Tuesday, October 23, 2012

Affordable Care Act...coming to a community pharmacy near you?

After sitting through several meetings last week, some of which included discussion of the value-based purchasing and readmission reduction programs that are included in the Affordable Care Act, I wonder how long it will take for the government (through Medicare-D plans) to implement similar programs that impact the world of community pharmacy.

You see, as pharmacy attempts to move forward and take a more proactive role in patient care we are going to be held accountable for results.  Since individual pharmacists have not been granted provider status, the accountability will be passed to the actual pharmacy.  This could be a good thing for the professional practice of pharmacy.

Now I have no knowledge of anything like what I am going to write about being in the works, but after hearing the presentation last week it seems entirely possible.  And probably likely in the near future.  Actually, I've wondered for quite a while about how long it would be until community pharmacies would be reimbursed based on performance.  As the Affordable Care Act develops over the next several years, I can see similar programs being rolled out to the retail pharmacy.

Some of the measuring sticks for the hospital world under the value-based purchasing aspects of the ACA center on clinical outcomes, patient satisfaction scores, clinical outcomes, and efficiency in delivering medical care.  This could very easily be translated to the community pharmacy setting.  Can you imagine the change that would occur in the community pharmacy world if reimbursements were tied to things like time spent counseling patients, patient satisfaction scores, medication in-stock rates?

Imagine walking into a retail pharmacy and actually having a pharmacist be able to counsel a patient without worrying about falling behind by a dozen prescriptions.  Imagine working at a pharmacy that has adequate pharmacist-staffing to allow for the patient interaction.

Of course this would have to be implemented in a manner similar to what is being done to hospitals.  A certain percentage of reimbursements from government plans would be withheld, with pharmacies who achieve the goals receiving that money at the end of the year.  This type of incentive would make some of the chain pharmacies focus less on the volume of prescriptions and more on the quality of care delivered to our patients.

Maybe extra reimbursements would be distributed to pharmacies that offer community education programs and show results.  The few studies that have focused on the impact of pharmacist care on patient outcomes might actually be able to be implemented on a large scale.

What would happen if reimbursements were tied to the patient's perception of the care they receive at the pharmacy?  If your patients believe that you are providing quality care and surveys back that up, you get an extra 4 or 5-percent on your reimbursements.  I think the chains might react if better reimbursements are tied to the satisfaction scores.

The national pharmacy organizations have been pushing for inclusion of the pharmacist in the different health care models that are being debated.  If we are included, we are going to need to show results.  Be prepared to make the necessary changes and show your results.


Steve said...

Eric, you describe an interesting and hopeful scenario for community pharmacists. It would be fantastic to see a paradigm shift to a value based reimbursement process in the world of community pharmacy. Thanks for your look into the future, I only hope it is not science fiction.

PharmD Blogger said...

I am ready for this change. We need to be included in this structure of reimbursements based on clinical outcomes. Make a certified technician take some more classes so they can check prescriptions and let the pharmacist counsel the patients. It is the future. Reimbursement from insurance companies are so small that we need to find new ways to be paid.

Anonymous said...

The only problem I see with your program is the only thing that makes my patients happy is REALLY short wait times. Taking time to counsel the previous patient makes for a cranky current patient.

Anonymous said...

If what was mentioned earlier about certain techs being able to verify pharmacists, there shouldn't be much difference in extended wait times. the cashier can ring the patient up then direct them to the council window where the pharmacist is waiting.

Anonymous said...

I thought I recognized a different blog photo, and I see that you're now a critical access director.

I've worked at several critical access hospitals part-time and PRN. Critical access pharmacy staff tends to support a director and a full-timer or two part-timers, and two to four techs.

I'm a small-town person, but trained in institutional pharmacy 25 years ago.

The directors of critical access hospitals where I work are all from retail, one's a previous owner, and the others were chain drug managers. As a part-time person, my only significant observation is that those from retail tend to kowtow too much to nursing administrators, as if nurses in general in small settings have precedence, when in reality, in major settings, pharmacy is its own branch of the managerial tree. Never, ever, underestimate your depth of knowledge!

Good luck, God bless, and Merry Christmas.