Ways to increase sales and profitability for Pharmaceutical

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all right good afternoon everyone I'm Pam Andress and I want to welcome you all to one of our complete RX knowledge series events so the goal of this series is to share news information and best practices for hospital and health system leaders today's program is going to focus on the many ways your Pharmacy Department can and should be positively impacting each stage of the revenue cycle all participants will be on mute but we encourage you all to submit your questions using the Q&A feature on your screen and there's also going to be a couple of poll questions throughout the panel discussion and we would really appreciate everyone's participation with those as well I'm now going to introduce our speaker panel Dana Fox is the program development manager for complete RX Dana oversees the enhancement and optimization of operational processes and the launch of new Pharmacy Le initiatives Justin sod is director of Pharmacy informatics and in his role Justin supports Health Systems to optimize their information systems enhance billing capabilities and Implement new hardware and software Technologies now both of our speakers are Pharmacists and they have over 15 years of Hospital experience so they're uniquely qualified to discuss those real world challenges and opportunities for revenue cycle enhancement I'll go ahead and cover the objectives of our discussion today first we're going to outline the critical stages of the hospital revenue cycle we'll then move into reviewing best practices for revenue cycle management and then the identification of new Pharmacy Le revenue streams and with that introduction I'm going to turn it over to Dana Fox Thank you Pam first let me get started by explaining some of the current challenges that we see within the revenue cycle the regulatory area is one area that is rolled out annually with some changes CMS drops C CMS will drop coding and billing changes of at in January of every year additionally there are Market changes going on in the drug Market on a daily basis drugs change we change frequently in how they are supplied and packaged this is another area you need to be cognizant of additionally payer practices change regularly within your institutions drug schedules payment lists throughout the year are changing depending on who your insurance providers are and how you're Contracting with them these need to be monitored and and reviewed prior to doing any changes within your revenue cycle finally technology is another area that impacts your Pharmacy revenue cycle automated dispensing cabinets electronic medication records and computer systems all work together through interfaces and changing and exchanging data throughout your health system these requ require daily reconciliation and also monitoring to make sure that the data is Flowing freely throughout your Institution okay so having discussed those challenges we're going to go ahead and launch our first poll question and the question is what is your biggest revenue cycle challenge today is it a regulations and Market changes B payer practices or C technology and we'll give you just about 10 seconds to complete that poll all right we'll go ahead and close out the poll and we see that 50% said technology which is is probably not at all surprising to this group because there have been so many technology changes and implementations here and we're going to cover the revenue cycle next but you just you have to understand the vastness of how large that cycle is and how many people are touching that so I'll let Dana cover that next thank you Pam as you can see in front of you we've have a a depiction of the hospital revenue cycle it initiates with the patient registration this is the intake process where the patient will come into your health system or hospital where you verify some patient information and also get the insurance cards and and information pertinent to the visit next you move on to the patient exam and treatment this is area where they visit a clinician treatment is is written or the review of the patient to then bring them into other parts of the health system next we're move moving on you see Pharmacy formulary and purchasing this is the management and in upkeep of your Pharmacy Library if you will where you hold your information as as well as where you purchase your pharmaceutical moving on you can see dispensing and transactions and informatics this is where your information is housed and exchange throughout your health system it's a very key portion because things Change Daily and you have to keep up information moving on patient billing after your after the orders are completed in your transaction system a bill is dropped and this is a key portion because you have to have your coding and units properly uh in in your system so you can drop a bill additionally moving forward you have patient assistance and Retail this is an area that as the patient moves to an outpatient setting where you can have an impact as well upon discharge and and changing with their outpatient visits finally you have in in the other part of the cycle you have Payment Processing this is where you're working through the billing office and processing the appropriate records and then AR and denial processing that is where the back end where you see any problems being worked throughout your system if you notice throughout the revenue cycle we have areas highlighted in green these reference areas where Pharmacy can positively impact your revenue cycle and make a difference within your institution now let us let us move forward with discussing the five ways Pharmacy can impact the revenue cycle there are three overarching themes that we will cover one generating service Revenue two reducing costs and spend and three capturing full reimbursements let me let me now move over to Justin so he can discuss the patient exam thanks Dana for this discussion the the clinician exam is really outside of the scope of what we're going to talk about we do understand that pharmacist can run outpatient clinics such as anticoagulation diabetes hypertension pain management vaccinations and other NTM Services what we really want