Retail/Ambulatory Market Niche

[Its Z]

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CMS will start to penalize hospitals for patients readmitted within 30 days of discharge for certain disease state. Private payors will follow as they always do.

Literature suggests that up to 40+ % of readmission is due to issues pertaining to medications.

Helping health care organizations and systems including the smallest hospitals in the US with a program to incorporate an outpatient pharmacy program to open the 4 walls of hospital to care for patients should be incorporated through programs such as MTM, CHF clinic etc.

Seize the opportunity.

 

[rxlea]

Old news.

Already working on it. 😀

 

[gsRx]

Ambulatory Care is something I would definitely be interested in, Pharmacists can do so much good reconciling Med issues before patients leave the Hospital, and once they are out if we weren't glued to the computer screen verifying scripts. Having rotated in several hospitals, and having had the pleasure of working retail for several years already, you tend to think a lot more about all aspects affecting patient non-compliance that a lot of healthcare professionals don't. I didn't like the one rotation I had in ambulatory, but I am going to Mid year so I am waiting to see what's out there.

 

[Its Z]

Old news.

Already working on it. 😀

Old news is if all you're doing is working it and setting it up.

Brilliance is with knowing what you know and then teaching it to those thirsty for a high consulting fee. $10,000 - $30,000 per gig is about right.

 

[Its Z]

Ambulatory Care is something I would definitely be interested in, Pharmacists can do so much good reconciling Med issues before patients leave the Hospital, and once they are out if we weren't glued to the computer screen verifying scripts. Having rotated in several hospitals, and having had the pleasure of working retail for several years already, you tend to think a lot more about all aspects affecting patient non-compliance that a lot of healthcare professionals don't. I didn't like the one rotation I had in ambulatory, but I am going to Mid year so I am waiting to see what's out there.

There's a missing piece. How do you capture 100% of the patients discharged when their prescriptions are going everywhere in town?

There's a way..

 

[gsRx]

There's a missing piece. How do you capture 100% of the patients discharged when their prescriptions are going everywhere in town?

There's a way..

Work out a contract with the Hospital to follow up with MTM on all high risk for readmission discharges?

 

[Ackj]

Contract with hospital for post-discharge follow-up. Could also contract with 3rd party after they receive a claim for hospitalization.

 

[MountainPharmD]

CMS will start to penalize hospitals for patients readmitted within 30 days of discharge for certain disease state. Private payors will follow as they always do.

Literature suggests that up to 40+ % of readmission is due to issues pertaining to medications.

Helping health care organizations and systems including the smallest hospitals in the US with a program to incorporate an outpatient pharmacy program to open the 4 walls of hospital to care for patients should be incorporated through programs such as MTM, CHF clinic etc.

Seize the opportunity.

Great idea except it won't be pharmacists doing it.

It will be nurses who are a whole lot cheaper than pharmacists. They are already doing it most locals with diabetes clinics. The natural path for hospitals to expand into something like this would be through the nursing staff. Plus a nurses scope of practice is wider than that of a pharmacist. They can draw blood for labs, perform phsical assesments ect.

 

[rxlea]

Great idea except it won't be pharmacists doing it.

It will be nurses who are a whole lot cheaper than pharmacists. They are already doing it most locals with diabetes clinics. The natural path for hospitals to expand into something like this would be through the nursing staff. Plus a nurses scope of practice is wider than that of a pharmacist. They can draw blood for labs, perform phsical assesments ect.

it depends. Pharmacists are doing it here but we have collaborative practice/prescriptive authority + immunizations in ths state. It's pretty badass.

And Z is right. I know someone that doubled their entire year salary in 2 months time with all the consulting they did. It's not a pipe dream.

There are other opportunities with IT and meaningful use standards/CMS. Quality improvement is big.

 

[deleted205891]

There's a missing piece. How do you capture 100% of the patients discharged when their prescriptions are going everywhere in town?

There's a way..

Do discharge counseling and get them the meds before they leave the hospital (bring it to them at bedside). That's what we do. Always ends up a mess though, and sometimes the patients leave before we get a chance to counsel them.

Of course this is at a VA, so we can make much more accurate med recs than most other places due to our EMR.

