Chair economics and 340B eligibility are the same decision.
Hospital outpatient infusion is the fastest-growing segment of 340B spending, and the place where drug margin, site-of-care policy and eligibility collide. Most infusion consultants ignore 340B. Most 340B consultants have never modeled a chair. We do both.
At a glance
- 01US AIC market
- ~$12.5B (2026)
- 02Cancer share
- ~31% of applications
- 03Hospital-based share
- ~55%
- 04Modeled together
- 340B + reimbursement
Why the two halves get advised separately — and why that fails
When a health system evaluates whether to open, relocate or expand an infusion center, the pro forma usually comes from an operations or reimbursement advisor. It models chair count, utilization, staffing ratios, payer mix and reimbursement per code.
What it very often omits is that moving infusion from a hospital outpatient department to a freestanding location can change 340B eligibility for the drugs administered there. On a service line where drugs are the dominant cost, that single omission can invert the entire business case.
Meanwhile, site-neutral payment policy continues to compress reimbursement on the most common infusion codes, white bagging moves drug acquisition off your books entirely, and payer steerage pushes patients toward provider-preferred sites. Each of these interacts with the others.
We build one model that holds all of it — operations, reimbursement and 340B — because that is how the decision actually behaves.
How one decision moves three variables
01Move HOPD infusion to a freestanding site
- Operational effect
- Lower facility cost, often better patient experience and parking
- Reimbursement effect
- Site-neutral rates typically apply; facility fee structure changes
- 340B effect
- Eligibility for drugs administered there may change entirely — frequently the dominant variable
02Add chairs at an existing HOPD
- Operational effect
- Capacity relief, better scheduling flexibility
- Reimbursement effect
- Marginal revenue per chair, subject to code mix
- 340B effect
- Eligibility unchanged; capture depends on correct location mapping
03Accept payer white bagging
- Operational effect
- Inventory and safety handling complexity increases
- Reimbursement effect
- Drug revenue moves off your books; administration fee only
- 340B effect
- 340B volume falls for affected drugs and patients
04Open a new service line site
- Operational effect
- New staffing, new referral pathways
- Reimbursement effect
- New payer contracts and rate negotiation
- 340B effect
- Registration timing is critical — an unregistered quarter is permanently lost
Infusion center consulting — common questions
01Does moving infusion to a freestanding site affect 340B?
It can, substantially. Eligibility depends on the registration status of the site, its relationship to the covered entity, and whether it qualifies as a child site under the cost report. On a service line where drug cost dominates, this variable frequently outweighs the facility savings that motivated the move in the first place.
02What utilization do we need for a new infusion center to work?
There is no universal threshold — it depends on chair count, payer mix, drug mix, staffing model and whether the site is 340B eligible. The same chair count can be strongly profitable or clearly unviable depending on those inputs, which is why a generic benchmark is not useful.
03How do we respond to payer white bagging mandates?
Options include contract negotiation, clinical safety and handling policy, patient access arguments, and in some states legislative protections. The right response depends on your payer concentration and state law.
04Can you help with an existing center rather than a new one?
Yes, and this is a large share of our infusion work. Optimization of an existing center usually focuses on utilization, scheduling, referral leakage, code mix and 340B capture — often with materially better return than opening anything new.
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Next step
Modeling an infusion decision this year?
Bring us the pro forma you already have. The fastest value we add is usually telling you which variable it is missing.