CHICAGO—Although operating an infusion center has its challenges, it still can offer advantages to your practice if you run it efficiently.
Mr. Jay Salliotte
That’s what Jay Salliotte, MBA, managing director with Advanced Rheumatology of Okemos, Mich., and Nehad Soloman, MD, of Arizona Arthritis & Rheumatology Associates in Glendale, shared during the session, Don’t Lose Your Shirt! Building and Managing a Thriving Rheumatology Infusion Practice. Their session was held during the inaugural Practice Innovation Summit in advance of ACR Convergence 2025.
“Infusion and injection programs are not set it and forget it,” he said. They require constant monitoring and adjusting. “There is risk and margins are shrinking, but it still is a worthwhile effort,” Mr. Salliotte explained.
Dr. Nehad Soloman
Here are other pearls from Mr. Salliotte and Dr. Soloman on how to efficiently operate an infusion center at your practice:
- Start simple. You don’t need multiple chairs, snacks, blanket warmers and other luxury conveniences to get started, Mr. Salliotte said. Consider starting with just one infusion chair, perhaps even for a limited number of medications. Once you’re comfortable with the work involved, you can then expand your operations.
- Pick your infusion staff and schedule strategically. State laws may guide who you’re able to hire to provide infusions. You don’t necessarily need someone working full time. Depending on the infusion business size, it’s not uncommon to have, say, an infusion nurse who works hourly one or two days a week. Watch for “infusion fatigue” settling in around 14 to 15 infusions, Mr. Salliotte cautioned. However, some skilled infusion nurses may be able to handle more. “You want to make sure your nurse isn’t overworked, but is working and efficient,” Dr. Soloman said.
- Have someone (or more than one person) at your practice with a clear role in tracking the infusion market. There’s a lot of instability within the biosimilar market, and you’ll need someone to stay on top of medical and billing policy changes. Don’t leave this responsibility to be performed on the fly. Make sure to also look at payer portals proactively for changes they may post, and have someone manage your infusion inventory system, Mr. Salliotte advised.
- Verify insurance information with the carrier, but also double and triple check information with the patient. Practices know the importance of verifying insurance coverage for patients in advance, but information can change rapidly. Therefore, Mr. Salliotte’s practice will intentionally ask patients two or three times if they’ve had any changes to their address or insurance. That’s because it sometimes takes that second or third ask before a patient remembers a recent change. That’s crucial to know before you start to administer an infusion.
- Plan for stockpiling. In recent years, there have been temporary shortages and backorders for items involved with infusions, such as IV bags and prefilled saline syringes, Mr. Salliotte said. Plan with infusion staff what amount of stockpiling you feel financially and logistically comfortable having in case a shortage hits again.
- Benchmark against yourself. “Don’t worry too much about other practices,” Mr. Salliotte advised. Instead, pay close attention to your own practice stats related to items such as average days in accounts receivable (A/R), average A/R at the end of the month, and average time from prescribing decision to treatment and then to payment. Always re-evaluate how you can improve these numbers. “You need to look at every metric,” Dr. Soloman said.
- Don’t assume 100% reimbursement from an insurance company for infusion services is a good thing. “Is that a happy-day situation, or not?” Mr. Salliotte asked. “It’s really not. That means you left money on the table.” This generally means the insurer has a reimbursement higher than what you asked for, but they’re not going to pay you more than what you asked for. When you encounter this scenario, make sure to reassess your fee schedule.
- Understand specific billing and coding considerations. Mr. Salliotte said one such consideration is that the time for an infusion starts when the actual medication is started, not when the IV port is inserted. Then, to bill for an additional hour, the infusion would have to run at least 31 minutes into the next hour. That’s one example, but there are others you and your infusion team will want to know and understand.
- See where you can save money on infusion drugs. You can always ask for a discount, even if companies balk at the idea, Mr. Salliotte said. You also can explore multispecialty group purchasing organizations for more power in numbers. Although rebates may help, keep in mind some are simple but others require a lot of paperwork.
- Be wary if the cost of an infusion drug seems too low. Mr. Salliotte has received calls from distributors that offer very low pricing only to find out the drug is sourced outside the U.S. The salesperson may say the drug is shipped from Florida, for example, but if you probe further, they reveal it was made in the Caribbean or another area outside the U.S.
- Market your infusion practice among local medical groups and among other local specialties where there may be patient overlaps, Dr. Soloman advised. This may include dermatology, endocrinology, neurology, ophthalmology and orthopedics.
Vanessa Caceres is a medical writer in Bradenton, Fla.
Reference
- Harrop C/Medical Group Management Association (October 2025). Does your margin have breathing room? Insights from MGMA DataDive Benchmarks. https://www.mgma.com/mgma-stat/does-your-margin-have-breathing-room-mgma-stat-datadive
