How Site-of-Care Restrictions Impact Infusion Therapy Access

Changes in healthcare policy and insurance mandates are reshaping how patients receive specialized medical treatments. For medical providers who prescribe infusion therapy, one of the most significant shifts is the rise of site-of-care restrictions. These policies, implemented by insurance payors, often require patients to move their treatments from hospital outpatient departments to alternative settings like ambulatory infusion centers (AICs). Understanding this trend is essential for ensuring your patients maintain continuous, affordable access to the care they need.

The Shift to Ambulatory Infusion Centers

Insurance payors are increasingly focused on managing the total cost of care. Infusion therapies, particularly for complex chronic conditions, represent a significant expense. When these treatments are administered in a hospital outpatient department, the costs can be substantially higher than in other settings. As a result, many payors now designate ambulatory infusion centers as the preferred site of care for non-urgent infusion services.

This policy change has a direct impact on providers and their patients. When a patient’s insurance plan imposes a site-of-care restriction, they may no longer have coverage for infusions at their current hospital. This can lead to confusion, administrative burdens for your practice, and potential interruptions in therapy if a suitable alternative is not found quickly. For providers, partnering with an infusion center such as Healix Infusion Care is essential to guarantee a smooth transition of care.

Ambulatory Infusion Centers, like Healix Infusion Care, average ~50% lower cost compared to hospital outpatient infusion centers.

The Financial Burden of Hospital Facility Fees

One of the primary reasons for the cost difference between hospitals and AICs is the presence of facility fees. Hospital systems often add these significant charges to a patient’s bill simply for receiving services within their facility. These fees are intended to cover the high overhead costs of running a large, multi-service hospital, but they also increase patients’ out-of-pocket expenses.

Many patients are unaware of facility fees until they receive a surprisingly high bill. This can lead to financial distress and, in some cases, cause patients to delay or discontinue their prescribed therapy.

• Hospital Infusion Centers: Frequently bill for facility fees in addition to the cost of medication and its administration. This results in higher costs for both the patient and the payor.
• Healix Infusion Care: We do not charge facility fees. Our billing is transparent and straightforward, covering only the medication and the clinical services required for its administration. This model aligns with payor mandates and significantly reduces the financial burden on your patients.

By referring patients to a center that has eliminated facility fees, you can help protect them from unexpected costs and promote better long-term adherence to their treatment plan.

The Benefits of Referring to Healix Infusion Care

Partnering with an experienced ambulatory infusion provider like Healix Infusion Care offers a reliable solution to the challenges posed by site-of-care restrictions. Our model is designed to provide high-quality clinical care in a cost-effective, convenient setting for patients. Referring your patients to Healix ensures they receive the care you prescribed in an environment built for their comfort and safety.

Significant Cost Savings for Patients

The most immediate benefit of transitioning care to Healix is the elimination of facility fees. This directly translates to lower out-of-pocket costs, making treatment more affordable and sustainable. By reducing financial barriers, you empower patients to remain compliant with their therapy, leading to better clinical outcomes. Our transparent billing practices provide peace of mind and predictability.

Ambulatory Infusion Centers, like Healix Infusion Care, average ~50% lower cost compared to hospital outpatient infusion centers.

Enhanced Convenience and Access

Navigating a large hospital campus can be a stressful experience. Patients often face challenges with parking, long walks to the infusion department, and extended wait times. Our infusion centers are designed to overcome these obstacles.

Healix Infusion Care centers offer a more convenient experience with features like:

• Easy-to-access locations
• Free and convenient parking
• Efficient scheduling to minimize wait times
• A calm, comfortable, and private setting

This focus on convenience reduces the logistical stress associated with regular infusion treatments and helps create a more positive patient experience.

Clinical Excellence and Specialized Care

Choosing an AIC does not mean compromising on quality. Our infusion centers are staffed by highly trained clinical teams, including experienced nurses who specialize in infusion care. We operate under strict clinical protocols to ensure patient safety and treatment efficacy. Because our focus is solely on infusion services, our staff develops a deep expertise that benefits every patient who walks through our doors.

Seamless Administrative and Clinical Support

We understand that managing referrals, insurance authorizations, and care transitions adds to your practice’s workload. Our team is here to provide comprehensive support. We handle the benefits investigation and prior authorization processes, coordinating directly with the patient and the payor. This allows your office to focus on clinical decision-making, rather than administrative tasks.

Our team works as an extension of yours, ensuring we have all the necessary clinical documentation and that the patient’s transition to our center is smooth and efficient.

Partner with Healix to Ensure Continuous Care

Site-of-care restrictions are becoming a standard component of modern healthcare. By proactively partnering with a trusted ambulatory infusion provider, you can ensure your patients continue to receive their vital therapies without interruption or financial hardship. Healix Infusion Care offers a solution that satisfies payor requirements while prioritizing clinical quality, patient convenience, and affordability.

To learn more or refer a patient, please use the contact information below. Our team is ready to support you and your patients.

• Phone: (800) 958-4042
• Online: Refer to Healix using our secure provider portal to get started
• Fax: Send completed order forms directly to (833) 786-0025.

*Disclaimer – This information is for educational and informational purposes only, and does not constitute medical advice or professional services. It is intended as a general resource to help understand diagnoses and treatment options. If you have concerns about a medical condition or are interested in a specific treatment, please consult your healthcare provider.