to focus is on the treatment prescribed it's the pharmacist specialty it's what we went to pharmacy school for you know we can provide cost-effective treatment that allow for decrease in drug spend and increase in revenue on the inpatient side the clinical pharmacist can participate in interdisciplinary rounds and can offer cost-effective treatment Alternatives that could generate increased Revenue through reimbursements also they can participate in clinical protocols such as IV Topo conversions antibiotic stewardship to reduce length of stay renal function monitoring and dosing as well on the outpatient side pharmacists get the opportunity to treat patients with over-the-counter remedies these treatment options reduce ER visits for minor ailments as well as avoid drug drug interactions with prescribed medications in addition pharmacists can point the patients and customers to store branded generics to to drive up profit margins Dana can you tell us a little bit about the pharmacy formulary sure Justin the formulary is is a library within your Hospital Pharmacy it's an important part of your daily activities in the formulary you try to control the amount of drugs that you have within your hospital system this is very important the maintenance that you do on a daily basis with prices item updates throughout your city system require a lot of intervention it is important to keep these updated daily with changes with respect to ndc's National Drug codes because as you receive different drugs those change and it's important with the billing process additionally within your formulary you need to have an aligned process with your pnt your Pharmacy and Therapeutics committee so you can control the number of line items that you have most importantly to consider is if you have different drug classes you can consolidate from 10 items down to one so restricting your formulary limits the number of line items that you have for billing and maintaining systems additionally a non-formulary process is key identifying drugs that come into your institution that are not part of your formulary is imperative once these drugs are used you need to capture information to understand the National Drug code and other billing information so you can submit those properly and get paid for those services this process identifies those drugs and allows you to acquire that information on the front end finally bulk and Specialty drugs present their own unique problems in how they are packaged and repackaged within the facility it is important to keep those items at the Forefront when you're building your formulary so you can process them appropriately when dropping a bill Justin Justin's going to review how Pharmacy buyers also are important in the process so Pharmacy buyers involvement in the purchasing and the tracking of medications is very important in the revenue cycle stream in order to evaluate purchase and efficiencies of aligning of systems is mandatory the pharmacy buyers use several platforms to purchaser drugs including wholesalers Specialty Pharmacy suppliers manufacturers and other backordered uh suppliers that provide Pharmaceuticals to the companies these buyers have to purchase drugs in multiple purchasing quantities such as buy the unit like IVIG buy the vile such as insulin even by the box which is usually unidose Meds by the case such as IV piggybacks and even by the pilot like IV fluids in addition to the different ways that you can purchase a drug they also can be done with multiple prices such as whack go and even 340b this can get extremely costly if the buyer is not doing it right but it can generate Revenue with increased margins if done correctly a common denominator for all the systems to compute these numbers should be established needs to be an Apples to Apples comparison also we have to manage the data and the line items you can't calculate how much you've made if you don't even know what you've spent we have to know your expenses and know your purchase amounts weekly monthly and even annually have a drug budget and compare it versus your actual incurred costs review drug utilization versus onhand inventory turns so revenue is not tied up on the shelves dispensing transactions in informatics is also important and one of my favorites in the medication dispensing process there needs to be Staffing efficiencies having trained staff low turnover lean processes and work flows can increase these efficiencies other opportunities include Outsourcing like telep Pharmacy or Pharmacy management firms Pharmacy automation with robotics automated dispensing cabinets reduce workload and actually reduce returns in credits in addition you can in increase your dispense and your charge capture to make sure you are billing for all the medications you are dispensing medication storage carousels high-speed unit dose packagers and even high-speed labelers all help to increase the efficiency of the pharmacy for instance if it takes 2 minutes minutes to fill an order and two minutes to deliver that order to a floor you have four minutes total at 500 orders you're looking at 33 hours worth of work for a technician to go put this in the an automated dispensing cabinet it could be about eight hours that gives you an additional 25 hours a day to work with as far as the pharmacy drug dictionary build goes we talked a little about about dispensing units versus billing units earlier but I like to delve more into it now the dispensing units versus the billing units needs to match so you are capturing all of the revenue that is associated with the dispense on the bill there can be limitations though with cpoe and basic EHR platforms sometimes these billing units are hard to set up and we'll talk more about that later in general an optimization of your formulary should be done to to ensure full charge capture bulk products including the bolt product setup need to be especially looked at closely in a retail setting when you dispensable product the whole dispense and the whole vial or tube is dispensed all at once in an inpatient setting you have a daily Administration on a mar this can get tricky there are different ways that this should be set up some include zero dosing charging on Administration as well as inter differently