Our goal is to help advance the infusion center industry through education. We aim to educate patients, medical providers and staff, along with other national stakeholders about the importance of office-based Infusion Centers. The following information is meant to be a resource for basic education on the infusion industry and the office-based Infusion Center landscape.
“Infusion” or “infusion therapy” refers to the delivery of medications directly into the veins of a patient, also known as intravenous or IV administration. Sometimes infusion medications are referred to as “injectables” and are lumped into the category that includes provider-supervised intramuscular (IM) and subcutaneous injections (Sub-Q/SQ). “Provider-Supervised” means that they are not typically self-administered by the patient without a medical provider physically present. We often refer to both intravenous (IV) and injectable (IM,SQ) medications in our discussions if they are provider-supervised. A medication that is provider-supervised will likely be administered in an office-based setting (Infusion Center). Intravenous/Infusion or injectable methods of drug delivery are typically used when oral/pill medications are insufficient , inappropriate, or unavailable. Many of the newest medications are Biologic (made or derived from living cells) and cannot be taken orally like a pill because they will not remain effective after exposure to the digestive system.
Many infusion medications are prepared at the time of treatment by a medical professional, commonly a registered nurse. If the medication is intravenous (IV) it will likely be prepared and added to an appropriately sized bag of sterile solution (IV Fluids) which is then administered intravenously through an IV catheter placed by the registered nurse. Some IV and injectable medications come in pre-prepared forms that may not require as much advanced preparation.
To learn more about the basics of infusion, checkout our Infusion 101 educational module.
A wide variety of conditions are treated with infusion (IV) and injectable therapy. Many of the newest infusible and injectable medications are used to treat autoimmune conditions – diseases in which the body’s immune system attacks healthy cells. Infusion therapy is also used to treat a number of other conditions including: infections that are unresponsive to oral antibiotics, cancer and pain associated with cancer, migraines, osteoporosis, osteoarthritis, congestive heart failure, hemophilia, and many more.
Examples of autoimmune conditions treated with IV or injectable biologics include:
- Inflammatory Bowel Diseases, including Crohn’s Disease and Ulcerative Colitis
- Rheumatoid Arthritis
- Multiple Sclerosis
- Psoriatic Arthritis
- And many others…
An Infusion Center is any physical location where infusion/injectable medications are routinely administered under the supervision of a healthcare provider (Medical Doctor, Nurse Practitioner, etc). Usually, this means that the location will have some form of part-time or full-time dedicated space where medications are prepared and administered. Infusion Centers do not include offices who only inject medication as a normal part of their patient procedures in exam rooms. (Example: a Family Practice physician who administers vaccines, steroids, and other agents to patients as a normal part their practice would not be considered to have an Infusion Center.) Infusion Centers are more commonly found in the specialties of Oncology, Hematology, Infectious Disease, Gastroenterology, Rheumatology and others where there are multiple infusible medications for diagnosis’s in their fields of specialty.
Although there is some crossover, most Infusion Centers fall into 3-4 categories.
- Office-Based Infusion Centers
- Hospital-Based Infusion Centers
- Pharmacy-Based Infusion Centers
- Stand-alone Infusion Centers
Office-Based Infusion Centers:
These are locations where a physician or physician group is providing/administering infusion/injectable medications as a distinct part of their practice. There is typically dedicated space and some dedicated staff for the Infusion Center. Larger offices may have multiple Infusion Center locations to better accommodate their patients in different parts of town. Some offices may only treat their own internal patients while other may accept and treat patients referred by other healthcare providers in their communities. For fee-for-service billing, these office-based locations typically fall into the “place of service” 11 code. NICA believes that the Office-Based Infusion Center is currently the most cost-effective site of care for patients needing infusion/injectable therapy.
Hospital-Based Infusion Centers:
These are locations that are owned or operated by Hospitals or Institutional organizations. They are almost always located directly within or on the campus of a Hospital facility. Hospital Outpatient Infusion Centers are sometimes referred to by industry as HOPD’s. All hospitals administer IV/injectable medications as part of their emergency department and inpatient services, however, if they do not have a dedicated facility/department for outpatient infusion services, then we do not consider them to have an Infusion Center. Hospital Infusion Centers may administer a wide variety of therapies including antibiotics, whole blood, blood products, chemotherapy, biologics, and many others. For fee-for-service billing, these hospital outpatient Infusion Centers currently fall into the “place of service” 22 code.
