In-house pharmacist builds up bottom line

ABSTRACT: Staff pharmacists do more than just mix drugs-they monitor inventory, optimize billing, and oversee drug protocols.

Today’s shrinking drug reimbursements are forcing community oncologists to adopt more creative business models to shore up their bottom line, such as hiring full-time pharmacists.

On the surface, this might not seem fiscally sound; after all, oncology nurses can mix chemotherapy agents and are paid considerably less than a clinical pharmacist. But according to a 2006 MedPAC study, a growing number of oncologists say that pharmacists increase their profi ts by, among other things, recommending chemotherapy and supportive care drugs based on eff ectiveness and on price.

Chemotherapy regimens are under constant revision, and NIH has made error prevention a national priority, so an oncology/pharmacist relationship seems like a natural progression. In fact, a majority of oncology practices that have eight or more oncologists also employ pharmacists and pharmacy technicians (Am J Health- Syst Pharm 63:1774-1775, 2006).

What about the smaller practice?

Although larger physician practices clearly can benefit from a staff pharmacist, the average oncology practice in the United States is just 2.4 physicians. Where do the smaller practices stand?

Due to cost, smaller practices are at a distinct disadvantage in the oncology/ pharmacy trend, said Steven L. D’Amato, RPh, BCOP, clinical pharmacy specialist, Maine Center for Cancer Medicine & Blood Disorders, Scarborough. But he noted a less expensive option.

“Hiring a qualified oncology pharmacy technician is one approach that is very successful. In fact, we utilize seven technicians in four sites. They have ordering responsibilities and also provide inventory monitoring and control. This frees registered nurses to do what they should be doing, taking care of our patients,” Mr. D’Amato told Oncology News International.

In today’s tight environment, capturing every billable dollar is absolutely necessary. Regardless of the system used to capture charges-electronic health record (EHR) or manual-having a pharmacist control and monitor inventory can enhance charge capture.

“Having a rapport with billing is also very important. As new drugs enter the oncology arena, it is important that the correct billing and diagnosis codes are entered into the system to prevent the denial of claims,” Mr. D’Amato said.

He explained that pharmacists, especially in the private practice setting, now perform almost all of these functions.They also play a vital role with payers, as they can provide the clinical data and rationale for various treatment regimens that payers may question.

Moreover, he said, pharmacists help in contracting for services (pharmaceuticals, supplies) to provide the best possible pricing for practices/institutions. “Monitoring performance around incentive-based contracts can make a big difference in practice revenue,” he added.

Medical error prevention Mr. D’Amato said that phamacists excel at preventing medication errors, especially in oncology with its high potential for drug interactions.

Using an EHR to screen for interactions is helpful, he noted, but the pharmacists’ role is much broader, including reviewing patient medication profiles, performing drug reconciliation, educating clinical staff and patients, and verifying chemotherapy orders.

In addition, Mr. D’Amato said, pharmacists can be essential in setting up an EHR. “Having a pharmacist enter regimens and orders, establish dose-limits, incorporate administration instructions (diluents, administration time), and establish sequencing of agents, cycle lengths and durations, all contribute to a reduction in medication errors,” he said. This can also be accomplished in a manual system, he pointed out, although it’s much more tedious.

“Just having a pharmacist available to provide physicians with drug information that may suggest the best approach to a patient’s therapy can mitigate potential problems,” Mr. D’Amato said.

How do pharmacists bill?

In an interview, Dan Buffington, PharmD, MBA, president and CEO of Clinical Pharmaceutical Services, Tampa, Florida, explained that pharmacists can only receive direct compensation for a limited amount of Medicare Part D prescription drug services. However, he said, the AMA’s Current Procedural Terminology (CPT) editorial panel approved a series of codes called Medication Therapy Management (MTM) that describe pharmacist clinical services.

“These codes became permanent in the CPT 2008 and provide a nationwide coding structure for pharmacists and payers. The codes operate in the same way as other allied healthcare practitioner codes, in a time-based methodology,” Dr. Buffington said.

He explained that MTM codes are designed to be generic in nature, meaning that they can apply to any practice setting and describe the continuum of pharmacist interventions, from basic patient education and drug regimen review through medication therapy coordination services.

“Pharmacists take a long view of a patient’s medications, ensuring optimal management of both risks and costs associated with the treatment of cancer patients,” Dr. Buffington said.