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Infusion & OPAT Economics Calculator

Drug acquisition, nursing, chair time, supplies and reimbursement across a full course of therapy — by site of care.

Illustrative assumptions. Default values here are example inputs for demonstration only — not validated reimbursement rates, costs or benchmarks. Replace every field with your own practice’s figures.

Site of care

Where is therapy delivered?

Coverage frequently determines this before clinical factors do. Where the practice neither supplies the drug nor administers it, those revenue and cost lines fall away — but the coordination work does not.

The course
weeks
/day
Drug & administration
$

Your own acquisition cost under your purchasing arrangement. We publish no drug prices.

$

Your contracted or expected payment. Part B separately payable drugs are broadly ASP-based; commercial terms vary.

$
The work
min

Chair-occupying time: access, infusion, observation, turnover.

$
hrs

Authorisation, vascular access, lab scheduling and chasing, weekly review, complication triage. Largely uncompensated unless structured.

$
Clinical revenue & risk
$

The billable encounters the course genuinely generates.

%

Denial, authorisation lapse or underpayment. In buy-and-bill a hard denial is a realised inventory loss, not deferred revenue.

$

Contribution per course of therapy

$1,640

$273 per week across a 6-week course, after risk-adjusted revenue and direct cost.

Where the money goes

Gross revenue$6,300
Revenue at risk−$378
Drug acquisition−$2,016
Nursing time−$2,002
Coordination−$264
Contribution$1,640
Doses in course
42
Drug revenue
$2,436
Administration revenue
$3,024
Monitoring revenueCaptured regardless of site of care
$840
Total direct cost
$4,282
Contribution per course
$1,640
Coordination as share of marginThe uncompensated work, expressed as what it costs your margin
14%
Courses needed to cover fixed cost
15 / month

Coverage for home infusion of antimicrobials differs materially between Medicare and commercial insurers, and that difference frequently determines site of care. Model each payer class separately rather than blending them.

How this is calculated

  • Doses = weeks × 7 × doses per day.
  • Revenue lines that the practice actually captures depend on site of care: drug and administration revenue accrue only where the practice supplies and administers.
  • Risk-adjusted revenue = gross revenue × (1 − share at risk), reflecting denial, authorisation lapse and underpayment.
  • Contribution = risk-adjusted revenue − (drug acquisition + nursing time + coordination time).

What it does not do

  • It publishes no drug prices, ASP-based payment amounts or margins — every figure is yours.
  • It does not model the Medicare Home Infusion Therapy benefit's specific eligibility, drug-list and professional-visit rules; verify those against current CMS guidance.
  • It does not value avoided readmissions, which accrue mainly to the hospital and are the basis of a contracting conversation rather than a claim.

Now that you have a number

Want to pressure-test this against your actual claims data?

This model is only as good as the assumptions you put into it. Persistex works with independent infectious disease practices on billing, coding and revenue cycle, and a practice review starts from your actual payment and denial data.

Analyze My ID PracticeExplore Persistex

Prototype: these routes to a demonstration form. No data is transmitted or stored.

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