13 Things Smart Providers Ask About Infusion (IV) Therapy

Medical infusion therapy lounges are becoming an increasingly popular addition to healthcare facilities, offering patients a comfortable environment for IV therapy under medical supervision.

Infusion delivers medication directly into the bloodstream, bypassing the digestive tract, which allows for full bioavailability and controlled dosing that some therapies require. Whether infusion is appropriate for a given patient, and what clinical benefit to expect, is a determination for the treating provider.

At Remy Healthcare, we specialize in partnering with healthcare clinics to establish and maintain quality infusion lounges using our extensive network and 340B program experience to make quality care more accessible and help practices thrive.

After several years in the medical field, Remy Sales Director (and Registered Nurse), Eugene Dinkelis has helped practice owners improve patient outcomes with 340B Pharmacies and Infusion therapies. Here are the 13 most common inquiries he gets from practices interested in adding infusion therapy lounges.

FAQ 1: Does Remy handle prior authorizations for infusion therapy?

Yes. Remy takes prior authorizations off your team's plate so your clinic can stay focused on patient care.

Prior authorizations can be incredibly labor-intensive, requiring detailed paperwork and consistent follow-up with insurance providers. We're experts in navigating the complexities involved in getting medications approved for infusion therapy, especially those considered high-cost.

We manage the prior authorization process end to end, from initial submission through payer determination, using our expertise to navigate insurance requirements efficiently. Approval decisions rest with the payer, but by owning the administrative work we keep cases moving so patients start treatment as quickly as possible, without added stress on your existing administrative or medical staff.

FAQ 2: When Remy evaluates the Electronic Health Record, are they looking for codes or prescriptions?

Yes. Initially, Remy focuses on diagnostic (dx) codes when evaluating your Electronic Health Records (EHR) to create a pro forma.

Diagnostic codes provide a comprehensive understanding of your unique patient population and the need for infusion therapies, helping us identify patterns and determine the feasibility and financial impact of setting up an infusion lounge in your facility.

Once we have an agreement, our Nurse Practitioner conducts an in-depth review of patient charts to identify potential treatment opportunities. This involves reviewing diagnostic codes and relevant prescriptions to capture a complete picture of patient needs.

As partners, our role is to support your physicians and provide them with additional resources and potential treatment options, not to dictate how they should practice medicine - your physicians always retain full control over treatment decisions.

FAQ 3: What time period does Remy use to validate the need for an Infusion Clinic?

We conduct an analysis based on patient data from the previous 6-12 months. This data forms the basis of our pro forma, a detailed financial projection that helps you understand the potential return on investment and operational impact of the infusion clinic.

Focusing on a 6-12 month period allows us to accurately assess trends in patient diagnoses, treatment patterns, and potential demand for infusion services, identifying consistent needs and predicting future utilization of the infusion clinic.

FAQ 4: Does an FQHC's FTCA malpractice coverage extend to infusion services?

It can be, but it depends on two things, and both need to be verified for your health center specifically.

FTCA deemed coverage can extend to infusion services when the service falls within the health center's HRSA-approved scope of project, and when the individual administering the infusion qualifies as a covered employee or an eligible contractor under the deeming statute. Where a claim meets those conditions, the federal government stands in as the responsible party, which is meaningful liability protection for the health center and its staff.

The fact pattern worth flagging: if the nurse administering infusions is employed by a third party rather than the health center, deemed coverage is not automatic. Contractor coverage under FTCA is narrow and fact-specific, and a third-party-employed clinician is exactly the arrangement that needs to be examined rather than assumed. See FAQ 7 below for how staffing is structured in a Remy partnership.

Confirm your own position with your FTCA and risk-management counsel and with HRSA's Bureau of Primary Health Care before you rely on deemed coverage for infusion. Remy's compliance team works alongside our partners on scope and documentation, but the coverage determination is not ours to make.

FAQ 5: Is additional insurance needed to add infusion services?

Not likely. Additional insurance is only required for services that fall outside the standard scope of operations as defined under your existing coverage, typically referred to as gap insurance.

Gap insurance provides a safety net for services that go beyond the usual scope of your operations, covering liabilities or risks that are not covered under existing insurance policies or the Federal Tort Claims Act (FTCA) malpractice coverage. Establishing what constitutes 'in-scope' versus 'out-of-scope' activities is crucial in determining the need for additional insurance to maintain compliance and financial stability while expanding services.