 

[Its Z]

Great idea except it won't be pharmacists doing it.

It will be nurses who are a whole lot cheaper than pharmacists. They are already doing it most locals with diabetes clinics. The natural path for hospitals to expand into something like this would be through the nursing staff. Plus a nurses scope of practice is wider than that of a pharmacist. They can draw blood for labs, perform phsical assesments ect.

You really can't see beyond what you can see in front of you... can you.😎

 

[konkan]

Nice summary

Accountable Care and Health System Pharmacy

The term "Accountable Care" was created with the passage of the Patient Protection and Affordable Care Act of 2010, hereafter, referred to as the Affordable Care Act (ACA), but commonly referred to by political pundits as "Obama Care". Accountable Care is a reimbursement model that ties quality and cost reduction together for the treatment of a particular patient group. Accountable Care is the biggest single change in Heath Care financing since hospitals began using the DRG group reimbursement method used for Medicare Patients in the mid 1980's.

Accountable Care Organizations (ACO) are networks of physicians and other providers who work together to improve the quality of heathcare services and reduce the costs for patient populations. The ACA authorizes the Center for Medicaid and Medicare Services (CMS) to contract with ACOs starting in 2012. The greatest cost savings expected from the utilization of the ACO model is keeping patients out of the hospital. This is the antithesis of the current hospital payment system and usual hospital purpose and mission, which is to treat sick people.

It has been reported that in the year 2000, approximately 125 million Americans (45% of the population then) had a chronic condition or disease and 61 million of these same Americans had multiple chronic diseases with 78% of health care dollars being spent on patients with chronic diseases or conditions. Certainly, there is no better opportunity for utilization of a clinical pharmacist when the primary treatment modality is with a medication.

The ACO environment will require pharmacists to participate in direct patient care and impact outcomes across the continuum of care or face shrinking numbers of pharmacists for inpatient care. This is a huge Paradigm Shift for Health System Pharmacy including our professional organizations. Health System Pharmacists will now encompass more ambulatory pharmacy practice and further blur the demarcation between community and hospital pharmacy practice.

Accountable Care Organizations will require pharmacists to continue to:

Demonstrate impact to the bottom line.
Become involved in direct patient care.
Increase utilization of technology especially information systems that can link hospital and ambulatory or office environments.
Empower pharmacy technicians.
Become proficient in caring for chronic diseases.
Collaborate with other disciplines.

All of these are elements of the Pharmacy Professional Practice Initiative (PPMI) as we continue to retool future pharmacy practice.

The healthcare reimbursement landscape is rapidly changing as we speak and the success and future of pharmacy practice will depend on our ability to move quickly into ambulatory direct patient care roles that are tied to monetary benefits and superior qualitative and quantitative measures that support the outcome metrics of the ACO. Hospitals are beginning to show lower census where private physicians practicing in an ACO or a patient centered medical home model where the physicians are incentivized to keep patients out of the hospital.

Pharmacists have been at a disadvantage because they have not been recognized as a "Provider" by CMS and be able to bill for their professional services. The ACO model moves away from the traditional ‘fee for service' model utilizing a recognized "Provider" to a reimbursement model that rewards all members of the health care team when performance goals of quality and cost are met.

Health System Pharmacists must recognize this change in direction and react quickly as this is an opportunity to leverage medication expertise in the hospital and ambulatory care settings to improve patient outcomes. Pharmacy directors may have to re-think the level of resources directed at hospitalized patient and consider new ambulatory pharmacy services that will be requested of them very soon.

The American Society of Health System Pharmacists (ASHP) has convened a task force this past July to study the ACO model to help pharmacy programs integrate into the ACO model of care.

 

[MountainPharmD]

You really can't see beyond what you can see in front of you... can you.😎

Oh I can my friend. I am one of the biggest out of the box thinkers you will ever meet. I am also a realist. Reduced payment to hospitals means reduced services and reduced staffing. Medicare is the single largest payer for many hospitals. I think you will see a small percentage of hospitals stop taking Medicare patients.

I do not think most hospitals have a clue what is about to hit them. At the least the two I have inside information on down here do not.

