Feature | Concierge POS Delivery

Mobile POS Takes Pharmacy to the Bedside

A pilot program to improve HCAHPS scores at Community Hospital in Munster, Ind., through bedside delivery of medications is now a full-time program, thanks to the dedication of the hospital and outpatient pharmacy staff in employing mobile POS and creating a process that is effective for the pharmacy and easy for the patient to use.

The ways pharmacy can impact trends in healthcare — lower costs, increase patient adherence, and lower hospital readmission rates — aren’t always apparent. But when an idea does work, and the pieces fall into place, solutions seem obvious — as Frank Bieda, R.Ph., manager of Community Surgery Center Pharmacy in Munster, Ind., found when he was presented with the challenge of developing a bedside medication delivery service.

“It’s the same thing as when you suddenly get air conditioning,” says Bieda. “How did we ever live without it?”

Neil Gorski, Pharm.D., left, and Frank Bieda, R.Ph., have been instrumental in taking a bedside checkout concierge program from pilot to full implementation.

In this case, a pilot run of a concierge delivery program to address the changes in Medicare reimbursement by lowering readmissions rates, and the role of HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) scores, presented the pharmacy with an opportunity to be a key player in hospital patient satisfaction and improved adherence. The challenge presented by Community Surgery Center Hospital Director of Pharmacy Beth Clements to Bieda focused on how to ensure patients had medications and counseling before leaving the hospital. By catching patients before they are discharged, the hospital would have a chance to track if such counseling helps lower readmission rates and improve HCAHPS scores. “The program was driven initially by HCAHPS scores, but we saw that if patients understood medications before they left, if they had medications in hand, it would be a tremendous help to their recovery,” says Bieda, who manages a staff of nine. “The studies that were out there showed that even some of those small interventions have a big impact on readmissions. We wanted to have hospital services that improve the patient experience.”

Developing a Program

The theory behind the program was pretty simple: identify patients who were willing to have their initial prescriptions filled by the retail pharmacy. As far as logistics, Bieda felt it was critical that the patient experience was seamless, with counseling, payment, and signature capture at bedside. One of the first things Bieda and his group did was contact their pharmacy system vendor, HBS, to see how to interface handheld point-of-sale (POS) devices with the pharmacy system to capture all the relevant data in real time, and handle the financial transactions. The planning began in January 2014, and the pilot went live in the summer of 2014.

Bieda knew one requirement to make the system effective was syncing the handheld device with the pharmacy’s POS system. The fact that the hospital had its own WiFi was an infrastructure advantage. “We could sync so the POS pushed all the information over to the pharmacy management system,” says Bieda. “We needed to have real-time bank-card capture. When you’re at the bedside, and someone gives you a bank card, you want to be able to swipe it and get confirmation that payment has gone through immediately. And we needed them to sign for HIPAA.” Bieda did not want the staff to take a bank card back to the pharmacy only to find it didn’t work, or that there was a problem with the prescription and the patient’s insurance. “We all know healthcare is not free, and it’s a delicate situation if the card doesn’t work,” says Bieda. “We don’t want complications, but we do need to be paid.”

In the pilot Bieda and staff decided to start the concierge program on the orthopedic floor, since they knew the nurses there and felt they would be receptive to working on the project. Also, this specialty has a limited number of medications dispensed, such as antibiotics, muscle relaxants, and pain medications. Once they had picked the floor, Bieda and Neil Gorski, Pharm.D., the lead concierge pharmacist, met with the nurse who managed the floor. Gorski notes that as more nursing staff gets onboard and the relationship between pharmacist and nurse grows, it’s smooth sailing, as the nurses will encourage patients to sign up for the concierge service. “They want to see their patients go home with their medications,” says Gorski.

Connecting People, Connecting Systems

Gorski and Bieda designed an intake system that uses the nurses’ expertise during the admissions interview and the interface between the Epic hospital system and the HBS system. If a patient says yes to the concierge program, then the patient pops up in a folder in the pharmacy system. Gorski will review the list at the beginning of the week, and then visit with the patients to get the details about their procedure, their medications, and the pharmacies they use. In the Epic patient file, its noted prescriptions will go to Community Pharmacy. “We can list several preferred pharmacies in Epic,” says Bieda. “When the patient says, ‘I want to use your service,’ I can go and re-sort the priority. With doctors who are e-prescribers, the script goes right into our HBS system, and we know the patient is ready to go.”

Once the patient is in the HBS system, the staff fills the prescription, and Gorski or another pharmacist will go out to the floor to see the patient. At bedside, the pharmacist reviews the medications with the patient, provides the drug monographs, covers any drug interactions or side-effect warnings, answers questions, and has the patient sign on the iPod. When the pharmacist runs the bank card, it processes through the register at the pharmacy, and when it’s approved, the patient signs for it, again on the iPod. The signatures are pushed back to the HBS system, which is important in case of any audits. “We are dealing with a number of PBMs. If we get an audit, even if you have the best intentions, with paper signatures you can have trouble staying organized,” Gorski says. “I can look at a certain day, and within 30 seconds have the signature sent to the PBM.”