for cpoe but there's really not one best practice it depends on the software and the versions that will work best for your facility single and multi-dose fals also prove to be a little bit tricky we encouraging our Pharmacy buyers to purchase the smallest fals and to limit the multi-dose vile use use in ance with capturing all the revenue generated from these products Dana can you help describe what the charge Master does to help in this role yes Justin I will think of your charge description Master as a database this database undergoes constant change on a on a daily basis there's important information that is stored here that we need to keep keep in mind when we we work through the revenue cycle billing and coding details are located here and cross over to the business office on a daily basis charge formulas are also housed within your CDM these are updated on a daily or monthly basis depending on what you have coming into your system the the the charge description Master is also updated by a formulary service vendor or fsv one of the most common ones is FDB or First Data Bank they provide wholesale at awp or average wholesale price that is used to used in your system to price your drugs this is updated on a monthly basis and provides NDC and pricing changes failure to keep up on a monthly basis can result in falling behind in your drug pricing or missing price increases or decreases additionally with changes in the market the fsv load can identify where your system may be incorrectly identifying things and items will kick out it is important to work those when you do update your your your formulary I'm sorry your CDM on a monthly basis finally I want to highlight three drugs here the first Dera Prim Vasa strict and EpiPen these are are all high cost drugs that you may have read about in the last three years they've had significant price in price changes that have impacted the market what's key about these is the price change if you did not keep up your CDM you could be spending more on the drug than what you are getting reimbursed so it is imperative to keep your CDM up to date with updates one I'll highlight is epip pin in May of 2011 the drug cost $164 in May of 2016 when we all started to see it in the news it cost $68 you can see the marked increase that happened throughout that time if you were doing your drug price increases on a quarterly basis you would have missed increases on this drug and fallen behind in your pricing a more current drug to consider with price increases that may be impacting your institution currently or in the upcoming months is insulin this drug in recent stories has shown an increase of 400% and is used daily in a large population Within in your institution we have also discussed these same topics in a previous webinar within our knowledge series if you want to look at high-cost drugs and how they impact the market Justin can you share more information about patient billing and how that impacts the cycle absolutely so one of the areas that we're going to talk about now is the um Health Care common procedure coding system also known as hick piix the hick piix has a J Code plus modifiers that are linked with medications the reason they call them J codes is because the code begins with a J there are multiple coded items that Medicare uses that have different letters medications usually start with an A or J these J codes are used to build Medicare Part B for injectables and Specialty drugs have having missing or wrong codes or multipliers leads to less reimbursement we're going to use an example of Unison or ayin and so bam has a J Code of 0 J 0295 with a billing unit of 1.5 grams in the fourth quarter 2016 payment allowance that were just released in September it has a billing chargeable unit of $3.69 so for a three G vile it would be $7.39 payment allowance if you did not have your multiplier set to two for a three gram dose you would be missing out on $369 worth every single time the drug was dispensed doing some quick math at three doses per day on a patient over 365 days a year it would equal $4,040 55 per day of each patient treated so if you just had five patients in the entire year on this medication every day you're talking $20,000 in Lost Revenue you not only an inpatient we can see results like this but outpatient areas as well can help generate Revenue Dana how can help patient and Retail help generate revenue for facilities Justin I'll I'll highlight a few points here we're going to review patient assistance Specialty Pharmacy and Retail Pharmacy starting off patient Assistance programs are offered by pharmaceutical companies this is one way for you to service un uninsured patients and also set and and and replace those drugs that they use at no cost reducing the revenue cycle impact for lack of payment for uninsured patients one thing to consider when doing this is setting up your program to have it follow through your revenue cycle to back out any charges within your system the patient assistance program is can be budget neutral from a revenue neutral from that standpoint and can assist your facility additionally specialty pharmacies are an opportunity for you to increase your Revenue if you have if you manage specific disease States or have Physicians practicing in C in certain subsets or practices this may be an opportunity for your institution to expand services within your Pharmacy business line servicing these populations can provide unique opportunities through a specialty pharmacy to ma to manage those patients through clinical monitoring and providing drug Services both on the inpatient and outpatient Arenas a thorough assessment of your population is important to understand if this is is an option that you should take advantage of in your institution finally Retail Pharmacy is another solution that can increase your your Pharmacy revenues outpatient Retail Services can be aligned with your impatient Pharmacy to meet patients at that discharge when they have a lot going on you can get far you can get prescriptions filled within your institution and have them have them filled and ready to go when the patient leaves the institution Additionally you can follow up with those customers to see if they would be interested in refills