The $716 billion dollars that will be needed to pay for Obama care is in a large part going to come from cuts in Medicare payments to providers. It will be done under the guise of supposed increased efficiency, fraud, waste and abuse prevention, and payments based on quality indicators.

 

[MountainPharmD]

The ACO environment will require pharmacists to participate in direct patient care and impact outcomes across the continuum of care or face shrinking numbers of pharmacists for inpatient care. This is a huge Paradigm Shift for Health System Pharmacy including our professional organizations.

Being the realist I am this is what will happen to pharmacists. Eveything he hospital spends money on is going to be under a microscope because of the reduced payments Medicare will provide.

Pharmacists are expensive and have a limited scope of practice. Nurses on the other hand are less expensive than pharmacists and have a greater scope of practice. With the reduced revenue caused by Obama care hospitals will have plenty of nurses to shift into new roles. Nurses have been running anticoag, diabetes and lipid clinics longer than pharmacists have. They can do it for a reduced cost and do not have to have special protocols signed by physicians.

The fact is pharmacists are a big non revenue producing expese in a hospital. Very easy for a hospital administator to start in the pharmacy department when makeing cuts.

 

[Its Z]

How do you call yourself an outside the box thinker??

Core Measures, Meaningful Use, Readmission are all quality initiatives that drive the cost down for the CMS.

Quality care is not an individual effort such as your statement "nursing is cheaper than pharmacy so labor reduction will be in the pharmacy."

Delivery of quality care means it's optimized using expertise of every team member to provide efficient and effective care.

Pharmacy staffing isn't determined by the lack of revenue in the pharmacy department. It's determined by the volume and the level of service.

That being said, pharmacy used to be major source of revenue before the DRG. But for the past 30 years, everyone believed it's nothing more than a cost center.

Not today. Pharmacy is a major source of revenue when played right. Every community and academic hospital should have a retail pharmacy that's interfaced with the inpatient pharmacy and be not only the conduit for transition of care and medication reconciliation, it should extend the care once the patient leaves the four walls of the pharmacy. Be it inclusion of DME and Home care, the days of "sayonara you've deen discharged from the hospital" are over.

Pharmacist save money and earn money in health systems.

Kaiser and VA are the ultimate model today though not perfect. The person or a group of experts who can enhance the model and bring it to the rest of the healthcare in the US will get very wealthy.

That means tying all the PBM and Prescription data together.

 

[rxlea]

Being the realist I am this is what will happen to pharmacists. Eveything he hospital spends money on is going to be under a microscope because of the reduced payments Medicare will provide.

Pharmacists are expensive and have a limited scope of practice. Nurses on the other hand are less expensive than pharmacists and have a greater scope of practice. With the reduced revenue caused by Obama care hospitals will have plenty of nurses to shift into new roles. Nurses have been running anticoag, diabetes and lipid clinics longer than pharmacists have. They can do it for a reduced cost and do not have to have special protocols signed by physicians.

The fact is pharmacists are a big non revenue producing expese in a hospital. Very easy for a hospital administator to start in the pharmacy department when makeing cuts.

30% of health care expenditures are on hospitals, 30% are salaries, 20% are Rxs, and then there is everything else. The whole point is to transition from a culture of treatment focused care to prevention focused care. Private insurances don't like it when people spend time in the hospital. The more they pay out, the higher the premium and the bigger the expense to the employer to cover employees, not to mention intangible or indirect costs associated with that.

Prescriptions and MTM save money. That is a fact. They keep people out of the hospital, improve quality of life and productivity, and prevent complications. Continuity of care is extremely important!

The narrow view the media and whoever else that doesn't have a clue have is not helpful.

 

[ttopping]

Though I don't have all the details, we just received a 2 year grant for a "transitional care pharmacist". They have been at the position for a couple of months now, getting lists of patients being discharge, coordinating with nursing managers, figuring out who would benefit most from this service. I know it involves counseling, coordinating with their outside pharmacies, follow up calls, etc.

Between our management and the pharmacist, still trying to feel out what the best approach is with being efficient and effective (as it's only one person right now), but it's exciting that we've taken this step at least. We'll see in a couple years how it turns out and we might be hiring on more positions if the numbers go where we hope.

