Considerations for Opening an In-Office Infusion Center
If you work in a physician-based practice and have been thinking about opening an in-office infusion center for your patients we wrote this post especially for you. Deciding to open an Infusion Center is not the same as deciding to offer vaccines, sonograms, or many other ancillary services. Infusion requires careful consideration and commitment, so we have created a quick primer on the requirements, costs, and commitments you must be willing to make in order to be successful in opening your Infusion Center doors.
What defines the term Infusion Center? If the practice has some minimum space and/or personnel dedicated to the business of infusion, I like to say that the practice has an “Infusion Center.” Giving a few Prolia injections a month in regularly used exam rooms likely doesn’t qualify for the term, but it’s not my call after all.
There is no one-size-fits-all approach to opening and managing an Infusion Center. I have seen just about every variety of Infusion Center model – from a folding chair in a utility closet with a nail in the wall (for the IV bag) – to a 40 chair luxury suite with heated massage chairs and a catering menu. I personally have minimum requirements that I believe offer the best chance of clinical and financial success and those experiences were used to create this post.
Minimum Requirements for your new Infusion Center:
- You must have the patients
- You must have dedicated space
- You must have some dedicated staff
- You must have the cash and financial wherewithal
Infusion Requires Patients
It would seem like an obvious observation, but not every provider/practice/specialty will have the kind of patient population that can utilize infusion therapy. In order to create long-term success for your Infusion Center, you must have a minimum of treatments weekly/monthly to cover and ultimately exceed your overhead costs. Since most infusion treatments are interval dosed in bi-weekly, monthly, and longer frequencies – it requires many patients to get to a steady patient flow per day, per week and so on. In my experience, there is no perfect specialty that will always have the right patient population for an infusion center. While it is true that specialties like Rheumatology, Gastroenterology, Neurology, Immunology and Infectious Disease lend themselves to a higher concentration of patient disease states that utilize infusion therapy, the specialty in and of itself is not a qualifier for success.
Majority of infusion treatments are for diagnosis that are fairly rare in the U.S. population. As an example, Rheumatoid Arthritis (RA) affects only about 0.6% of the US population according to the CDC and not every patient with RA will need an infusible/injectable biologic medication. Other autoimmune disease like Multiple Sclerosis (0.09%), Crohn’s Disease (0.2%), Psoriasis (2%), are also in the lower percentage of the general population.
This means that the practice geography, population density, number of providers in the practice, and other factors have an important impact on the number of prospective patients and therefore the number of treatments possible in your Infusion Center.
How many treatments do you need to break even? That depends on your commitment to the next two requirements, but in general, you need enough treatments to cover the cost of your infusion nurse payroll and the general overhead of your Infusion Center. If you have not done the math and answered the potential or existing patient population question, don’t read any further. Having a realistic understanding of your patient population is number 1 on the list. Infusion is not a “build it and they will come” business model.
Infusion Requires Dedicated Space
However tempting it is to “borrow” some exam room space in an “as-needed” attempt to minimize costs – Don’t Do It! Your infusion patients need dedicated space and resources.
Providing in-office infusion is not a weekend hobby. If you are not prepared to commit the space, you are probably not ready to commit the staff, or the cash needed to create a successful and robust Infusion Center.
The Infusion Center workflow is not the same as your practice workflow. Treating it as such will start you and your office team down a path of bad habits that co-mingle infusion workflow with your practice workflow. Infusions require separate and specialized patient workflows, documentation, supplies, and inventory management systems. All of these systems need a place in your practice they can call home. For the sake of your infusion patients and your infusion nurse, you need to create the most practical, comfortable, and safe environment possible. If you were the patient, imagine what you would want and expect from your physician, then use that as a guide to creating your own Infusion Center space.
Infusion Requires Dedicated Staff
If I were to tell you that we were going to start a $1,000,000 healthcare business together, but I was going to staff it with a part-time medical assistant (I can say this because my wife was an MA for 8+ years), you probably would not invest in my business model. Yet, many providers each year make the decision to start in-office infusions and, in a misguided effort to reduce cost, they put the burden of managing this new service on the backs of their existing staff while requiring them to maintain their current workloads as well.
Even the smallest Infusion Centers will quickly rack up an annual spend of $1,000,000 or more due to the expense of the infusion medications. For many practices, the Infusion Center is the largest revenue and expense line on the P&L statement. Why would you put part-time effort into something that important to your bottom line? Your practice likely has multiple staff members in multiple roles to manage patients, set appointments, and bill and collect payments. Why would anyone think that you wouldn’t need at least one dedicated team member for your Infusion Center?
Even with the best workflow, scheduling, and inventory management systems (we are partial to one in particular – weinfuse.com) I would still seriously recommend dedicating someone to have ownership of the Infusion Center as their primary role in your practice. There are simply too many balls to juggle not to have someone who can stay in touch and track all the variables required to keep patients on schedule, authorizations updated, inventory in stock, and reconcile all the things necessary to treat an infusion patient and, most importantly, get paid for doing it.
If you can’t get comfortable dedicating some staff to your new Infusion Center, you probably are not ready to take on this new venture in your practice.
Infusion Requires Cash
This last consideration is really a summary of the first 3. It takes cash or free cash flow from a busy and thriving practice in order to have the right space, the right staff, and the right equipment and supplies to operate a safe and successful Infusion Center.
Like any startup business, adding an Infusion Center to your practice will require that you invest some resources into the space, systems, staff, and inventory needed to operate. If you want to create a better patient experience, you may want to invest additional dollars in the space itself and in the amenities offered to your patients.
Registered Nurses (RN’s) that are familiar and experienced with in-office medications are (and should be) expensive. While your Infusion Center grows, you may have to pay some minimum hour shifts in order to attract a consistent and reliable infusion nurse for your practice. This means that you may need to pay some nursing hours when you don’t have enough patients to keep him/her busy. That cost can be a great motivator to get your infusion chairs full.
With regard to your medication inventory, resist the urge to take long terms (60-90 days) with your infusion vendors in an effort to reduce the required cash needed to stock the center with your first Buy&Bill drugs. While systems like WeInfuse can help greatly to reduce your extra inventory days on hand, there is always some inventory you need to own in cash so you don’t rely entirely on vendor credit to float your center. Having more of your own “skin in the game” will help keep you focused on the kinds of tasks and processes you need to ensure that all Infusion Center workflows happen correctly in a way to maximize the profitability and minimize the loss in your center.
In no way shape or form is this post meant to serve as some kind of “Infusion Centers for Dummies” guidebook. Anyone that tells you that adding and maintaining an in-office infusion center is easy likely does not have the experience and expertise needed to advise your practice. Infusion Centers are complex endeavors that require a great deal of planning and sustained focus to operate safely, efficiently, and at a profit.
Here is the good news – If you are good with the requirements mentioned above and you invest in systems that create process dependent workflows (as opposed to people dependent workflows), you can operate a thriving Infusion Center that will serve as a critical patient access point for not only your patients but those of your surrounding community.
Want to learn more about how WeInfuse can help you create and sustain a thriving Infusion Center in your practice? Take a look at our website, request a demo and we can start a conversation about how to begin or revive Infusion for you.