-AMAZONPOLLY-ONLYAUDIO-START-By Ed Vess, R.Ph., and Paul Baldwin
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No sector of the healthcare industry has been affected more than long-term care over the past year. What are the keys to success going forward? And why marketing your pharmacy‘s unique offerings and continuing to push for provider status will be critical.
A year ago COVID-19 was not on anyone’s radar screen. Our assumption was that the near future would be like the near past. Then we were suddenly facing a once-in-a-lifetime pandemic that has wreaked havoc on both the national economy and the healthcare industry. Such is the nature of all crises: We never see them coming.
No sector of the healthcare industry has been affected more than long-term care (LTC). The sector was already suffering from decreases in resident population, new Medicare Part A payment models, and increasing pressure from Medicare managed care. The virus accelerated these changes as nursing homes suspended new admissions and hospitals canceled elective surgeries that required rehabilitation. On top of that, nursing homes seemed to be ground zero for the spread of the virus and were forced to spend more on protective equipment, training, and staffing.
The years ahead look to be more of the same, with occupancy rates continuing their plunge. The American Health Care Association sponsored a survey that suggests that more than 70% of nursing homes predict they will not be able to sustain operations at the current pace over the next year.
Long-term care pharmacies have experienced a substantial reduction in prescription volume as nursing home occupancy plummets, while costs related to compliance with the new infection control regimens have spiked. The industry’s revenues have not been hurt quite as much as retail, but both sectors have lost business to mail order, the only pharmacy sector that has seen increases in utilization.
For pharmacies that have not diversified into home- and community-based services, the future is almost completely tied to the fate of the institutional sector. As nursing homes go, so go these pharmacies.
The number of pharmacies that have a primary National Provider Identifier (NPI) taxonomy code for long-term care pharmacy continues to grow. While growth is not robust, it appears that entrepreneurs see opportunity in the sector. The larger threat comes from new companies, fueled by venture capital, that are poised to capture share by the aggressive implementation of technology platforms to deliver medicines just in time at lower cost.
Key to success in the future will be the ability to differentiate one pharmacy from another. Independent pharmacies currently spend less than 1% of revenue on marketing, while experts recommend budgeting 5% to 8% of revenue. This is challenging in a period of decreasing revenue, but cutting costs alone is unlikely to reverse the fortunes of the LTC pharmacy sector.
A Seat at the Table
The American Society of Consultant Pharmacists (ASCP) reports that long-term care pharmacies now have an official seat at the table in the federal government’s Operation Warp Speed campaign and are seeking a leading role in ensuring rapid distribution of future COVID-19 vaccines to eldercare facilities. T.J. Griffin, R.Ph., senior VP of PharMerica’s LTC Pharmacy, was selected to serve as a representative of ASCP and all of LTC pharmacy on a committee charged with implementing the White House’s COVID-19 vaccine acceleration program, according to a recent ASCP announcement.
The committee is charged with how to deploy 400 million doses of the vaccine to logistical sites across the country for rapid distribution to pharmacies once the vaccine is cleared for use. The existing relationship LTC pharmacies have with nursing homes and assisted-living facilities make them ideal agents as they can leverage their existing delivery chain.
Opportunity for Pharmacy
An increasing number of LTC pharmacies are adding immunization administration programs to their service offerings to the facilities they serve. With an increased societal awareness of respiratory infections, this year’s influenza immunization rates are expected to improve significantly. Many pharmacists will use this as an opportunity to identify deficits in their patients’ immunization history. A significant number of patients have not completed the Centers for Disease Control and Prevention (CDC) recommended series of vaccines. Most prevalent in this area would be the pneumococcal vaccines recommendations.
Pharmacy is uniquely positioned for the proposed documentation and reporting of COVID-19 vaccines. Vaccine administration reporting to state immunization registries and primary care providers is a standard of practice for most immunizing pharmacists. The vaccine history lookup and scheduling of doses are easily implemented in the pharmacy workflow.
Pharmacists are seeing benefits from offering additional clinical services to eligible patients. Diabetes self-management education and support (DSMES) have been shown to be cost-effective by reducing hospital admissions and readmissions. Many states require all public and private health insurance plans to cover diabetes self-management education and training (DSME/T). Consultant pharmacists are in a prime position to make this part of their clinical review process. Pharmacist intervention in other programs has also shown patient improvement. Reimbursement is payer specific and will often depend on the residence type of the patient.
As pharmacists across the spectrum stepped up to the challenge of the COVID-19 pandemic, we can hope policymakers have taken note of the value pharmacists bring to our nation’s health system. Pharmacist provider status is a benefit for all.
Ed Vess, R.Ph., is director, pharmacy professional affairs, at RedSail Technologies, where he develops and maintains professional relations with pharmacy organizations representing community, institutional, and long-term-care pharmacists. He can be reached at ed.vess@redsailtechnologies.com.
Paul Baldwin is a veteran healthcare policy and government relations executive with 30 years of experience in pharmaceuticals and pharmacy. He can be reached at paul@ltcpharmacy.net.