 

[MountainPharmD]

How do you call yourself an outside the box thinker??

Core Measures, Meaningful Use, Readmission are all quality initiatives that drive the cost down for the CMS.

Quality care is not an individual effort such as your statement "nursing is cheaper than pharmacy so labor reduction will be in the pharmacy."

Delivery of quality care means it's optimized using expertise of every team member to provide efficient and effective care.

Pharmacy staffing isn't determined by the lack of revenue in the pharmacy department. It's determined by the volume and the level of service.

That being said, pharmacy used to be major source of revenue before the DRG. But for the past 30 years, everyone believed it's nothing more than a cost center.

Not today. Pharmacy is a major source of revenue when played right. Every community and academic hospital should have a retail pharmacy that's interfaced with the inpatient pharmacy and be not only the conduit for transition of care and medication reconciliation, it should extend the care once the patient leaves the four walls of the pharmacy. Be it inclusion of DME and Home care, the days of "sayonara you've deen discharged from the hospital" are over

Pharmacist save money and earn money in health systems.

Kaiser and VA are the ultimate model today though not perfect. The person or a group of experts who can enhance the model and bring it to the rest of the healthcare in the US will get very wealthy.

That means tying all the PBM and Prescription data together.

If this is so great then why is it taking federal legislation to force it on everyone?

Obama care is paid for by paying providers less money. Plain and simple.

I will give you an area that needs serious attention. How about capturing all the revenue you are losing because of poor or non existant documentation and not complying with insurance requirements such as precerts? 100's of millions of dollars are lost by hospitals a year because they are not getting paid for everything they do.

 

[Its Z]

If this is so great then why is it taking federal legislation to force it on everyone?

Obama care is paid for by paying providers less money. Plain and simple.

I will give you an area that needs serious attention. How about capturing all the revenue you are losing because of poor or non existant documentation and not complying with insurance requirements such as precerts? 100's of millions of dollars are lost by hospitals a year because they are not getting paid for everything they do.

Did I ever tell you the story about the shoe salesman?

 

[pharmasaur]

http://accred.ashp.org/aps/pages/directory/residencyProgramInformation.aspx?ID=210040

"Transition of Care" PGY2 at UCSD

 

[deleted129840]

--

 

[Caverject]

CMS will start to penalize hospitals for patients readmitted within 30 days of discharge for certain disease state. Private payors will follow as they always do.

Literature suggests that up to 40+ % of readmission is due to issues pertaining to medications.

Helping health care organizations and systems including the smallest hospitals in the US with a program to incorporate an outpatient pharmacy program to open the 4 walls of hospital to care for patients should be incorporated through programs such as MTM, CHF clinic etc.

Seize the opportunity.

Walgreens is starting a new program to capture this because we dont have enough leadership within our health systems to emphasize it's importance!

 

[joetrisman]

Walgreens is starting a new program to capture this because we dont have enough leadership within our health systems to emphasize it's importance!

I saw this!

I was also at a meeting the other day where a local large academic teaching center was incorporating outpatient pharmacy services to the patient to have the meds delivered beside (as mentioned above) before discharge. They were tracking the intervention on readmission rates.

 

[GamecockPharmD]

This is intriguing but how is this program implemented for individual pharmacists interested in doing this? I could see a small independent having the connections for this. But someone who works at CVS trying to make money on the side won't be able to. Surely you cannot make as much money doing this versus retail. Pharmacists can't agree on how much to charge patients for MTM sessions. And there aren't many insurances that cover MTM. Patients will not be willing to pay for these services out of their own pocket. The only way it would be worth the hassle is to charge 75 - 100 dollars per session. The hospital won't pay a pharmacist for these consulting services. At least I highly doubt it. Hospitals will be the ones creating these positions more than likely. And these jobs will be given to residents even though retail pharmacists would be qualified. We can't get away from verifying scripts in front of a screen long enough to do anything else. And damn any idea of any technician verifying scripts. That is our baby and if the law changes their goes our jobs. "Empowered" pharmacy techs my ass. If that is what Obamacare is going to do to pharmacy then we have to get his ass out of there.

