Retail/Ambulatory Market Niche

[MountainPharmD]

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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.

Page 2 suckers!!!

You can have all the great tools, EMR, resourse, whatever.....you cannot change the fact patients can go where ever they choose. Thats why the system is open. There is patient choice. What good does it do to have a hospital retail pharmacy linked to dischrged patients linked to CHF, lipid, diabetes and coumadin clinincs if the patients can go some where else, chosse not to participate or simply choose not to do what the doctor said. At least in a closed system like the VA or Kaiser the patients cannot go some where else. You have a captive audience.

I believe the whole purpose of the healthcare law is to get us closer to a single payer healthcare system. A system where there is no choice and a maximum amount of control. I do not think that is necessarily a bad thing.

 

[Its Z]

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.

This isn't about my retail pharmacy. You're still not seeing this clearly. By the way, I wouldn't call 8 figure gross margin as a few extra bucks.

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.

Revenue cycle review is very robust here. I have been involved with revenue (not charges) study and assessment for the past half decade. Actually wrote a program now used by many hospitals to evaluate and resubmit bills.

Today we capture almost 100% of what we bill because every denial is reviewed. Both inpatient and outpatient. On the inpatient side, itemized drug bill doesn't affect many payors such as Medicare & Medicaid due to DRG. Correct and proper billings are important of course. With private payor, it depends on the contract. Some are % of charges with a CAP which means once capped, it doesn't matter how we bill.

You're harping on this because this is what you hear. You're right there are opportunities there. You're welcome to go consult and help hospitals maximize their revenue. One caveat...CMS won't pay for re-admission no matter how well you bill.

Because you're not in an acute care setting, you're not familiar with the emphasis on quality measures tied to reimbursement. I don't fault you for it. But you and I are not seeing this in a same way. There are peopole out there charging $30,000 per consult...1 week worth of work to implement Transitional Care while you're out there saying it's nothing new with no opportunities.

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, Thrsey are already doing it in Northern California. If you have some great idea to revolutionize pharmacy then go for it.

Teaching non-HMO how to do this is a new thing. It's not about running a pharmacy. It's about capturing data, identifying high risk patients, and taking care of these patients outside of the 4 walls of the hospital to prevent re-admission. And showing health systems how to do it.

The key is data. Marrying data from companies such as Emdeon... Relay Health... have it flow through acute care setting to identify patients...etc. There's a lot more to what I'm saying. Not in a position to spell it out for you. Some have figured it out... Most haven't.

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.

Keep researching.

 

[Its Z]

Page 2 suckers!!!

You can have all the great tools, EMR, resourse, whatever.....you cannot change the fact patients can go where ever they choose. Thats why the system is open. There is patient choice. What good does it do to have a hospital retail pharmacy linked to dischrged patients linked to CHF, lipid, diabetes and coumadin clinincs if the patients can go some where else, chosse not to participate or simply choose not to do what the doctor said. At least in a closed system like the VA or Kaiser the patients cannot go some where else. You have a captive audience.

I believe the whole purpose of the healthcare law is to get us closer to a single payer healthcare system. A system where there is no choice and a maximum amount of control. I do not think that is necessarily a bad thing.

Baylor does it.
U Penn does it.
There are hospitals reaching out to get this going. Non HMO.

The opportunity is in showing these hosptials..

You're still looking at it as revenue generation for the owner of the pharmacy.

I'm saying be the consultant who implement the program to get paid for it. Have a data management and operational software to do it then contract it...then sell the business.

 

[Its Z]

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?

Hopefully they fail. They're limited to only patients they service.

As a hospital, like it or not when a patient is admitted, that patient is now a "member" of the hospital and a liability. And because of the re-admission mandate by the CMS, hospitals are forced to take care of them after they're discharged.

Certainly those big retails can be contracted out to do so. But since all the data generated in the hospital is kept with the hospital, hospital owned pharmacy is an ideal place to extend the care.

Risk stratification and analysis of the future prognosis of these patients need to be looked at carefully. Most hospitals don't have this tool. But the tools are out there.

 

[rxlea]

Mountain, capturing outcomes is where it's at ... Then using that to improve quality, meet meaningful use leads to reimbursement. Continuity of care has to happen. Every point of care from admission to putting the meds in the patient hands and then monitoring them ...

do you know how much money goes into designing an instrument for that? not to mention how much someone will pay for you to tell them what they can do to change their practice to meet those standards to improve outcomes?

 

[deleted129840]

HRSA is part of HHS. And it sure sounds to me like the money from 340B is ultimately coming from the government since they are paying a lot of the bills for eligible institutions and (safety net hospitals, etc) and patients.

"Only nonprofit health care organizations that have certain Federal designations and/or receive funding from specific Federal programs are eligible organizations (covered entities) that can register, be enrolled and purchase discounted drugs through the 340B Program. These include Federally Qualified Health Centers, Ryan White HIV/AIDS Program grantees, and certain types of hospitals and specialized clinics."

