This article was originally published by Medscape on June 10, 2026 and is republished here with permission. The views and opinions expressed in this post are solely those of the author and do not necessarily reflect the official policy or position of InfuseTrack. Read the original article here.
When I began my journey in private practice in 2007, I quickly recognized a gap in how infusion therapies were being delivered to patients with rheumatologic disease. Many of my patients faced logistical challenges navigating hospital-based infusion centers — delays, fragmented care, and limited physician oversight. By 2008, I made the decision to build something different: an in-office infusion center within my practice.
At the time, I explored partnerships with several infusion management companies. While their models appeared operationally convenient, I found a lack of transparency in their protocols, billing structures, and contractual terms. More importantly, their approaches did not align with the level of control and patient-centered care I envisioned. That realization ultimately led me down the more difficult — but far more rewarding — path of building and managing the infusion center independently.
Building From the Ground Up
Starting an infusion center within a private practice demanded a willingness to step into unfamiliar territory: finance, operations, and logistics. One of the earliest hurdles was managing the financial burden of drug acquisition. Negotiating extended payment terms with vendors — including McKesson, Metro Medical, and Henry Schein — became essential to sustaining early operations and maintaining cash flow.
Clinically, I approached the process methodically. Each medication introduced into the infusion suite required its own framework: protocol development, cost analysis, and alignment with reimbursement pathways. Initially, I relied heavily on pharmaceutical manufacturer guidance, but over time, these protocols evolved into more comprehensive systems incorporating dosing standards, billing codes, and safety measures tailored specifically to my patient population.
Early Challenges and Hard Lessons
Looking back, the early phase of development was marked by trial and error. I underestimated the importance of financial infrastructure and lacked a clear system for tracking profit and loss. Billing processes were another steep learning curve; understanding electronic medical record workflows, auditing claims, and navigating reimbursement complexities proved just as critical as delivering the infusion itself.
These gaps, while challenging, became defining learning moments. They forced me to rethink the structure of the practice and invest in building systems that could support long-term sustainability.
Creating Stability Through Systems
Over time, I implemented several key changes that transformed operations. Establishing an in-house billing team provided greater control and accountability. Developing structured financial tracking tools brought much-needed visibility into the economics of the infusion center. Negotiating 90-day credit terms improved liquidity and reduced financial strain during growth phases.
These operational shifts were not immediate solutions but gradual improvements that created a more stable and scalable foundation.
Scaling With Purpose
The infusion center began modestly, with four chairs and a single nurse working 1 day per week. Growth was intentional and driven entirely by patient demand. As volume increased, we expanded to six chairs and extended nursing coverage to multiple days per week.
Rather than adopting rigid staffing models, I prioritized flexibility. Today, our system supports a 4:1 patient-to-nurse ratio, with scheduling intervals designed around infusion duration and patient needs. This adaptability has allowed us to maintain efficiency without compromising quality of care.
The Human Element: Staffing and Culture
If there is one area that continues to require constant attention, it is staffing. Early on, I chose not to rely on temporary nursing staff, recognizing the importance of consistency for both patient comfort and clinical quality. Building a dependable team required time, trust, and a willingness to adapt schedules to meet the needs of skilled nurses.
This investment in people has been one of the most valuable decisions in the evolution of the infusion center.
Designing Reliable Workflows
As the practice matured, standardization became critical. We developed infusion reaction protocols to ensure consistent responses across therapies, improving both safety and team confidence.
Inventory management also evolved into a structured system. With buy-and-bill medications, even small inefficiencies can lead to significant losses. Implementing dedicated oversight, separating sample medications, and routinely monitoring expiration dates became essential safeguards.
Navigating Prior Authorizations
Perhaps one of the most complex aspects of infusion management is the prior authorization process. What initially felt like an administrative burden became a core operational function requiring precision and foresight.
We developed a proactive, multistep workflow:
- Initiating authorizations well in advance
- Re-verifying benefits before procurement
- Enrolling patients in manufacturer support programs
- Ordering medications only after full approval
Despite these systems, approvals for new therapies can still take weeks, reinforcing the need for careful planning and patient communication.
What I Would Do Differently
If I were to start again, I would approach the process with far greater structure from the outset. Financial tracking systems, billing expertise, and standardized workflows would be established before seeing the first infusion patient.
More importantly, I would replace uncertainty with confidence — recognizing that while challenges are inevitable, they are also manageable with the right framework in place.
Closing Reflections
Today, the infusion center is not just an extension of my practice — it is an integral part of how I deliver care. It allows for continuity, accessibility, and a level of personalization that would be difficult to achieve in other settings.
For physicians considering this path, my experience offers a simple perspective: While the process is complex, it is also deeply worthwhile.
Guest Author: Padma Rao Chimata, MD, is a board-certified rheumatologist, fellowship trained in rheumatology and geriatrics. She has been in private practice since 2007 and is the founder and director of Katy Rheumatology & Associates in Katy, Texas. She is the 2026 president of the Harris County Medical Society (West Branch) and is a member of the Texas Medical Association and the American College of Rheumatology.
Citations: How I Did It: Establishing and Scaling an Office-Based Infusion Center – Medscape – June 10, 2026.
Image: Adobe Stock