 

[Its Z]

This will have no impact on 99% of pharmacists who are employed filling prescriptions.

 

[Its Z]

I saw this!

I was also at a meeting the other day where a local large academic teaching center was incorporating outpatient pharmacy services to the patient to have the meds delivered beside (as mentioned above) before discharge. They were tracking the intervention on readmission rates.

That's right.
But there still are gaps and missing pieces. The person or group who can convert it to a marketable package with key components such as software linking all the data and outcomes results will become very wealthy.

 

[GamecockPharmD]

Do you foresee any opportunities in this for a plain-Jane retail pharmacist? Who would have the biggest advantage in implementing a program like this? Do you think an independent would? I am asking this since you included it in the title of the thread. I think this is very interesting. I think it would be a longshot for most RPHs to get involved in something like this but we definitely need to have more opportunities for pharmacists that want to do more than dispensing. We have to preserve the dispensing role and protect it but other revenue sources is always a good thing.

 

[joetrisman]

That's right.
But there still are gaps and missing pieces. The person or group who can convert it to a marketable package with key components such as software linking all the data and outcomes results will become very wealthy.

My wife is a computer software developer, you have business experience, and I am young, have a lot of debt, and can be easily exploited into working a lot of hours. Let's make this happen!

 

[Its Z]

Do you foresee any opportunities in this for a plain-Jane retail pharmacist? Who would have the biggest advantage in implementing a program like this? Do you think an independent would? I am asking this since you included it in the title of the thread. I think this is very interesting. I think it would be a longshot for most RPHs to get involved in something like this but we definitely need to have more opportunities for pharmacists that want to do more than dispensing. We have to preserve the dispensing role and protect it but other revenue sources is always a good thing.

There may be an opportunity for an independent owner to partner with hospitals to provide transitional care... not sure what's the best approach. Being on site at the hospital would be a good place to start then provide discharge prescriptions and counseling...... along with on site clinic in the pharmacy.

 

[Its Z]

My wife is a computer software developer, you have business experience, and I am young, have a lot of debt, and can be easily exploited into working a lot of hours. Let's make this happen!

Healthcare software is where it's at.

 

[MountainPharmD]

There may be an opportunity for an independent owner to partner with hospitals to provide transitional care... not sure what's the best approach. Being on site at the hospital would be a good place to start then provide discharge prescriptions and counseling...... along with on site clinic in the pharmacy.

Okay...So you are proposing to do what Kaiser and the VA do. Again if those systems are so great why haven't they been voluntarily adopted by everyone? (I think the VA has a very good system).

 

[Its Z]

Okay...So you are proposing to do what Kaiser and the VA do. Again if those systems are so great why haven't they been voluntarily adopted by everyone? (I think the VA has a very good system).

C'Mon.. you already know the answer.

Many reasons.

VA and Kaiser are HMOs. They have a better prescription history for their members than any joe shmoe community hospital can imagine.

This poses a great challenge for the rest.

If you ever decide to take your head outta your ass and get out of your cubicle to see the rest, you will realize hospital owned retail pharmacy program is fixing to see an explosion of growth. And also cut into your little world of PBM by doing employee scripts.

 

[MountainPharmD]

C'Mon.. you already know the answer.

Many reasons.

VA and Kaiser are HMOs. They have a better prescription history for their members than any joe shmoe community hospital can imagine.

This poses a great challenge for the rest.

If you ever decide to take your head outta your ass and get out of your cubicle to see the rest, you will realize hospital owned retail pharmacy program is fixing to see an explosion of growth. And also cut into your little world of PBM by doing employee scripts.

Sorry man the butt is firmly planted in the cubicle!

A hospital owned retail pharmacy program isn't going to cut into my world...someone still has to manage the pharmacy benefit. You think the hospital has the time or resourses to do that? The little profit you make on your employee pharmacy will be gobbled up in administrative costs and hassles.

What makes you think a hospital owned pharmacy is going to be any better or anymore profitable than the 7000 or so Walgreens and equal number of CVS's on every street corner in America?

 

[Its Z]

sorry man the butt is firmly planted in the cubicle!

