Risks Pose Surmountable Hurdles to IV Hydration Pop-Ups

Intravenous hydration therapy is moving fast from being a strictly medical procedure in a traditional healthcare setting to a popular self-care solution offered in med spas, pop-ups and homes, a fix for everything from dehydration to brain fog and lethargy and, of course, hangovers.

By one estimate, the North American market had reached $1.6 billion by 2024 and was expected to grow at an 8.7% rate annually through 2030.

But some aren’t totally sold. As one insurance underwriter dryly commented to me: “Oh, yes. IV treatment centers. We used to call them bars.” It’s a perspective colored by reasonable concerns over the inherent risks to these businesses, the effective management of which is critical for patient safety but also business sustainability.

Here’s what operators should keep in mind.

Managing a range of exposures

An early comer to the business, board certified anesthesiologist Dr. Jason Burke offered up IV drips from a clinic on wheels, a 45-foot-long “Hangover Heaven” bus that criss-crossed the Las Vegas strip starting in 2010.

It was novel and responsive to consumer interests, but the setting was rife with exposures, many stemming from lack of quality management – in terms of infrastructure more than the business approach. 

For example, mobile IV hydration clinics aren’t required to have the same rigorous vetting processes of suppliers and their product (whether fluids, bags or needles) that a hospital system has in place against the downside risks of contamination or faulty packaging.

Another risk: how sufficiently clinical standards overall are being met in this more informal therapeutic environment. The individual dispensing the treatment may have the proper qualifications. But do those go hand-in-hand with proper training? 

Further, when a foreign substance is being put in the human body, toxicity (sometimes in terms of too much of a good thing) has to be guarded against, never mind the potential for a bad batch of fluids. That’s a potential liability of huge concern to insurers, especially when combined with looser supplier controls that can come into play.

The regulatory concerns

Ultimately, though, much of the risk of the business stems from lack of or spotty oversight by regulators, at the federal and the state levels.

Like medspas as a general category, federal regulators haven’t laid out standard operating procedures for mobile hydration operations. States have varying rules on licensing requirements for those providing services, training required and scope of practice.

Generally, these specify that services are carried out by trained and licensed healthcare professionals like nurses or physicians. Some additionally require physician supervision. Other states yet may allow licensed phlebotomists or paramedics to administer IVs. 

California and New York are considered regulatory exemplars, with strict rules emphasizing physician ownership and comprehensive requirements for IV therapy administration. States with more lenient Corporate Practice of Medicine (CPOM) laws also may have more relaxed operational requirements: Anyone can own an IV therapy clinic in Alaska or Delaware; Ohio allows non-physician ownership but requires a licensed physician as medical director.

The regulatory environment should be a concern to existing and prospective hydration clinics (not to mention patients) as it gives rise to compliance risks and can impact insurance coverage.

How best to manage the risks

Underwriters are looking at the diligence operators take in covering their exposures. To that end, IV hydration clinics are well-advised to be both thorough and rigorous in establishing and adhering to operational processes, procedures and accountability. 

It won’t be that difficult to get insurance against the various risks, but it’s not inexpensive and may not be the most robust coverage. That means no one should give short shrift to risk management, especially given a litigation environment where nuclear verdicts of $10 million or more are common.

Start with processes, specifically those for acquiring all the materials that are required to safely provide IV hydration therapies. This means that dependable supply channels are set up and working. An adequate inventory of the materials necessary to provide the service is on hand; a process is in place to guard against shortages. And other processes establish what’s in the fluids and what, specifically is being utilized for clients.

Secondly, clinical procedures must be spelled out in detail, supported by training and appropriate medical supervision. More than simply “how” to put a needle in a patient’s arm, staff must be trained to recognize and respond to potentially negative turns – say, allergic reaction or excessive bleeding.

Finally, accountability  – well-documented policies, procedures and controls, especially relative to employees – is critical from a risk management standpoint. An IV hydration clinic may have done everything by the book, but still have a negative outcome. The best defense will hinge the ability to point to solid documentation and controls – and a business positioned for the long haul.

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