Communication between pharmacy system and POS devices, nursing staff, and patients plays an important part in making a successful concierge program. Bieda explains to patients that they can participate in the program without changing pharmacies. With the program in effect for about 18 months, Bieda estimates the pharmacy is capturing between 5% to 10% of the discharges, with two iPods in use. Not everyone is interested in the program. Bieda says the staff explains that the patient doesn’t spend more than he or she would in a traditional pharmacy setting. “There is a lot of labor involved, but from our perspective, we wanted the patient to know the service is not going to cost them any more money, and they can transfer the prescription to the pharmacy of their choice,” he says. “Of course we’d love to be their pharmacy, but we do discourage going to different pharmacies because it’s easier for a pharmacist to catch a drug interaction when he can see all the patient’s prescriptions.”

Gorksi says the staff can talk with physicians to ask for a substitute if the cost of the prescribed medication is high. “We are able to help patients find assistance programs,” says Gorksi. “Because we have this complete picture, we can help the patient to be able to afford their medications, and this helps with compliance.”

Bieda agrees, adding that the pharmacy can find manufactures’ coupons, like one getting the first month’s fill free for a patient. “We can deliver to bedside at zero cost, and it’s a win-win when you let the patient know he just saved $300,” he says. “This makes the HCAHPS scores go up. And it’s not just the HCAHPS we want to help with: We want our patients to say they had a great experience at Community Hospital.”

One hiccup with the handheld POS device and software is that the process of running bank cards can be fickle due to banking industry security issues. “We had to download digital certificates to iPods to meet requirements as information passes through the systems,” says Bieda. “It can be a moving target. If you get something that works consistently, it makes the job so much easier at the bedside.”

The Soft Return on Investment

Hospital administrators want to see how the program works with the entire hospital population, says Bieda. The challenge with serving the entire hospital patient base, with about 440 to 460 beds, is the number of specialties involved and the handling of a larger range of medications, more PBMs, and the formulary. There are challenges, such as when a physician changes a medication and the patient doesn’t want to pay the increased co-pay. Or when the PBM needs a prior authorization. The concierge program handles all these details. “We’re just three to five minutes from any floor, but it’s labor intensive because all of these patients are new to the HBS system,” says Bieda. “But like with any new patient, there is the initial registration of getting all the information. If the patient doesn’t have his or her insurance card with them, then we’d have to call or use the local pharmacy, which the pharmacy is usually happy to do. We’re not trying to take their patients away, just provide this service.”

There has been steady growth, with the pharmacy filling about 600 scripts a month through the concierge program.

“When we did the pilot program, we were talking about a few drugs, with the margins on those drugs very slim,” says Bieda. “It’s hard, but it’s important to track these soft dollars.” Bieda has pharmacy staff who track the patient history (if the patients are part of the program) to see if the program has been successful. “As the HCAHPS scores creep up, how do these scores equal dollars reimbursed?” he says. “It’s hard to connect these two dots and understand the soft-dollar profit.”

If the concierge software could run on an iPad, that would be ideal, says Bieda, as iPods are small for older patients. Bieda says he’s working with HBS to have the system tag patients to make it easier to pull reports. Now a technician keeps spreadsheets monitoring prescription volume, activity, costs, patient name, room number, and the floor that prescriptions are generated from. The tech is looking at the acquisition costs and the payment, with the goal to have a true picture of profits. One improvement Bieda hopes for is a monitoring system that lets his staff run reports on certain drugs or for a certain floor.

A Growth Area for Pharmacy

The mobile device gives the pharmacist the opportunity to interact with patients at the right time, when they are most aware of the steps they need to take to get better after a procedure, and this, Gorski says, will improve patient education. “With this education, we can improve the overall health status of the patient, and that can have an impact on healthcare spending,” he notes.

From a healthcare standpoint, Gorski sees the potential benefits of pharmacists and nurses working together to aid patient education and adherence. If there is a newly diagnosed diabetic patient on several medications, nine times out of 10, he or she doesn’t really know what the medication is for, says Gorski. When pharmacists and nursing staff coordinate, they can train the patient on the proper storage of insulin, for example, and the best techniques for injections. With this sort of personal care, the patient will have a better chance of staying compliant. “There are studies showing that patients who are in the hospital are more open to new information about a disease state or a condition,” says Gorski. “When you are hitting the patient with information from a number of fronts — from the physician’s staff, the nursing staff, and the pharmacy staff, to catch any interactions — it’s more effective.” CT

Maggie Lockwood is VP and director of production at ComputerTalk. She can be reached at maggie@computertalk.com.

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