusions: We demonstrate that transfusions in non-hospital settings are safe and cost effective to meet a patient's transfusion needs. Changes in CMS billing regulations could make this practice widely available.