A hospital owned retail pharmacy program isn't going to cut into my world...someone still has to manage the pharmacy benefit. You think the hospital has the time or resourses to do that? The little profit you make on your employee pharmacy will be gobbled up in administrative costs and hassles.

What makes you think a hospital owned pharmacy is going to be any better or anymore profitable than the 7000 or so walgreens and equal number of cvs's on every street corner in america?

340b

Oh....and that's what Kmart used to say about the small retailer out of Bentonville Arkansas.

 

[All4MyDaughter]

340b

Oh....and that's what Kmart used to say about the small retailer out of Bentonville Arkansas.

Yeah, the 2 340b pharmacies I rotated at had VERY favorable bottom lines.

 

[rxlea]

Sorry man the butt is firmly planted in the cubicle!

A hospital owned retail pharmacy program isn't going to cut into my world...someone still has to manage the pharmacy benefit. You think the hospital has the time or resourses to do that? The little profit you make on your employee pharmacy will be gobbled up in administrative costs and hassles.

What makes you think a hospital owned pharmacy is going to be any better or anymore profitable than the 7000 or so Walgreens and equal number of CVS's on every street corner in America?

The ones I've seen seem pretty darn sweet 😀

 

[Its Z]

More and more physician practices are being bought or being incorporated into health systems. This alone will shift prescription volume to pharmacy owned by the hospital or independents on campus. CVS and WAGs can try their amcare model but the pharmacy that can provide the discharge medicine to the patient as they leave the hospital are better suited to follow their care once they're home.

The Transitional Care model is here to stay.

Oh...and you'd **** brick if you knew how much profit we're generating through 340B.

 

[MountainPharmD]

More and more physician practices are being bought or being incorporated into health systems. This alone will shift prescription volume to pharmacy owned by the hospital or independents on campus. CVS and WAGs can try their amcare model but the pharmacy that can provide the discharge medicine to the patient as they leave the hospital are better suited to follow their care once they're home.

The Transitional Care model is here to stay.

Oh...and you'd **** brick if you knew how much profit we're generating through 340B.

Oh I know the profit on 340b. You and I talked about that when you were back here in Texas. We both know of a little employee hospital pharmacy here in Texas that is not doing to bad. In fact I believe I told you and and/or your buddy I thought 340b pricing was a great way to make money. You sort of brushed me off and said that wasn't a big deal and not a good reason to have a hospital owned retail pharmacy because you could save the overhead and just use a retail pharmacy like Walgreens and still get the 340b pricing.

There are already independants and even corp retail chains that have pharmacies on hospital campuses. I think every major hospital in Dallas and the surrounding suburbs has a retail pharmacy. This is nothing new. Walgreens has a pharmacy in the main building at UT Southwestern. None of these pharmacies are setting the world on fire or revolutionizing pharmacy practice. Hell they are there because a small part of the day they have a captive audience. When people go home they go to Walgreens or CVS depending on which one is closer.

People are not tied to a hospital. Just because they went to your hospital one time doesn't mean they will ever come back. So you have a retail pharmacy that sold them their discharge meds one time. Big deal. They go back home and get the next month filled at Walgeens and then the following months at whatever pharmacy has the best transfer coupon.

Not every hospital is 340b eligible.

 

[Its Z]

back then 340B only allowed 1 contract pharmacy. Now it's limitless. More and more retail scripts are now captured through 340B then before.

This aint about making money through prescriptions and refills nor through counseling.

It's about finally incorporating pharmacy practice beyond the 4 walls of the hospital.

It's about preventing readmission. It's a big deal. You just don't see it because you don't live it everyday. It's also about knowing how to put this program on the orbit.

It's not about just having a retail to fill scripts. It's capturing employee scripts and saving millions. We have over 100,000 employees in our system and many more including family members.

It's expanding the outpatient infusion and oncology program under 340B and making it profitable.

It's about providing DME and homecare to patients who are discharging after surgery.

You're seeing things myopically. Precriptions volume and PBM.

I'm seeing it as pharmacy as a part of the comprehensive healthcare.

I'm seeing it as a possibility of finally tying all the electronic prescription data into one tree to provide the comprehensive medication reconcilliation program whereever the patient goes.

Open your eyes.

Dream a little and broaden your vision.

