Have you ever been approached by a member of your senior leadership team who recently came back from a conference and excitedly approached you about an “amazing” opportunity to capitalize on revenue. It was probably something along the lines of “Hey, so I hear there are big bucks in specialty pharmacy… have we explored that here?” To which you either respectfully direct them to the outpatient pharmacy group, launch into a discussion on the complexity of the factors involved in the decision to grow a specialty pharmacy service, or run back to your office and “google” specialty pharmacy. Either way, as reimbursement models change and managing patients across the continuum becomes a more important focus for health care organizations, Pharmacy leaders are being asked to look “outside the box”, (the inpatient box) for new sources of revenue generation and ultimately begin bridging the gaps between “inpatient” and “outpatient” services.
The “Ambulatory Care Enterprise” is a broad term that can be used to describe services to manage patients across the continuum. While the scope continues to increase, some common services associated with the term include specialty pharmacy, retail pharmacy services, home infusion pharmacy, ambulatory clinic pharmacy visits, transition of care services, and outpatient infusions services. Important drivers for the shift in the ambulatory business models include:
Site of Care Management-- Commercial and Government payers are starting to limit the site of which infusions may be administered to limit the higher costs often associated with outpatient hospital departments.
Decreasing self-insured patient costs—If you have never explored the idea of operating your own outpatient pharmacy, hospital administrators may want to hear about how a retail pharmacy could save health-plan costs through eliminating the PBM/retail pharmacy mark-up for members.
Readmission penalties/Bundled payment strategies—Moving to a value-based purchasing system and avoiding readmission penalties is a high priority to prevent Medicare take-backs. (Expected to be over $450 million in 2016). Outpatient pharmacies, discharge call-backs, and pharmacist appointments have all shown to help prevent readmissions.
Changes in state laws—State have started expanding their collaborative pharmacy practice acts to include provisions that allow for initiation of medications. Other states even require insurance to recognize the pharmacist as a provider for reimbursement. Could this be a new source of revenue for your institution?
What is your organization doing to explore the ambulatory care enterprise? How can you integrate pharmacy services across the continuum? If you do not offer any or all of these services, where do you start? Check out the May 15th edition of AJHP article “Building value: Expanding ambulatory care in the pharmacy enterprise” for a comprehensive overview of the considerations by pharmacy leaders.
Managing the complexities of inpatient services along with these outpatient services can be complicated and out of many pharmacy director’s comfort zone. Differences in payment models, contracting necessities, state laws, and patient populations are just a few items that need explored.
For even more information you can get C.E. and learn how two health systems have approached facets of their ambulatory expansion! These are exciting times for health system pharmacy… and urgent times to explore the development of the ambulatory aspects of your pharmacy enterprise!
(C.E. Webinar: “Advancing the Ambulatory Care Enterprise – Establishing Sustainable and Innovative Patient Care Models Across the Continuum”) See more at: http://elearning.ashp.org/products/5234/advancing-the-ambulatory-care-enterprise-establishing-sustainable-and-innovative-patient-care-models-across-the-continuum)
Best Regards,
Brian Latham, Pharm.D.
Director of Pharmacy/Home Infusion
St. Rita’s Medical Center
St. Lima, OH
Erin Taylor, Pharm.D.
Assistant Director, Acute Care Pharmacy Services
Baystate Health - Department of Pharmacy Services
Springfield, MA