Pharmacies brace for a double wave of DIR fees while paddling against profit struggles. Enter Pharmacy AI: a transformative vehicle to navigate stormy waters, enhance efficiency, and prioritize patient care.
As the broader world has settled into a post-pandemic existence, the pharmacy community is bracing for yet another major disruption. Early next year, the Centers for Medicare and Medicaid Services (CMS) will remove the application of retroactive direct and indirect remuneration (DIR) fees and move DIR fees to the point of sale instead.
Pharmacies will face a double wave of DIR fees as they enter 2024, with a large chunk retroactively for late 2023 claims and point-of-sale DIR fees beginning January 1, 2024. Many cash-strapped community pharmacies are barely staying afloat and wondering whether they can navigate these uncharted waters successfully.
The pace at which pharmacies need to adapt is beyond what the current system will allow.Understaffed pharmacies with pharmacists and technicians already at the point of burnout can’t be asked to “row harder” against the massive headwinds of DIR fees and the plummeting profits of prescriptions.
Yet some groundbreaking pharmacies, like a handful using billing automation to streamline medical billing, are pivoting and questioning the need to keep their existing business model at all. Navigating the next phase of pharmacy will require a new vehicle altogether: pharmacy AI.
Pharmacy AI isn’t about taking your current system into the shop and tacking on some new tech. It’s a ground-up rethink about how to propel your business forward. Your AI-driven pharmacy is a helicopter, not a boat, rising above the troubled waters of PBM control and regulatory change.
The good news is your upgrade will be cost effective and purpose-built for your business. By bypassing PBMs, pharmacies can eliminate clawbacks, enhance workflow efficiency, and get paid for care already provided by pharmacists such as comprehensive counseling activities. Reducing the toil of billing administration can help pharmacies rise above and refocus on their skill as providers, not just their transactional throughput.
Forward-looking pharmacies will be searching for ways to build up cash as they prepare for the DIR double whammy. Using pharmacy AI, such as auto-billing technology, can give pharmacies a much-needed profit boost while also setting themselves up to thrive in the future.
By reducing administrative costs and relieving the burden of cumbersome medical billing, pharmacies can retake control of their business and generate revenue without the need for a bunch of new team members. This also means improved patient outcomes become aligned with a profitable pharmacy model; a win-win for patients and community care.
This all sounds great, but what does adopting AI into the pharmacy model actually look like? Adopting AI into the pharmacy model can revolutionize the way we manage health care operations. Let's consider the example of a Fall flu vaccine clinic, a process that can often be cumbersome and exhausting for pharmacists and technicians.
Traditionally, pharmacists and techs have to juggle multiple tasks, such as administering vaccines, assessing patient eligibility, providing education on possible adverse effects, and meticulously documenting encounters for billing purposes, all while maintaining filling operations; however, with AI integration, this process becomes more seamless and efficient.
Imagine a scenario in which patients are swiftly evaluated for vaccine eligibility using AI algorithms. Clinic schedules are optimized automatically, eliminating the need for manual appointment and scheduling tools. The encounter claim is auto-generated, saving time for pharmacists who only need to review and sign off on the final documentation.
By injecting streamlined AI solutions into clinical workflows, appointment booking, note management, and billing administration are automated. This not only frees up valuable time for pharmacists to focus on patient care and counseling but also ensures accuracy and precision throughout the entire process.
Embracing AI in pharmacy operations offers tremendous benefits, enhancing overall efficiency and patient experience. By unifying various tasks through AI-powered systems, pharmacies can provide a more integrated and cohesive health care service to their communities. The enhanced efficiency of pharmacy encounters will undoubtedly be appreciated by patients, motivating them to frequent their local pharmacy more often.
Beyond brick-and-mortar pharmacy wins, pharmacy AI can be deployed to improve the cost and adherence of medication regimes. On the affordability side, community pharmacies would love to research all the non-preferred drugs available to customers via their pharmacy benefit and have that information at the ready. There just isn’t any time.
But pharmacy AI can do that research in the background and cue up lower cost recommendations at the point of care. Not only does this kind of automation lower costs for patients and pharmacies, it puts the focus back on patients, not products.
Pharmacy AI also offers significant assistance in addressing medication adherence flags. Operating behind-the-scenes, at very little cost, AI improves patient outcomes and healthy equity through proven methods of comprehensive medication management (CMM).
By analyzing patient data, including prescription records and refill patterns, AI can identify usage patterns and indicate individuals at higher risk of non-adherence. This proactive detection of non-adherence allows pharmacists to contact patients or health care providers for further attention.
No longer constrained by the relentless PBM cycle, every community pharmacy in the United States now possesses the means to seize control of its profitability by harnessing the potential of pharmacy AI. By bypassing PBMs, pharmacies can eliminate clawbacks, optimize workflow efficiency, and at last, receive rightful compensation for their exceptional care.
In the face of the impending double wave of DIR fees, the pharmacy community must seek innovative solutions to navigate these uncharted waters successfully. Pharmacy AI emerges as a transformative vehicle for change, propelling pharmacies above PBM control and regulatory changes. Embracing AI is not just about adopting new tech; it's a ground-up rethink of how pharmacies can thrive in the future.
Pharmacy AI not only holds the potential to boost profits and improve patient outcomes, it also empowers pharmacies to adapt and prepare for the challenges ahead. From revolutionizing flu vaccine clinic efficiency to optimizing medication adherence and affordability, AI-driven solutions offer a holistic approach to patient care and business success.
In this new era, automation becomes the formula for successful outcomes, freeing pharmacists from the burdensome tasks of the past and enabling them to take control of their pharmacies' destinies. As AI reshapes the pharmacy landscape, pharmacies must seize the opportunity to grab the controls and steer their businesses towards a future prioritizing patient well-being and efficient care delivery. With pharmacy AI as their compass, pharmacies can navigate these transformative times and redefine their role as providers, not just pill dispensers.
About the Author
Samm Anderegg, PharmD, MS, CEO and co-founder of Docstation.