 

[All4MyDaughter]

HRSA is part of HHS. And it sure sounds to me like the money from 340B is ultimately coming from the government since they are paying a lot of the bills for eligible institutions and (safety net hospitals, etc) and patients.

"Only nonprofit health care organizations that have certain Federal designations and/or receive funding from specific Federal programs are eligible organizations (covered entities) that can register, be enrolled and purchase discounted drugs through the 340B Program. These include Federally Qualified Health Centers, Ryan White HIV/AIDS Program grantees, and certain types of hospitals and specialized clinics."

340b pricing is based on discount pricing from pharmaceutical manufacturers.

 

[MountainPharmD]

Mountain, capturing outcomes is where it's at ... Then using that to improve quality, meet meaningful use leads to reimbursement. Continuity of care has to happen. Every point of care from admission to putting the meds in the patient hands and then monitoring them ...

do you know how much money goes into designing an instrument for that? not to mention how much someone will pay for you to tell them what they can do to change their practice to meet those standards to improve outcomes?

All that is great and I do not disagree. However, my point still stands. How do you expect to improve patients outcomes in an open system where patients have a choice to do what ever they want?

Wonderfull! You get paid $50,000 to consult with a hospital to tell them how to set up a transitional care model to provide continuity of care and improve patient outcomes. The hospital spends 10 million dollars buying software, hiring and training employees, and in the end nothing has been done except spending a lot of money. In the end patients have a choice and they can choose to do nothing, not listen to the doctor, not follow instuctions and end up back in the hospital 10 days later all the while your wiz bang outcomes software and hospital retail pharmacy and CHF, lipid, and diabetes clinics are hanging around doing nothing except consuming resourses.

One thing I learned from retail pharmacy is people are lazy and stupid. They would rather take a pill than do 30 minutes of moderate exercise 3 times a week or cut a small amount of fat from their diet. They will go to the worlds worst pharmacy CVS simply because it is .02 seconds closer to the house. And they damn sure are not going to expend any effort or give a rats ass about improving outcomes so the hospital can make more money.

Remeber this one little fact and make sure you engineer it into any program you create. People are lazy and stupid. If it is not incredible easy, not one second inconveineant and the patient has to expend zero effort to participate it will fail.

 

[Its Z]

You're saying in a closed system people have no choice?

It doesn't matter where patients get drugs.. once the patient is admitted that patient is your member.

You said it yourself VA and Kaiser have successful programs. Their members have choices too. But if their outcomes are better are you saying they are smarter than non HMO members?

You have said basic concept that patients will do whatever they want to therefore this program will not work yet youve said it works in HMO. That conflicts since a patient of closed system though less likely to choose other providers they do have choices.

When a program is sold to an institution so is a QA process and monitoring to ensure it improves the outcome.

Your skepticism isn't unwarranted.

But your argument is based on your belief system and opinion while I'm basing it on evidence based practice that's gaining momentum. Sorry you refuse to get on the train.

 

[MountainPharmD]

You're saying in a closed system people have no choice?

It doesn't matter where patients get drugs.. once the patient is admitted that patient is your member.

You said it yourself VA and Kaiser have successful programs. Their members have choices too. But if their outcomes are better are you saying they are smarter than non HMO members?

You have said basic concept that patients will do whatever they want to therefore this program will not work yet youve said it works in HMO. That conflicts since a patient of closed system though less likely to choose other providers they do have choices.

When a program is sold to an institution so is a QA process and monitoring to ensure it improves the outcome.

Your skepticism isn't unwarranted.

But your argument is based on your belief system and opinion while I'm basing it on evidence based practice that's gaining momentum. Sorry you refuse to get on the train.

Of course it is based on my belief system and opinion! Thats all I have when it comes to this discussion. I am just trying to stimulate discussion and come at it from a different angle.

 

[Its Z]

I will spell it out one last time since you can't visualize it.

Patients will be risk stratified. Software
Prescription transmittal is tracked. Software
Patient is taken care of by home health. People
Drugs will be provided if not filled. Outpatient pharmacy.
Routine monitoring of the patient both remote and on site. People software
Follow up at MD. Track through software
Prescription HX...build ..use for future med rec...software

We will continue the care.

 

[Its Z]

This will prepare hospitals to become ACOs when time comes. And those who can't adapt to the changes will be shut down.

We are having thus discussion today because most other disciplines of healthcare have robust outpatient programs associated with healthcare orgs. The pharmacy truly is the last frontier...

We are attempting to integrate outpatient pharmacy to become more robust. Not just pill pushing.

 

[cycloketocaine]

What a yawn fest....

 

[Its Z]

What a yawn fest....

You have other fest that's more exciting?

 

[cycloketocaine]

You have other fest that's more exciting?

I do!

 

[MountainPharmD]

I will spell it out one last time since you can't visualize it.

Patients will be risk stratified. Software
Prescription transmittal is tracked. Software
Patient is taken care of by home health. People
Drugs will be provided if not filled. Outpatient pharmacy.
Routine monitoring of the patient both remote and on site. People software
Follow up at MD. Track through software
Prescription HX...build ..use for future med rec...software

We will continue the care.

