CHICAGO—As declining reimbursements continue to challenge rheumatology practices, practice-owners and managers continue to explore ancillary streams of income. During an ACR Convergence 2025 session titled Enhancing Practice Profitability: Exploring Ancillary Streams of Revenue for Rheumatology Practices, seasoned rheumatologists shared details regarding extra services they offer that have broadened their practice revenue streams and enhanced patient care, including infusion services, ultrasound, research and remote therapeutic monitoring/chronic care management.
Here are a few pearls for each of these options.
Infusion Centers
Some rheumatologists are starting infusion centers to offer infusion-based medications to patients. Although these centers require constant monitoring and adjusting, they also can serve as a win-win for both rheumatologists and their patients.
A few tips include the following:
- Check your state laws around infusion centers, including any qualifications regarding who can supervise the center.
- Reach out to specialists in your area (such as oncologists) who have established policies and practices around infusion and have been advocating for years, advised Tien-I Karleen Su, MD, FACR, of the Amicus Arthritis & Osteoporosis Center in Whittier, Calif. “We have to reach out to them and say, ‘How did you do this?’” Dr. Su said.
- Choose your infusion center staff strategically based on who is allowed to work in the center and what their schedule is, recommended Nehad Soloman, MD, of Arizona Arthritis & Rheumatology Associates in Glendale. For instance, you may have a nurse who works one or two days a week. Aim for efficiency without overworking your infusion staff when it comes to patient volume.
- Make sure you have space in your practice for at least one patient chair, as well as a refrigerator for the medication.
Ultrasound
Nilanjana Bose, MD, MBA, of Lonestar Rheumatology in Houston, said her onsite ultrasound services do not provide a major profitability boost, but they have been helpful. She leases the machine and said as a one-doctor clinic, it’s small-volume use.
“It helps us monitor responses to treatment,” she explained. “It’s great to have because people don’t want to go to an imaging center.”
Dr. Soloman said his practice uses ultrasound with diagnoses related to Sjögren’s disease, polymyalgia rheumatica and differential diagnoses. “Having the data from the service to manage and track patients is very helpful,” he said.
Here are a few pearls if your practice considers adding ultrasound services:
- Expect to take two to three months to get your ultrasound technician fully acquainted with ultrasound for rheumatology, Dr. Su said.
- Plan a set amount of time for each patient receiving an ultrasound, but expect some adjustment. For instance, Dr. Su’s practice recently aimed for 15 minutes with each patient, but they have realized timing may need to extend to 20 minutes. At Dr. Bose’s practice, the tech takes about 30 minutes per patient because the images take awhile to upload.
- Use your ultrasound services as a marketing tool. It can be a marketing boost for your practice when you let patients know they could get ultrasound done at your office versus traveling to another medical center.
- Remind coders and payers that ultrasound within rheumatology has special, specific codes, Dr. Su said.
Research Services
Working with a research company or setting up your own in-house staff to recruit patients for relevant clinical trials can also help build ancillary streams of income. It’s a service the session presenters said they enjoy and find useful, although physician-owners should feel passionate about research if they want to pursue this, Dr. Soloman said.
Both Drs. Bose and Su partnered with research companies, while Dr. Soloman’s practice has a research team with 15 staff members, including a chief of research and a research manager.
Here are a few tips to build your research services:
- Work with your potential research partner to make sure you’ll have enough patients to refer for studies. “Otherwise, the whole set up is a lot of work,” Dr. Su said.
- Consider whether you have enough patients who will want to take part in trials. “If you’re in an area where people have good insurance, it may be hard to find patients,” Dr. Su said. Her patients who take part in trials love participating and feel as if they are getting white glove service, she said.
- Be prepared to get familiar with the large amount of work and regulatory steps involved with setting up a trial. This will be the case even if you work with an outside company.
- Determine whether your staff will work a portion of their time with research and another portion with other duties. For example, this could be a 60/40 or 70/30 split, Dr. Soloman said.
- Know that with great work comes great responsibility. Taking part in and leading clinical trials is exciting, but a little nerve-wracking, too. “The buck stops with you when you’re the [principal investigator],” Dr. Soloman said. “It’s not something you should take lightly.”
Remote Therapeutic Monitoring
Some practices use remote therapeutic monitoring and chronic care management to track patients. These types of monitoring help both with patients on the individual level, and also population health management.
If your practice wants to try it, here are a few pearls to consider:
- Decide whether you want to partner with a company or have someone handle it in-house. Dr. Su used a company at first but then switched to in-house staff.
- Work with staff members who will be patient when it comes to teaching older patients about technology related to monitoring.
Vanessa Caceres is a medical writer in Bradenton, Florida.