Based on overwhelming feedback on our original Blog Post – Considerations for Opening an In-Office Infusion Center, we decided to reboot the original article and re-post it here with some minor edits. We are continuing to help new and existing Infusion Centers open and improve across the country. If you have ever considered opening or expanding your own in-office Infusion Center or Infusion Suite, take a moment to read below.
If you are a physician-based practice and have been thinking about opening an in-office Infusion Center (aka Infusion Suite) for your patients, we wrote this post especially for you. Creating an in-office Infusion Center is not the same as deciding to offer vaccines, sonograms, or many other ancillary services. Infusion requires careful consideration and commitment. We have created a quick primer on the requirements, costs, and commitments you must be willing to make 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 office-based Infusion Center. We 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 infusion chair luxury suite with heated massage chairs and a personal meal menu for patients.
We have selected some minimum requirements that we believe offer the best chance of clinical and financial success and offered them in this post below:
- You must have the right 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. To create long-term success for your Infusion Center, you must have a minimum number of treatments weekly/monthly to cover and ultimately exceed your overhead costs. Since most infusion treatments are dosed in bi-weekly, monthly, and longer frequencies – there is a certain volume of patients needed to get to a steady patient flow per day, per week and so on.
In our experience, there is no perfect medical specialty that will always have the “perfect” patient population for an in-office Infusion Center. While it is true that medical specialties like Rheumatology, Gastroenterology, Neurology, Immunology and Infectious Disease lend themselves to a higher concentration of patient disease states that utilize infusion therapy, a specific specialty, in and of itself, is not always a qualifier for success.
Majority of patient infusion treatments are for diagnoses that are 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 diseases such as 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 in-office 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 yet taken the time to do the math and answer the potential or existing patient population question, don’t read any further. Having a realistic understanding of your practice patient population is number 1 on the priority list. The in-office Infusion Center is not a “build it and they will come” business model. Not doing the homework will be an expensive lesson to anyone who rushes in without being prepared.
Infusion Requires Dedicated Space
Tempting as it is to “borrow” some extra exam room space in an “as-needed” attempt to minimize costs – Don’t Do It! Your infusion patients need dedicated space and other resources.
Providing in-office infusion is not a weekend hobby. If you are not prepared to at least 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 in-office Infusion Center workflow is not the same as the physician 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. 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. Imagine that you are your own Infusion Center patient and think about the kind of environment you would expect from your physician, then use that idea as a guide to creating your own Infusion Center space.
Infusion Requires Dedicated Staff
If we were to tell you that we were going to start a $1,000,000 healthcare business together, but we were only going to staff it with a part-time medical assistant (Yes, I can say this because my wife was an MA for 8+ years), you probably would not invest in our business model. Yet, many providers each year make the decision to start in-office Infusion Centers.
In a well-intentioned but misguided effort to reduce cost, physicians put the burden of managing their in-office Infusion Center on the backs of their existing staff, while requiring them to maintain their current office duties 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 and get paid for each infusion treatment. 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 required to achieve the first 3. It takes cash or free cash flow from a busy and thriving practice to have the right space, the right staff, and the right equipment to operate a safe and successful Infusion Center.
Adding an Infusion Center to your practice will require that you invest resources into the systems, staff, and inventory needed to operate. If you want to create an ideal patient experience, you may want to invest additional dollars in the space and amenities offered to your patients.
Registered Nurses (RN’s) that are experienced with in-office medications are expensive (for good reason). While your Infusion Center grows, you may need to pay some minimum hour shifts to attract a consistent and reliable infusion nurse presence 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. This cost is a great motivator to get your infusion chairs full!
With regards to your medication inventory, resist the urge to take longer terms (60-90-120 days) with your medication vendors 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 specialty inventory. 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 and in a way to maximize profitability and minimize loss.
Conclusion
In no way, shape, or form is this post meant to serve as an “Infusion Centers for Dummies” guide.
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 profitably.
Here is the good news – If you are comfortable with the 4 requirements mentioned above and 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? Tour our website, request a demo and let us start a conversation about how to begin or revive in-office Infusion services for your practice.