It's about damn time!

Ya think you can tell me the story about the shoe salsman now or do I have to beg?

 

[Its Z]

Thi shoe company is trying to expand the territory.

So salesman A is sent there. He gets off the plane and sees no one is wearing shoes. He laments no one wears shoes and he gets back on the plane comes home.

So the company sends Johnny. He gets off the plane and sees no one wears shoes. He shouts in JOY...."holy crap...no one wears shoes here....I'm going to sell everyone shoes!!!"

Don't be salesman A.

 

[rxlea]

All that is great and I do not disagree. However, my point still stands. How do you expect to improve patients outcomes in an open system where patients have a choice to do what ever they want?

Wonderfull! You get paid $50,000 to consult with a hospital to tell them how to set up a transitional care model to provide continuity of care and improve patient outcomes. The hospital spends 10 million dollars buying software, hiring and training employees, and in the end nothing has been done except spending a lot of money. In the end patients have a choice and they can choose to do nothing, not listen to the doctor, not follow instuctions and end up back in the hospital 10 days later all the while your wiz bang outcomes software and hospital retail pharmacy and CHF, lipid, and diabetes clinics are hanging around doing nothing except consuming resourses.

One thing I learned from retail pharmacy is people are lazy and stupid. They would rather take a pill than do 30 minutes of moderate exercise 3 times a week or cut a small amount of fat from their diet. They will go to the worlds worst pharmacy CVS simply because it is .02 seconds closer to the house. And they damn sure are not going to expend any effort or give a rats ass about improving outcomes so the hospital can make more money.

Remeber this one little fact and make sure you engineer it into any program you create. People are lazy and stupid. If it is not incredible easy, not one second inconveineant and the patient has to expend zero effort to participate it will fail.

It's not just about software!

Why do you think drug companies are incorporating patient reported outcomes into drug trials now? You're right. It's not just about efficacy. It's about whether the patient uses it or not. Real world effectiveness.

Retail pharmacies spend all this effort to enroll patients in things like ready fill while patients just throw the stuff into the back of their medicine cabinet. The question is WHY. Why doesn't the patient comply? Why don't they take it? People spend all this time criticizing druggies and medicaid babies at their pick up window but they forget what it means to be a pharmacist. That's why the public sees us as pill slingers. Nobody is stepping up and saying hey wait a minute...I'm the drug expert. I should be a part of ths team to find a way to get patients to take their meds, make sure they are on the right meds for them, and keep them out of the hospital.

Who better to design the programs, studies, software, etc than us that ensure optimal pharmaceutical care, monitoring, while improving patient adherence?

I get what you're saying. And it's hard to do at a place where you're doing a **** ton of scripts and people are yelling st you. I was there. I had gang bangers who were strapped yelling at me about their grandmas pain meds while a schizophrenic flips out at the drop off window and the phone is ringing and there is a doctor on the line. I get it. But it doesn't have to be that way. Apathy and pessimism keep us back. Maybe I'm an idealist but I'm not going into health outcomes just to sell companies a better way of doing things to make a buck. I'm doing it because I give damn. About you, about my patients, about the health care system. I want to find out wtf is wrong so I can change it.

 

[Its Z]

I do!

Elaborate

 

[Its Z]

It's not just about software!

Why do you think drug companies are incorporating patient reported outcomes into drug trials now? You're right. It's not just about efficacy. It's about whether the patient uses it or not. Real world effectiveness.

Retail pharmacies spend all this effort to enroll patients in things like ready fill while patients just throw the stuff into the back of their medicine cabinet. The question is WHY. Why doesn't the patient comply? Why don't they take it? People spend all this time criticizing druggies and medicaid babies at their pick up window but they forget what it means to be a pharmacist. That's why the public sees us as pill slingers. Nobody is stepping up and saying hey wait a minute...I'm the drug expert. I should be a part of ths team to find a way to get patients to take their meds, make sure they are on the right meds for them, and keep them out of the hospital.

Who better to design the programs, studies, software, etc than us that ensure optimal pharmaceutical care, monitoring, while improving patient adherence?

I get what you're saying. And it's hard to do at a place where you're doing a **** ton of scripts and people are yelling st you. I was there. I had gang bangers who were strapped yelling at me about their grandmas pain meds while a schizophrenic flips out at the drop off window and the phone is ringing and there is a doctor on the line. I get it. But it doesn't have to be that way. Apathy and pessimism keep us back. Maybe I'm an idealist but I'm not going into health outcomes just to sell companies a better way of doing things to make a buck. I'm doing it because I give damn. About you, about my patients, about the health care system. I want to find out wtf is wrong so I can change it.

How do you really feel?

 

[rxlea]

How do you really feel?

 

[Mahbubani]

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.

Do you have an idea of how you would craft such an application? I'm speaking more of conceptual ideas rather than the technical details.

 

[Its Z]

Do you have an idea of how you would craft such an application? I'm speaking more of conceptual ideas rather than the technical details.

Yup.