5 min read
2025-01-08
Retina practices buy anti-VEGF inventory at $1,500 to $2,200 per dose, then wait 30 to 90 days for reimbursement. Most fund the gap with a working capital line of credit. Smarter banking does not eliminate the gap, but it reduces what funding it costs.
A retina practice running anti-VEGF injections is operating one of the highest-volume drug spend businesses in outpatient medicine. A single Eylea, Avastin, or Lucentis dose can cost the practice $1,500 to $2,200, paid up front to the wholesaler. Reimbursement typically comes 30 to 60 days later, sometimes longer. Margins are slim. Volume covers it. But the cash gap between buying the drug and getting paid for it is real, and most practices manage that gap with a working capital line of credit. Smart banking does not eliminate the gap. It reduces what it costs you to fund.
The Buy-and-Bill Cash Cycle Is the Whole Game
A typical retina practice buys anti-VEGF inventory weekly or biweekly. A practice doing 200 injections a month spends $300,000 to $440,000 a month on drug acquisition. Reimbursement timing varies by payer:
Medicare and Medicare Advantage: 14 to 30 days.
Commercial: 14 to 45 days.
Medicaid: 30 to 90 days, sometimes longer.
Working AR for a busy retina practice routinely sits at $500K to $2M in receivables tied to drug-billed claims. That AR has to be funded. Most practices fund it with a working capital line of credit.
A Banking Structure That Maps to the Drug Spend Cycle
The structure most retina-heavy practices land on:
Root operating account.
Virtual account: drug acquisition reserve (funds wholesaler payments).
Virtual account: drug-billed reimbursement receipts (Medicare, MA, commercial, Medicaid).
Virtual account: surgical reimbursement (vitrectomies, scleral buckles, OCT-driven procedures).
Virtual account: exam reimbursement (E&M and minor procedures).
Virtual account: payroll reserve.
Virtual account: tax reserve.
Drug spend has its own ledger from acquisition to reimbursement. Your CFO or revenue cycle lead can answer "are we current on our drug billing?" at any point in the day, not just after a quarterly reconciliation.
Yield on the Reserve Pays for Part of the Bridge
Idle cash earning 1.75% APY across a typical retina practice's $1M to $3M operating reserve generates $17,500 to $52,500 a year. That does not eliminate your line of credit, but it offsets a meaningful share of the carrying cost. FDIC coverage runs up to $10M per entity through the IntraFi sweep network, so the reserve sits insured even on the days a large reimbursement batch lands.
ACH is $0 in both directions, so paying the wholesaler weekly does not introduce per-transaction fees. Wires are a flat $15 if a wholesaler requires one for a same-day order.
Visibility That Makes the Hard Decisions Cleaner
Per-stream virtual accounts give you the data to answer questions retina practices struggle with:
Are we breaking even on Medicaid injections after drug cost?
Which commercial payers are paying inside their contracted timing?
How much of our drug spend has not yet been reimbursed?
What is our current days sales outstanding on drug-billed claims specifically?
These questions are usually answered through manual reconciliation between the practice management system and bank deposits. A virtual-account structure shortens the answer to a dashboard view.
When the Migration Is Worth It
A solo retina specialist with one part-time injection day might not need this structure. A multi-provider retina group running 500 or more injections a month, especially one carrying a working capital line of credit, will usually recover the migration cost in the first quarter through cleaner cash visibility, recovered yield, and better working capital management.
The transition follows the same cadence as any other multi-payer migration: open the new account, provision virtual accounts, update payer EFT enrollments, run parallel for one cycle, close the old account. Six to eight weeks end-to-end.
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