A Prescription for Accountable Healthcare
Management Solutions

Pharmacy Management Solutions
Clinical Pharmacy Associates provides a range of services to meet the dual demands for quality and cost effectiveness in managing hospital pharmacies in today's increasingly complex healthcare environment. We make available both on-site consulting and on-line support to help Pharmacy managers navigate difficult pharmacy management issues without exposing their institutions to the high cost of outsourcing.

Among the benefits hospitals, Ambulatory Care Centers, pharmacy directors and risk managers derive from a relationship with us include:

  • Incorporating the latest pharmacy management techniques
  • Creating efficiencies for pharmacy service
  • Improving medication use management
  • Maximizing resources
  • Improving inter-departmental service

This program is packaged as a fixed annual fee support program with scheduled on-site visits and unlimited on-line support with tools to help manage the critical aspects of Pharmacy Service. Focused consulting and on-line tools are also available for those who want more tailored support.

Areas of support include:

  • Strategic planning
  • Medication Use Process Mapping/Analysis
  • Operational Dashboard Monitoring
  • Inventory control and purchasing management
  • Policies and Procedures
  • Staffing Assessments
  • Drug Cost Audits

Efficiency Reviews Consulting
Delivering enhanced pharmaceutical care is a difficulty faced by most hospitals today. Fast-paced medical innovation, reimbursement reform, adherence to quality requirements and limited resources are challenges they must meet. Clinical Pharmacy Associates' Efficiency Reviews assess pharmacies for process efficiency, compliance to laws and regulations, processes maximization, quality improvement, right-staffing and the management of costs and reimbursement.

We utilize proven benchmarks while taking into account specific hospital characteristics that make each facility unique. Based on value propositions, we provide clients with a report card identifying their major Pharmacy and medication management proficiencies and deficiencies along with the corrective actions they may need to take to address shortcomings. These can include activities in such areas as purchasing, inventory control, staffing, clinical programs, controlled substance management, IT resource effectiveness, billing and reimbursement maximization and compliance with quality initiatives.

For billing and reimbursement maximization, we verify that all required elements are submitted at the time the charge is generated and that ICD-9 codes, CPT codes, HCPCS codes and drug related revenue codes are assigned accurately. We assess if NDC numbers flow with determined reimbursable drugs and recommend drugs that should be limited to outpatient settings (and restricted to inpatient use). We determine if drug waste policies match revised CMS guidelines.

Our Associates are experienced pharmacy professionals who understand hospital workflow and the integration of information systems functionality for ease of inventory control, billing and medication dispensing. Mining practice data and interpreting pharmacy data to adjust systems processes are specific competencies we can deliver.

The consulting process looks to break down intra-departmental barriers between key stakeholders in the medication use process, including physicians, nurses and pharmacists. Sources of "breakdowns" are anticipated, and corrective actions are planned. We specialize in improving the efficiency of the pharmacy staff and other stakeholders in the medication use process by addressing their needs and concerns, increasing knowledge bases, building confidence and improving service.

Cost & Reimbursement Analysis
Drug costs and reimbursement control are critical factors in maintaining the mission and goals of health care organizations, especially in this era of rapid payment changes. In addition, faulty billing and cost accounting can expose organizations to fraud due to erroneous billing. Many of the problems lie in the building and maintenance of drug dictionaries, communication between financial and clinical IT systems and lack of knowledge of coding nuances required by Medicare and private payers.

CPA addresses these issues by providing expert analysis, verifying maximum reimbursement for each organization by determining that required elements are submitted to insurers in a timely manner. Our process includes identifying the accuracy of ICD-9, CPT, HCPCS and other medication-related codes as well as NDC and other drug identifying numbers that need to be set-up correctly in the drug dictionary. We also look to maximize reimbursement in both outpatient and inpatient settings, advise on which therapies can be reimbursed in either setting and establish drug waste policies in conformance with revised CMS guidelines. The result is a detailed assessment and plan to maximize reimbursement.

Pharmaco-Economic Analysis
Many approaches can be taken to gauge the clinical and financial impact of drugs, including cost avoidance, cost reduction, return on investment or outcomes. The most beneficial approach is to incorporate all of these methods by using pharmacoeconomic anaylsis. Utilizing this approach, CPA combines clinical drug analysis with economic projections based on institutional-specific data for identified patient illnesses. With economic modeling, our experts are able to analyze the total cost of treatment, thereby allowing our clients to direct their resources towards guaranteeing the most favorable outcomes at the lowest cost. The analysis is focused on emerging high-cost drug treatments to provide the critical analysis for each individual institution or insurer.

Our model for Pharmacoeconomic Evaluation is as follows:

Preliminary (Ground Rules):
1. Decide on perspective, patient, payer, provider
2. Decide if the evaluation is literature-based or real-world data based
3. Decide whether to include FDA-approved indications only or other possibilities

  1. In-depth drug or class evaluation:
    Specifically need:
    Indications for use
    Options for treatment of those indications
    Outcomes and probabilities of each occurring with each treatment option
    Clinical indicators which most strongly show differences between treatments
    Validated database indicators which can be used to track clinical indicators/outcomes
  2. Database query: How can you query your database to capture patients treated for those indications?
    May query by diagnosis, by drug treatment, by MD and so on
  3. Conduct literature and database search and develop lists of indications to study.
  4. Conduct drug or class evaluation, develop list of clinical indicators (or outcome measures) which are likely to differentiate between the treatment options for these indications
    LOS, days ICU, days on general ward, signs of efficacy, signs of adverse reactions, etc...
  5. Develop list of database items which can be correlated with the clinical outcomes list
  6. Develop list of cost indicators; cost per hospital day (actual or charge times cost/charge ratio), cost per ICU day, cost per complication (estimates from Accounting Department)
  7. Develop list of other indicators, if appropriate (e.g., Quality of life)
  8. Develop matched control group; list of patients with similar characteristics to study group (e.g., age, diagnosis), but treated in different ways
  9. Query database for outcomes/clinical indicators in study and control populations
  10. Compare outcomes in study and control populations to that in the literature.
  11. Diagram patient pathways (e.g,. by decision tree), consider cost and probabilities with each pathway
  12. Determine best method of analysis: cost effectiveness, cost benefit, etc. ("dollars per ___" life saved, year of life, event treated, etc...)
  13. Projections and simulations based on client-specific data to include total inpatient and/or outpatient costs
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