For example, if your Federally Qualified Health Center (FQHC) decides to expand services to include oncology infusions - a specialty not originally within the defined scope of your practice - hiring an oncologist to write infusion orders for such treatments would require the FQHC to purchase gap insurance.

Because coverage terms differ by policy and by carrier, confirm the answer for your own program with your malpractice carrier and counsel before adding services rather than relying on a general rule.

FAQ 6: Is Infusion Therapy considered an "additional service" by HRSA?

Often not - but this is not a state-by-state question, and it is not one to answer by assumption.

Scope of project is determined federally, health center by health center, through the services documented on your Form 5A. Infusion is frequently treated as a method of administering care already within an existing required or additional service rather than as a new service line, which is why many health centers can add it without a scope change. That depends on how your own Form 5A reads and on the therapies you plan to offer.

Take the question to your HRSA project officer before you launch, and confirm whether a change-in-scope request is required for your health center. Getting that answer in writing up front is far easier than unwinding it later, and it also matters for FTCA coverage and 340B site registration.

"From managing prior authorizations and evaluating EHRs to understanding insurance and staffing requirements, at Remy we demystify everything 340B and infusion-related. Whether you're concerned about compliance, patient coverage, or operational logistics, we've got you covered."

• Eugene Dinkelis

FAQ 7: Who employs the infusion nursing staff?

Staff provided by Remy, specifically the registered nurse (RN), will be employed directly by Remy Healthcare.

Although the nurse is an employee of Remy, their daily responsibilities will be carried out within your facility, focusing on providing high-quality coordination and infusion services to your patients.

This arrangement allows your clinic to benefit from the expertise of Remy's specialized healthcare staff without the complexities of direct employment, so you can avoid the administrative burden associated with hiring, training, and managing additional staff.

The result is infusion services are seamlessly integrated into your existing healthcare offerings, enhancing your capacity to deliver comprehensive care while maintaining continuity with other medical services you offer.

FAQ 8: Do you have problems recruiting Spanish-speaking staff?

No. Because we recognize the importance of addressing the linguistic and cultural needs of the diverse patient populations served by our partner facilities, we prioritize the recruitment of bilingual registered nurses (RNs) fluent in both Spanish and English.

We have established a robust recruitment process that targets bilingual professionals, especially in communities where there is a high demand for Spanish-speaking medical staff. This proactive recruitment strategy helps avoid potential issues in staffing bilingual personnel and makes our services more accessible to patients regardless of their primary language.

The goal is care that is effective, culturally sensitive, and easy to understand and navigate. Federal language-access obligations rest with the covered entity, and bilingual infusion staffing is one component of meeting them - it supports your language-access plan rather than replacing it.

FAQ 9: Does the infusion clinic need to be in the same location as the 340B pharmacy?

No. The infusion clinic does not need to be in the same physical location as the 340B pharmacy, but it must be situated within the in-scope space of the Federally Qualified Health Center (FQHC).

The key compliance requirement is that the infusion suite operates under the umbrella of the FQHC's main facility and adheres to the health center's 340B eligibility and compliance guidelines.

If the infusion suite sits at an offsite location, two registrations have to be in place before 340B drugs may be administered there: the site must appear on the health center's Form 5B, and it must be separately registered as a 340B child site in OPAIS. Child site registration runs on quarterly windows, so build the lead time into your launch plan.

This integration facilitates streamlined operations, maintains compliance with federal regulations, and optimizes patient care by making necessary treatments more accessible and cost-effective.

FAQ 10: Who is responsible for managing phones, scheduling, inventory, and billing?

Remy Healthcare takes full responsibility for managing all operational aspects related to the infusion suite, including handling phone communications, scheduling appointments, managing inventory, and overseeing billing processes.

By centralizing these administrative operations under Remy's management, we ensure infusion lounges are seamlessly integrated into your existing practice. Our experienced team custom tailors specialized systems and protocols to produce a bespoke solution that optimizes efficiency and accuracy in each of these areas while ensuring compliance and your total control over patient treatment.

For example, our scheduling system is tailored to manage patient appointments to avoid overlaps and ensure that each patient receives timely treatment.

Our inventory management tracks par levels and reorder points so medications and supplies are on hand when patients are scheduled, which keeps avoidable delays to a minimum.

Our billing processes are built around current coding and documentation standards, with review steps designed to catch errors before claims go out and to support timely, accurate reimbursement.

