Pharmacists Play an Important Role in COVID-19 Business Recovery

Pharmacists can provide a multitude of billing opportunities for their health systems and bringing these opportunities to executives is essential during a time of budget tightening.

As health systems try to begin recovering from the economic costs of the coronavirus disease 2019 (COVID-19) pandemic, pharmacists will play an important role in managing costs, increasing revenue, and providing great patient care, according to a session at the American Society of Health-System Pharmacists (ASHP) 2020 Midyear Clinical Meeting and Exhibition.

Pharmacists in all clinical environments are being pressured to do more with less while contributing revenue to minimize financial losses caused by the COVID-19 pandemic, said presenter Bonnie Kirschenbaum, MS, BS, FASHP, FCSHP, a consultant and columnist. She said many patients are not returning to pharmacies as anticipated, and some experts are predicting that the normalization of business operations could still be several months to a year away.

To begin recovering, Kirschenbaum said improved infrastructure must be the top priority of health-system pharmacies, not only in clinical offerings but also in data quality and reimbursement management. Obstacles to these developments include cumbersome information technology (IT) systems, a reluctance to embrace changes, and a lack of awareness about the necessity of change.

A second key focus will be bringing patients back into facilities and ensuring they have safe access to care. Patient involvement in their own health care decisions will continue to be a major shift, Kirschenbaum said, adding that the shift to telehealth has only increased patients’ involvement. Health care providers, including pharmacy staff, must support positive patient outcomes, prioritize patient experiences, respond to feedback and analytics, and understand patients’ realities, according to Kirschenbaum.

Major challenges for patients typically include a lack of care coordination and confusing billing. As such, the new emphasis on patient safety in health systems must take these concerns into consideration. Kirschenbaum said health systems should consider how they are perceived in the community, including any friction points and how much effort is needed for patients to access care.

Finally, Kirschenbaum said understanding payers and their requirements is absolutely vital for health systems to recover financially from the COVID-19 pandemic. Because payers’ goal is to pay only when their conditions are met and all documentation is provided, Kirschenbaum emphasized that medical facilities must submit a complete, clean claim that meets all of the requirements every time in order to maximize reimbursement and revenue.

Prior authorizations also play a major role in these reimbursements. Kirschenbaum said it is essential that everyone involved understands which drugs have these requirements, have a set procedure for how to handle them, and ensure proper electronic health record documentation before the order is written. She added that it is equally important for the authorization to remain a permanent part of the record in real-time sequence for auditing purposes.

Finally, Kirschenbaum said pharmacists can provide a multitude of billing opportunities for their health systems and bringing these opportunities to executives and advocating for the importance of pharmacies is essential during a time of budget tightening. These opportunities can include annual wellness visits, anticoagulant monitoring, chronic care management, diabetes education, medication therapy management, comprehensive primary care-plus programs for medication management, telehealth, transitions of care, and vaccine administration.

Like all health system leaders, Kirschenbaum said pharmacists need to be adaptive when confronted with the extreme unknowns of the COVID-19 pandemic and its recovery. She cited “threat rigidity” as another important obstacle to recovery, saying many individuals tend to freeze innovation and rely on what has worked in the past rather than turning to new ideas and adapting quickly to the circumstances. Avoiding common missteps, such as narrow thinking and conformity, will be essential to all health systems as they look to the future, Kirschenbaum concluded.

REFERENCE

Kirschenbaum B. COVID-19 Business Recovery: Pharmacy Answering the Call for Change and Innovation. Presented at: 2020 ASHP Midyear Clinical Meeting and Exhibition; virtual: December 7, 2020.