You ask why it takes government intervention? Why do we have seat belts? why do we have catalytic converters? Why do we have auto insurance? Why do we have speed limits?

These are all government interventions.

 

[Its Z]

in fact, if patient goes home and doesn't come back, that would be great.

But hospitals are graded on readmission rates. This is huge. This can potentially make or break a hospital. Quality measure mandated by the CMS is not anything to foo foo at.

It's real.

And medication is a major part of quality measures.

Pharmacy is important and it's time retail druggists join hands with inpatient pharmacy.

It's my vision and I'm working it, preaching it, and incorporating it to my practice.

You can sit on your ass in your cubicle and say why it's no big deal and why it won't work.

I'll just keep plugging along and make a difference to our profession.

 

[hereticmnk]

Misread, nvm

 

[deleted129840]

We have discharge counseling by clinical pharmacists and a retail pharmacy at the hospital where I work and it's pretty much just like Mountain PharmD says.

Also, 340B is administered by HHS. If providers start skimming a lot of money off the top they are just going to cut reimbursement.

 

[Its Z]

We have discharge counseling by clinical pharmacists and a retail pharmacy at the hospital where I work and it's pretty much just like Mountain PharmD says.

Also, 340B is administered by HHS. If providers start skimming a lot of money off the top they are just going to cut reimbursement.

Its administered by HRSA and its not a reimbursement program nor does it involve skimming. And government doesn't pay for the program. If you don't understand the program, don't pretend to know it.

And sounds like you underestimate the value of your outpatient pharmacy....or underutilized.

 

[MountainPharmD]

You're seeing things myopically. Precriptions volume and PBM.

I'm seeing it as pharmacy as a part of the comprehensive healthcare.

I'm seeing it as a possibility of finally tying all the electronic prescription data into one tree to provide the comprehensive medication reconcilliation program whereever the patient goes.

Open your eyes.

Dream a little and broaden your vision.

You ask why it takes government intervention? Why do we have seat belts? why do we have catalytic converters? Why do we have auto insurance? Why do we have speed limits?

These are all government interventions.

I hear brother but what you are dreaming about already exists. No myopia here. You are describing the Veterans Adminstration hospital system. An excellent system that works well. You know why? It is a closed system and the veterans do not have a choice.

You see choice is one of the problems with healthcare today. People can choose what doctor they see. People can choose what pharmacy they use and people can choose to take of themselves or do nothing. In an open system like we have now you can have all the integrated software and wiz bang reporting and organization in the world and it is all for naught if your patients choose not to participate. The only way it works is to have a closed system that patients are forced to use. I call it the you get what you get and don't throw a fit system.

You accuse me of not thinking outside of the box and being myopic. You could not be anymore wrong. I wrote a paper in pharmacy school 10 years ago describing my vision of the future of pharmacy. At the time all the experience I had was working in hospitals including the VA. What I proposed was taking the VA model and implemeting it in the civilian world. My vision was to have physicians form into groups of about 10 in order to save costs and streamline care. Patients would sign up with a group and have all there healthcare needs taken care of by the group including pharmacy. A group would consist of 10 physicians, 2 NP's or PA's and 2 pharmacists and other providers if needed like dieticians ect. There is a whole lot more to it thAn that but that was my basic idea. There is nothing new or visionary here. I took what I knew at the time which was the VA and hospital pharmacy and combined them to come up with what I thought was a more efficient way to delivery healthcare. The key to it was just like the VA people did not have a choice to go anywhere else. They got all of there healthcare services from the group.

Please spare me your uniformed opinion about how I do not think outside the box. Thats all I do all day is think about process improvement and better or more efficinet ways to do things. I have had half a dozen process improvments implemented in the 8 months since I started my new job and I am in the process of getting promoted into management after only 8 months. My mind is working 24 hours a day thinking about new and better ways to do things. Thats one of the many reasons I got out of retail. Idiots with no vision who would not listen to people with better ideas.

 

[Its Z]

Your 8 months of PI ? Lol

Let us know when you get promoted.

This isn't the VA model.

But if you think it is then its all good. But how many non HMO health system can act like an HMO? How do you make them act like an ACO?

