As policymakers grapple with reform to improve care quality and lower costs, the demand for medication management services is at an all-time high. While this dynamic presents plenty of opportunities and challenges for pharmacists and pharmacies, there are still many unknowns about alignment of care and payment incentives.
News: Long-Term Care
Pharmacies and Home Medical Equipment (HME) providers can gather patient data to improve patient medication adherence, set up synchronization programs and increase revenue.
I remember my dad taking me to watch the Atlanta Braves play the St. Louis Cardinals. I’ll never forget the Cardinals making their arrival, because their shortstop – Ozzie Smith – took the field with a trot, a cartwheel and a backflip. If a back flipping shortstop doesn’t make your heart race, you may not be a baseball fan. Theatrics aside, shortstops are exciting because they are often defensive captains whom others take cues from, the link between the infield and outfield and the second base ghost that keeps runners honest. Similarly, pharmacists are becoming the captains of the patient healthcare team: implementing patient care plans; connecting healthcare team members, patients and family members with meaningful assessments and therapy data; keeping conditions in check and intervening when necessary.
Medicare is a beneficial program for Americans who are over age 65 or have certain disabilities, but providers sometimes find compliance issues a challenge. An understanding of mandates and how to properly submit claims will ensure organizations are reimbursed for Medicare Part B-covered medications, equipment and supplies, such as nebulizer-inhalation medications, oral immunosuppressive drugs and diabetic testing supplies. Occasionally, providers may unknowingly submit noncompliant or even fraudulent claims for the products and services they offer.
We often equate regulatory mandates to government overreaching that impose roadblocks, which prevent pharmacists from providing solid healthcare to patients. However, changes and goals stemming from the Affordable Care Act (ACA) could actually give community pharmacies a new competitive advantage.
When the Meaningful Use process started, practices started being more diligent in collecting Business Associate Agreements from all their contractors who had access to their software.
Healthcare is ever changing and with those changes must come adaptation. There is a focus on quality of care versus quantity of care. Team-based care and pay-for-performance models are on the rise and pharmacists are a part of the equation.
In the previous edition of Insight, I said, “One competitive opportunity that never changes in pharmacy services is the percentage of your current customers who would recommend you to others.” I also mentioned, “Accomplishing high percentage scores requires a full-court press inside your operation for every employee to excel.”
Earlier this year, QS/1 partners, the Kentucky Department for Public Health (KDPH) and the Kentucky Pharmacists Association (KPhA), participated in a showcase to display the region’s overall capabilities to respond to a natural disaster or emergency and demonstrate services the state could provide, including fire, police, pharmacy and other disaster-response resources.
Flu season is here, meaning it is a great time to evaluate your status as an immunization provider. Since pharmacists are the most accessible healthcare professionals, we are valued members in our communities. Expanded scope and authority have provided pharmacists the ability to impact the availability and utilization of vaccines to a patient base that may not have otherwise been immunized.