This full-spectrum management by Remy enhances operational efficiency and improves patient satisfaction by providing a smooth and organized treatment experience. As your partners, we aim to allow you to focus on providing great patient care, not the administrative tasks associated with it.

FAQ 11: How does Remy help uninsured infusion patients?

Thanks to our extensive experience in the 340B arena, Remy offers an unprecedented range of solutions to help uninsured patients.

The Remy team actively works to ensure uninsured patients have access to necessary infusion therapies by helping them register for free drug programs offered by pharmaceutical manufacturers. These programs are designed to assist patients who do not have health insurance or who are underinsured, providing them with critical medications at no cost. This is particularly important in managing chronic conditions where consistent medication administration is crucial.

Additionally, for clinics not already enrolled in the 340B program, Remy can assess your readiness against HRSA's requirements and support registration and ongoing compliance. Eligibility itself is statutory and is determined by HRSA based on your qualifying federal status.

One operational detail matters here: most manufacturer patient assistance programs exclude drugs purchased at 340B pricing. Free-goods inventory supplied through a PAP and inventory purchased on the 340B account have to be tracked and stored separately, with dispensing documented against the correct source, so that a patient is never treated as receiving both benefits on the same dose. Commingling the two is a duplicate-benefit problem and a predictable audit finding.

Our approach involves a thorough assessment of each patient's eligibility for these programs based on the manufacturers' criteria. Then, we assist in completing and submitting the necessary applications and documentation, helping to mitigate the financial and administrative barriers associated with infusion drugs.

We're proud of our proactive efforts to assist uninsured patients, underscoring our commitment to champion inclusive care and support for all patients, regardless of their financial circumstances.

FAQ 12: Does Remy only offer drugs, or do you also do fluids and electrolytes?

While our primary focus is on administering prescription drugs through infusion therapy, we also offer the administration of fluids and electrolytes as part of our comprehensive service offerings.

This includes treatments such as hydration therapy, which is helpful for patients suffering from dehydration, electrolyte imbalances, or needing supportive care in various medical conditions. Offering both drug infusions and electrolyte treatments allows partners to meet a broader range of patient needs, providing a versatile and comprehensive infusion service. This dual capability enhances the overall care experience, ensuring that patients receive the necessary treatments efficiently and conveniently in one location.

While drug infusion services are often covered under insurance or through the 340B program, fluids and electrolyte infusion is not covered by most insurances and is a cash-based service (paid out-of-pocket by the patient). We ensure that all potential costs are transparently communicated to patients and their caregivers beforehand to help them make informed decisions about their care options.

FAQ 13: Is chemotherapy included?

Remy Healthcare specializes in the administration of biologic therapies rather than chemotherapy. While chemotherapy is a critical component of cancer treatment, it involves the use of chemical substances to stop cancer cells from dividing and growing and is not part of the services provided by Remy.

Biologics are advanced medicinal products often derived from living organisms, and used to treat various conditions such as autoimmune diseases, inflammatory disorders, and some types of cancer. These treatments include monoclonal antibodies and other types of protein-based therapies, which are administered via infusion.

Our focus on biologics allows us to concentrate on a specialized area of infusion therapy that supports patients with chronic diseases in managing their conditions effectively. This specialization ensures that our staff are highly skilled and knowledgeable in the latest advancements and protocols related to biologic therapies, providing the highest level of care and expertise to our patients.

What's Next?

As the demand for specialized infusion therapies continues to grow, understanding the logistics and benefits of setting up an infusion clinic within your healthcare facility becomes paramount.

Remy Healthcare is dedicated to assisting Federally Qualified Health Centers (FQHCs) and other medical providers in enhancing their service offerings through expertly managed infusion lounges and 340B program registration and compliance.

With our comprehensive support in handling everything from prior authorizations to marketing, Remy ensures that your facility can deliver high-quality care without the administrative burden.

Whether you are exploring the addition of infusion services or seeking to optimize your existing operations, our team of experts guides you every step of the way. Our tailored approach doesn't just meet the specific needs of your patient population, but is designed to align with your practice goals, ensuring a seamless integration and operational excellence.

Take the first step towards transforming your patient care services today. Contact us to request a free consultation and receive a customized pro forma. This no-obligation consultation will provide you with all the necessary information to make an informed decision about integrating an infusion clinic into your healthcare practice. Let us help you enhance your patient care capabilities and expand your services to meet the growing needs of your community.