Its not the concept. Its how do you bring forth the proven concept to a different setting

Implementation.

As you sit there and boast about what a Brilliant mind you are with Your paper and PI process, there are hospitals lined up willing to pay big bucks to those who can bring forth the transitional care.

You fail to see where lies the opportunity.

Did I tell you the story about the shoe salesman?

 

[Its Z]

Don't make me spell it out you dense sob....but rxlea touched on it..

 

[MountainPharmD]

Don't make me spell it out you dense sob....but rxlea touched on it..

Fist off I could care less about your little outpatient retail 340B pharmacy to make a few extra bucks. In the grand scheme of things it is peanuts. I have been out of hospital for 10 years and will never be back in it. I am not trying to portray myself as an expert in all things hospital. I do have some insight into the finacial side due to my wife being very involved in it. Funny thing is pharmacy is one of the things she bitches about being the most screwed up. You want to save some money pull your head out of your ass in the pharmacy and learn how to correctly bill for the medications you are dispensing so you are capturing 100% of the revenue. It doesn't matter how great the profit margin is on the 340B drugs you are dispensing. You are losing 10 times that in billing mistakes and errors and poor or non-existance nursing documention. Do you have any idea of the charge backs and audit reversals pharmacy gets because of all this. It may be different at your hospital but the ones down here I am familar with it is millions of dollars a year.

I am speaking in general terms about the new health care law. You seem to think this is a grand new way to make money. You have mentioned transitional care several times. Go to Kaiser Permanente's website and read all about it, They are already doing it in Northern California. If you have some great idea to revolutionize pharmacy then go for it.

I never said I have a brilliant mind. I am of very average intelligence. I just pay attention to detail and know how to do good research.

 

[MountainPharmD]

Your 8 months of PI ?

Whats PI?

Let us know when you get promoted.

Hopefully soon. I am in the process.

As you sit there and boast about what a Brilliant mind you are with Your paper and PI process, there are hospitals lined up willing to pay big bucks to those who can bring forth the transitional care.

You fail to see where lies the opportunity.

Did I tell you the story about the shoe salesman?

In my opinion transitional care will only work in a closed system like Kaiser. Tell me how you can possible get it to work in an open system? You answered the question above. How many non-HMO health sytems can act like an HMO...none because they can't. Having a captive audience is what makes it work.

 

[Its Z]

PI performance improvement.

What if I told you there's a tool to close the system in a non HMO?

Because its there.

Btw ACO is going to force these health systems to turn into pseudo HMOs.

 

[psychoandy]

Great idea except it won't be pharmacists doing it.

It will be nurses who are a whole lot cheaper than pharmacists. They are already doing it most locals with diabetes clinics. The natural path for hospitals to expand into something like this would be through the nursing staff. Plus a nurses scope of practice is wider than that of a pharmacist. They can draw blood for labs, perform phsical assesments ect.

going with RNs doing it is probably the easiest path for hospital admin, but i would posit that RNs/case managers/etc already are supposed to do discharge counseling and support and that is currently the status quo. i work for an ACO and currently the goal is for pharmacy to get involved in the low hanging fruit, specifically the patients at highest risk for bouncing back within 30 days per CMS. and surprise surprise, every stratified patient i've seen is perfect for an amcare pharmacist. the million dollar question is whether it saves money or not (and of course as a secondary, produces better outcomes).

any ACO at risk for getting reimbursement cut back due to readmits should be/already has been proactively funding these types of interventions. a couple pharmacists as a pilot is pretty cheap in the grand scheme of things. i just hope that pharmacy gets involved before nursing swoops up all the funding.

More and more physician practices are being bought or being incorporated into health systems. This alone will shift prescription volume to pharmacy owned by the hospital or independents on campus. CVS and WAGs can try their amcare model but the pharmacy that can provide the discharge medicine to the patient as they leave the hospital are better suited to follow their care once they're home.

The Transitional Care model is here to stay.

Oh...and you'd **** brick if you knew how much profit we're generating through 340B.

how can cvs/wags/big retail even get in on an amcare model without access to EMR? their current system is a total joke. or is that what they're paying for in terms of trying to buy their way physically onto academic medical centers/health systems?