Senior Care Pharmacies

The advisory and care management services LTC pharmacies offer are crucial to continuity of care, and the ongoing quality of care that patients receive. The average LTC facility resident takes 11-13 prescription medications each day. Medications for residents change frequently, particularly within 30 days of admission to a facility, and any time a resident undergoes a significant change in condition. With a growing, dynamic healthcare marketplace rightly placing a premium on quality care, positive outcomes, reduced hospital readmissions and more efficient use of taxpayer dollars, independent LTC pharmacies are an increasingly significant ‘value-added’ component in the broad continuum of care. Among a variety of key and growing responsibilities, LTC pharmacies are accountable for compliance with complex prescription regimes, and ensuring they are professionally reviewed for accuracy to prevent potentially deadly adverse drug reactions and interactions. Highly-engaged in tracking patients’ specific illnesses, medication needs, and payer sources, LTC pharmacies are poised to be an even more significant linchpin helping minimize patient readmissions and maximizing outcomes. Investing heavily in dispensing technologies to enhance compliance, improve accuracy, and reduce waste, LTC pharmacies also play an integral part in introducing electronic medical/administration records and other IT systems to help optimize communication between facility and pharmacy. These systems provide a variety of alerts, and other information, which help the nurse and facility administration make informed, real time decisions – the decisions that bring about better patient care and outcomes.

Unlike “retail pharmacies” (also known as “community pharmacies”) — which are open to the public and sell a wide variety of products beyond prescription drugs and other medications — LTC pharmacies are generally located in a warehouse-type facility, are not open to the public, and patients have no direct access. LTC pharmacies are designed for large volume, efficient drug distribution in a highly specified manner. In addition to dispensing and patient-specific custom compounding, the LTC pharmacy staff must be clinically oriented, and offer extensive consultative and technology resources to a skilled nursing center, or other setting served. The requirements imposed on LTC pharmacies are significantly more stringent than those imposed on retail pharmacies, including intensive pharmacist involvement in medication and patient care management. In fact, the job of the LTC pharmacist continues once a drug is dispensed while that of the retail pharmacist ends. LTC pharmacies remain an integral part of a patient’s care team and not only review patients’ ongoing medication regimens, but monitor their condition, coordinate and tabulate billing among multiple payers, and provide ongoing training and education to facility staff to ensure full-spectrum care management.

Skilled Nursing Facilities (SNFs), assisted living facilities (ALFs) and related care settings are experiencing a greater influx of higher acuity, post-hospital patients being prescribed a wider variety of complex medications and treatments. Working collaboratively with caregivers, a patient’s individualized medication management program overseen by an independent LTC pharmacist helps to more readily preempt – and prevent – avoidable readmissions, potentially life threatening drug interactions, and other complications like patient falls.

The Hospital Readmissions Reduction Program, part of the Affordable Care Act (ACA), seeks to reduce preventable readmissions within 30 days of discharge. Compliance failure results in Medicare reimbursement reductions. With close to half of hospitals’ Medicare patients discharged to SNFs and related settings, these facilities are integral to curbing readmissions. LTC pharmacies are a growing, necessary part of this equation.

FIRST PHARMACIST REVIEW

After receiving a patient order from the care facility, patient data is entered for fulfillment and billing purposes, and necessary data is provided to the Pharmacy Benefit Manager (PBM)/Prescription Drug Plan (PDP) to determine reimbursement eligibility, and amount.

Prior to dispensing, the pharmacist specializing in geriatric care reviews the order, confirms the accuracy of prescription entry based on the doctor’s orders, critically assesses the possibility for interactions with other current drug orders, and evaluates the appropriateness of every specific medication given each patient’s overall health care needs and degree of impairment.

SECOND PHARMACIST REVIEW & DELIVERY

After dispensing in packaging designed to enhance compliance and ease administration for the nurse, the medication is rechecked by the pharmacist, who confirms the correct medication is dispensed to avoid errors.

The packaged medication is delivered to the facility promptly on a 24/7 basis, and controlled substances are tracked and managed as mandated by DEA regulations. Medication delivery is the third largest cost for independent LTC pharmacies, and is driven by the significant labor required to sort, pack, prepare and deliver the orders, insurance, vehicle and fuel needs.

CONSULTATIVE SERVICES, RECORDS MAINTENANCE & COLLECTIONS 

LTC pharmacies review each patient’s medication regimen on a monthly and quarterly basis, and whenever there is a significant change in a patient’s condition — working jointly with patients, family members, doctors, and staff to optimize care, contain costs and minimize unnecessary or duplicative drug regimens.

On a monthly basis, the LTC pharmacy provides the facility a complete set of administration records used to properly document the medications and treatments provided to each patient. Appropriate payer sources are billed, funds are collected and tabulated, and patient billing issues are resolved. Multiple payers are involved, including state Medicaid, Medicare Part D and Medicare Part A. Private pay and co-pays are also billed and collected post consumption.

ONGOING TRAINING & EDUCATION

LTC pharmacies provide ongoing training to facility staff regarding antipsychotics, diabetes management, antibiotics, infusion therapy administration, narcotic documentation (and rules), Med Pass observations, psychotropic medications, blood-borne pathogens, depression, fall prevention and more.

The net result is fewer mistakes in medication administration, an increased level of caregiver knowledge and competency, and an overall improved standard of patient care.

Among the many duties performed by LTC pharmacies are:

• Comprehensive medication regimen review (MRR) which assures proper drug selection and decreased adverse drug events
• Present in-services to the facility staff on pharmacy related topics, and participate as a key part of each patient’s care management team
• Ongoing caregiver education to optimize on-site care
• Provide IV medications and infusion therapy services compliant with USP 797 requirements
• Maintain and sustain comprehensive inventory
• Manage patient reimbursement issues with Pharmacy Benefit Managers (PBMs), PDPs and other payers
• Provide facility with Medication Administration Records (MAR)
• Integrate with facility clinical software systems including e-MAR and e-prescribed programs to facilitate seamless information flow between healthcare providers
• Pharmacy operations and prescription order processing
• Compounding/Alternative forms of drug composition
• Special packaging to meet federal compliance standards, including Food and Drug Administration (FDA) requirements
• Pharmacist On-call service (24/7) and ability to deliver medications expeditiously upon receiving prescription order
• Delivery service (24/7)
• Emergency medications stored on-site at facility (24/7)
• Maintain reports, forms and prescription ordering tools