February 7, 2019
Inside: Partnering with a hospice care organization can strengthen your ties to the community while increasing your revenue.
Treating dying patients is a reality in many healthcare roles, from emergency rooms to operating rooms, and from children’s hospitals to nursing homes. For hospice workers, death and dying are integral parts of the job, but their mission isn’t to save sick patients. It’s to comfort them. Hospice patients have no more than six months to live and have pivoted their energy from fighting the disease to living out the rest of their days in relative peace.
Hospice care teams are multidisciplinary and incorporate everything from social workers to nurses. Yet much of the comfort available to terminally ill patients comes in the form of pharmaceuticals. That makes pharmacists a key component to the hospice team.
Pharmacists who work with hospice care facilities play a vital role in easing patients’ pain and protecting their quality of life. Services you can offer a hospice care organization include:
If you’re not already among the 40 percent of community pharmacists providing hospice care (according to the 2018 NCPA Digest), you could be missing a valuable opportunity to diversify your streams of revenue.
More than a million Medicare beneficiaries use hospice services every year, to the tune of $16.9 billion in 2016. A majority of hospice care in America is paid for through Medicare, though Medicaid and many private insurance policies will also pay for this care. As the United States’ population ages and Medicare enrollment increases, the use of hospice care will grow as well.
Experts also speculate that hospice enrollment has grown because of an influx of for-profit hospice care. In 2000, just 30 percent of hospice care agencies were for-profit. Twelve years later, 59 percent were operating for a profit. With for-profit agencies’ more aggressive marketing—and a general increase in the availability of healthcare information—more people are aware of hospice care as an option for themselves or their loved ones.
As an independent community pharmacist, your focus has always been on patients. Independent pharmacists have significantly more contact with patients than their chain-store counterparts. Their ties to the communities they serve are stronger, and their patients are more likely to be friends and neighbors.
Strong clinical skills and deep concern for patient contact is crucial to palliative pharmacy. Your expertise in monitoring patients through many stages in their life will serve you well in hospice care.
Adding the considerable prescription load of hospice patients can dramatically increase your prescription count. Patients will be taking palliative drugs to control pain and suffering while their primary diagnosis takes its toll. For Medicare beneficiaries, these drugs will be covered under Medicare Part A. However, many terminal patients will also have other health concerns that will bring additional scripts to your pharmacy, covered under Medicare Part D. For example, a patient with advanced dementia seeking hospice care may also have high blood pressure that requires medication.
While taking on all of the patients’ pharmaceutical needs is more profitable than handling just the palliative care, it’s also a smarter choice for the patient. Using just one pharmacy keeps all relevant records in one place and reduces the chances of negative drug interactions that can occur when prescriptions are being filled at multiple locations.
You choose your vendors carefully, select your employees thoughtfully, and stock products strategically. So it makes sense that you wouldn’t select just any hospice care organization to partner with. Here are some things to consider when choosing a partner.
A good partnership is one that lets you grow together, at a similar pace. Choose an organization with a patient load you can accommodate without hiring additional staff. It may make sense in the future to hire another pharmacist or pharmacy technician as the number of patients and prescriptions increases, but doing so immediately will cancel out much of the new revenue from hospice.
The Centers for Medicare & Medicaid Services (CMS) defines ACOs as “groups of doctors, hospitals, and other health care providers, who come together voluntarily to give coordinated high quality care to their Medicare patients.” ACOs were formed as a provision of the Affordable Care Act.
Pharmacists have already demonstrated their value to ACOs. They help keep healthcare costs low, looking for opportunities to switch patients to less expensive drugs. They improve overall quality of care by preventing adverse reactions and negative drug interactions that put patients in danger. (Read more about partnering with an ACO.)
Before you approach a hospice care organization you’re interested in partnering with, pull out your calculator. You may be able to offer discounted drug prices if the hospice is willing to turn over its entire case load to your pharmacy.
Because Medicare pays a per diem for hospice care rather than reimbursing providers for specific services, hospice facilities are always looking for ways to increase their margin without compromising care. A discount makes your collaboration more appealing.
Your profit per item will be slightly lower, but the increased volume will bring in more money overall. As long as you’re careful about how deeply you can afford to discount the drugs, all parties will benefit from the deal.
Hospice patients’ medication needs may vary dramatically from the patients you typically serve. Because end-of-life care involves so much pain treatment, you may go through more fentanyl and morphine than you would otherwise. Be sure you’re aware of how controlled substances are handled in your state and figure out if you’ll need to change anything about your workflow to accommodate greater quantities of these carefully monitored drugs.
Hospice patients also use plenty of common medications like acetaminophen, lorazepam, antidepressants, and prochlorperazine. When you’re working out a partnership, be sure to get details about the medications, dosages, and quantities used at the hospice. Then take a look at how you’d have to alter your current inventory ordering, and how that would affect your rebate status with wholesalers.
Partnering with a hospice care organization can help you grow your business, but taking a smart, researched approach is key.