Pharmacy-Based Infusion Centers:
Less common than the previous two are the Pharmacy-Based or Pharmacy-owned Infusion Centers. Typically these locations are part of a company that has a home infusion pharmacy and a focus on providing infusion treatments inside a patient’s home. The Infusion Center will be a space, typically within the offices of the pharmacy, where a patient can receive treatment on-site with a registered nurse. Sometimes, these locations are used so that a patient can receive their first infusion treatment and at the same visit, be trained to self-administer the remainder of their treatments at home without the supervision of a nurse.
Pharmacy Infusion Centers are distinct in that they do not commonly have a medical doctor or nurse practitioner on site directly supervising the infusions/injections. For this reason, under current government regulations, most of the Pharmacy Infusion Centers will not be able to receive payment from Medicare for infusion therapy.
Stand-Alone Infusion Centers:
These are the most difficult sites of care to identify. Stand alone infusion centers, sometimes referred to by industry as SOICs or AICs (Ambulatory Infusion Centers), are locations that are not obviously attached to or located on the premises of a Hospital, doctor’s office, or pharmacy. They may be located in retail shopping areas or other local business offices suite in non-medical areas of town.
There are some cases we are aware of where these locations can exist and service patients with private insurance. It is rare that Medicare patients are treated at this site of care because these locations do not typically have medical doctors or nurse practitioners physically present at any given time. Sometimes these locations are actually one of the other three types listed above, but are organized and marketed in a way that is not obvious to an observer.
New Infusion Center Models:
There are new innovative delivery models that combine traits of both the office-based model and the stand-alone model by the use of nurse practitioners (NP’s). These locations look and feel like a stand-alone operation but are commonly regulated and paid like a doctor’s office. In most US states, nurse practitioners can operate practices independent of a medical doctor’s office or direct ownership/supervision. For billing, these locations use the same classification as a medical provider’s office, place of service 11.
For these locations the nurse practitioner serves not only as the supervising provider, but may administer the infusions/injections as well. Under most current private payer and Medicare guidelines, additional RN staff may work “incident-to” the nurse practitioner so that the NP does not have to directly administer every medication to every patient in order to bill claims for the medication and service.
Infusion Center Management Companies:
Due to the rising complexity and cost of managing an outpatient Infusion Center, many physicians have turned to infusion management companies for assistance. Infusion management companies provide services to physicians and some HOPDs so that many of the challenges of operating an Infusion Center can be outsourced. Staffing, inventory management, facility setup and maintenance, technology systems, billing, etc. can be managed independently allowing the physician and office staff to focus on the medical practice itself and not the Infusion Center.
A infusion management company will have more expertise in dealing with complexities and common issues faced when running a safe and efficient Infusion Center. Independent Infusion Center management services are typically charged as a fee based on the volume of the location and the array of services being performed.
Infusions are administered by a variety of healthcare providers. Infusion Nurses (RN’s), Nurse Practitioners and Medical Doctors are the providers commonly administering IV/injectable medications in office-based Infusion Centers. In some cases, offices may use Medical Assistants (MA) to start IV’s or assist with patient treatments. Different areas of the country may have different regulatory requirements regarding who can administer infusion medications in the office setting.
Office-based Infusion Centers are critical parts of our healthcare system:
- They are generally more accessible geographically than hospital sites of care
- They are more affordable and efficient than hospitals and many other alternative sites of care
- They have a more controlled environment and are often more patient friendly due to their focus on infusion medication administration
Hospitals commonly have long wait-times and a confusing navigation process that is not patient friendly. Hospitals are typically located in major metropolitan areas and are not widely dispersed and accessible for rural and suburban communities of patients. Receiving an infusion in the hospital will typically take longer than the same infusion in an office-based Infusion Center. As a result, many patients find it difficult to get their infusions in the hospital and value the accessibility of their local office-based Infusion Center.
Receiving IV medication in a hospital is typically and exponentially more expensive than receiving the same medication in an office-based Infusion Center. Hospitals and many other institutional environments have the ability to charge much higher fees for their services even if they are offering the same or lower level of care for infusion patients.
Safety and Patient Experience:
Hospitals are big places with lots of staff moving from room to room and patient to patient. Many infusion patients are diagnosed with autoimmune disorders that commonly make them more susceptible to infections than the general population. We believe that the office-based Infusion Center is a more controlled environment that does not expose patients to the kinds of infectious disease that are present in hospitals and larger facility-based locations.
At a hospital, a patient may have a different nurse for each infusion treatment. Alternatively, office-based Infusion Centers commonly have a smaller more focused staff. Patients have reported developing deep relationships with the staff at their Infusion Centers and a more compassionate patient experience as a result.