and increasing your prescription volume this can be helpful for them because you keep them within the same name same network and have a medication list that helps with your impatience for medication reconciliation Additionally you can work with your clinics on visits to fill prescriptions for patients when they are are on site getting services this is another way to align patients within your network and also have a service Val have an additional value added service within your institution finally you can also administer vaccinations through your Retail Pharmacy pharmacist pharmacists can get trained to administer vaccinations and document them for the patients within your health system this is one area where you can compete against current marketpl current big box Market retailers that are providing the same service and keep patience within your network all right so thank you Justin we really appreciate your participation as well as Dana and all the insights that have been shared we're going to close it out with a quick poll question uh which initiative of everything that we've discussed would benefit your health system the most and a being clinical B being pharmacy purchasing C informatics technology D patient billing or CDM or E retail and patient Assistance programs just give it about 10 seconds here before we close out the poll all right we'll go ahead and close it and if you take a look at the results here we've got really most people going back to informatics and technology and again just pointing out that there is there's no Silver Bullet here there's no one specific best practice because of the differences obviously in hospital information technology and Hospital information systems and even if you're on the same system oftentimes there's different versions of that so just continuing to really focus on the processes and the training associated with those processes to maximize your Revenue um so before our panel gets started answering questions we just want to thank all of the participants that were on the call today we want to mention here too that there's a link to the recorded webinar that's uh going to be emailed out to all attendees for you guys to view at your convenience and for more information on completerx along with additional articles white papers webinars and events we encourage you to visit the complet rx.com website so we're going to go ahead and pull up a couple of questions here because we do have some that are outstanding and let's see we'll get started with uh for our panel you discuss those C CDM updates so what team members really need to be involved in this process who wants to take that I'll start okay um a couple key members that need to be involved in the CDM update is your one your pharmaceutical buyer the technician or pharmacist Who's involved in the purchasing process is key additionally your Pharmacy informatics Personnel who maintain your CDM need to be involved as well so you're identifying those drugs when they come into the institution and sharing that over to the informatics pharmacist and additionally you need to work with your billing department whoever your analyst is over there so your system matches from a description standpoint so your coding and billing matches on both your CDM side and your billing side Justin any others to add no I would definitely agree you know having that uh connection with uh the informatics the buyer and your accounts receivable or billing department to make sure that everything is aligned uh with the definitely even the jcodes and the multipliers and uh The Wack pricing versus go pricing and having all that information available and put in the system will will guarantee that you will get the the maximum return for uh your your billing charge okay so our next question we we talked a lot about maximizing revenue and so the question is what Revenue increases have you seen by implementing some of these initiatives it's a great question I'll take that one so um we've been working recently uh on several facilities that uh are going through these changes and it really depends on uh the size of facility uh smaller facilities uh 50 bet or less can can have a five to six figure increase uh in Revenue capture if done correctly these large facilities uh with either oncology or uh infusion centers uh not capturing the revenue not having the right J codes for CMS and other areas we've calculated seven figure Revenue increases easily so it's definitely important uh to monitor to make sure it's being done right uh it can make a big impact to your bottom line what do you think Dana I agree with that one other consideration to think of in your business Enterprise is also the time spent if you have to rebu and billers are having to work within your system both Pharmacy and the business office so not only are you capturing Revenue Vue but if done incorrectly you're spending a lot of time on that as well that's a good point so you mentioned Justin I think in one of the earlier slides about upcoming regulatory updates so what should our audience be considering when they're looking at that for their own hospitals yeah so CMS uh released a uh ruling on a JW modifier it was supposed to begin uh in July of 2016 uh it's actually been moved out to January 1st of 2017 and what this is It's a a modifier to the jced uh drug items that requires documentation of the amount of drug that's wasted from single dose vials if the whole vial is not used and this documentation of the amount of waste of drug needs to be on the patient medical record in addition to the bill so several EHR platforms have have struggled with getting this to be Doc documented on the patient's medical record but they are finally uh coming up with creative ways uh to meet this regulation so if if you haven't uh looked into making sure that this JW modifier is built in with your current EHR spilling system for the pharmacy it's definitely something to look into all right anything else to add to that Dana no Justin Justin gave a very good overview of what's coming okay all right well we're right at our time limit so we're going to go ahead and end today's discussion but I want to thank our panel again and all of our participants and everyone have a wonderful afternoon thank you