You’ve witnessed the major changes in the delivery and reimbursement of health care in this country since the passage of the Patient Protection and Affordable Care Act. So far, many of those changes have only affected hospitals and physicians.
That will soon change, however, as pharmacists work to become increasingly recognized as essential members of patients’ healthcare teams. As the entire health care industry moves to a performance-based model for reimbursement, pharmacists must engage the system and develop processes that accurately account for their influence on patients’ overall health.
Pharmacists can establish their place in Accountable Care Organizations (ACOs), performance-driven plan networks and transitional care teams, and receive recognition for their role in the cost-savings that result from better outcomes. But to get there, pharmacists must start monitoring their activities and documenting patient care successes. Here are a few of the ways pharmacists can prepare for outcomes-based programs right now.
1. Increase the clinical services you provide
As a community pharmacist, you have an opportunity to transition patients through the gaps in care that cause them to fall short of being healthy. Use this opportunity to establish your place in ACOs, performance-driven plan networks and transitional care teams by offering more clinical services. Look into providing screenings for high blood pressure, cholesterol and diabetes, or offer disease state-specific programs. Consider becoming accredited to bill for DME. You could also teach COPD patients proper techniques or screen patient profiles to determine risk factors for heart disease and asthma. As you document the outcomes of providing these services, you’ll have a useful record to show how your pharmacy has helped improve patients’ health.
2. Learn the primary areas payers look at
Accountable care focuses on prevention. The idea is to prevent patients from using acute care services or receiving unnecessary treatments or tests. Payers then reward health professionals who contribute to keeping patients, especially high-risk or chronic disease patients, healthier and out of the ER. Hospital readmissions are at the top of the Centers for Medicare & Medicaid Services’ (CMS) list regarding payment reductions to health service organizations. While there are no standardized quality measures for pharmacists yet, you can start tracking the major areas payers are already evaluating, such as high-risk medications, patients who take ACE inhibitors/ARBs, and adherence with diabetes, high blood pressure and COPD patients. It’s also important to maintain treatment guidelines in your practice. If it has been a while, JNC7, ATP III, and ADA are worth the time to review.
3. Complete your MTMs
CMS already requires health plans to complete MTMs with Medicare Part D patients. If your pharmacy does not complete the MTM, the case will be transferred to another pharmacy. By not doing the MTM, your pharmacy risks losing those patients and all of their dependents. In addition, keeping up with and documenting your MTMs will give you a proven record of improving patients’ outcomes—one you might need to reference in the future. To start, complete your MTMs on time and know the requirements.
It’s important to understand the difference between CMRs and TMRs. You’re required to complete an annual comprehensive medication review, or CMR, with Medicare patients. You also have to submit a summary in CMS’ standardized format after each CMR. Targeted medication reviews, or TMRs, are required quarterly for each patient, with follow-up interventions when necessary. Understanding these requirements will put you ahead when CMS does develop outcomes-based reimbursement programs in the future.
4. Align your pharmacy, staff and partnerships with the new healthcare landscape
The way health professionals receive reimbursement for their services has changed dramatically. Adjusting your pharmacy’s offerings and processes now will ensure that you are able to stay profitable in this new environment.
There are multiple ways to make this transition as smooth as possible. Start by making adjustments to your physical pharmacy. For example, you may need to designate a separate, comfortable area in your pharmacy to counsel patients, provide vaccinations or teach a health class.
It’s also important that everyone on your pharmacy team understands the new team approach to patient care, and the process changes they’ll need to make. Consistency is important in showing results, so if one team member isn’t on board, take the time to instruct and correct that person.
You can also form partnerships with other healthcare providers to get your business in line with the new model of accountable care. Reach out to the providers in your area to discuss how you can work together to improve patient outcomes.
5. Start an adherence program
Creating and implementing an adherence program at your pharmacy isn’t just a smart method of treating patients, it’s the future of your business. An adherence program helps your patients stick to their medication regimens and it also allows you to keep track of your pharmacy’s efforts to improve patient outcomes.
The good news is that pharmacists don’t have to recreate the wheel. First fill counseling; call, text or email reminders; and medication synchronization are all processes your pharmacy may already have in place. By expanding and tracking the services you already offer—and starting them if you don’t—you’ll be able to show results to justify reimbursement down the line.
Related articles:
Top 5 Challenges For Community Pharmacies in 2014
3 Business Skills Every Pharmacy Owner Needs
Why Your Pharmacy Needs an Adherence Program
