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Lou Ann Brubaker is the President of Brubaker Consulting, a company she founded in 1988 to exclusively serve post-acute care and related ancillary and technology companies. She spoke with ComputerTalk’s Maggie Lockwood about recent happenings in skilled nursing facilities and the impact on pharmacies and the software they’re using.

Read More About The Current State of LTC Pharmacy in The Cover Story

ComputerTalk: Lou Ann, what trends are you seeing?

Lou Ann Brubaker President, Brubaker Consulting

Brubaker: Last October there was a major shift in the Medicare reimbursement program. We went from the Prospective Payment System (PPS) to the Patient Driven Payment Model (PDPM). Where once skilled facilities drove revenue based upon the number of therapy minutes/per resident/per week, the focus is on individualizing care based upon clinical need AND co-morbidities. Therapy is now just another cost center. It’s forcing skilled facilities to look hard at more complex services like wound care, oxygen therapy, and IVs. It’s important pharmacies understand the shift in the payment model because medications are reimbursed separate from nursing and social services and Medicare predicts increased pharmacy spend under PDPM.

CT: What kinds of pressure will this bring to bear for pharmacists? Will there need to be increased documentation and patient-specific information to support SNF clients?

Brubaker: Absolutely there’s more pressure. At the facility level, it’s far more than just charting care. It’s more directly tying clinical pathways to care plans and more real-time risk assessments for things like falls. I think this will force pharmacies to look hard at what’s the real level of sophistication in the software they’re using and how it can be leveraged as a value-add in their services. How does the pharmacy software interface with what’s being used in my facility? What can you bring to my attention sooner?

The next target in that interface ought to be what the pharmacy can do to streamline a facility’s processes and take routine tasks off the facility table in respect to medication management.  As a facility I’m caring for people who, 15 years ago or so, would have been in the hospital. Current SNF admissions have a ton of co-morbidities. Nobody is coming in just because they had a broken hip. If they’re well aged they’ll be supported with home and community based services following hospital discharge. I need my clinical staff to be providing clinical care — spending less time on the administrative.

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CT: What are other ways pharmacists can provide value to their clients?

Brubaker: A good example is provision of a quarterly business review. If I’m an owner of 10 nursing facilities, I don’t want you to give me the overall enterprise level of information. I want you to show me where I have outliers in certain performance areas. If I’ve got one or two facilities that are really requesting a ton of stat deliveries, we may have a problem.

What data can your pharmacy provide about my attending physicians’ prescribing habits. Who should I be concerned about regarding antibiotic over-utilization?  Who isn’t consistently following formularies or are less inclined to take my Consultant Pharmacist’s recommendations? I can’t address things operationally in the aggregate – you’ve got to help me with the granular information. If I can go to a dashboard with key indicators you’re helping me do my job better.

The bottom line is that anything that a pharmacy can do to look for opportunities, using current algorithms in its pharmacy software, to help facilities them drill down and save money in terms of a Med A resident is invaluable. My margins are thin – I’ll look at any opportunity to improve them. If you can help me do that through your unique expertise I’ll marry your pharmacy.

A pervasive challenge in facilities is staff turnover. This means that the staff your pharmacy trained in IVs or inhaler use may not all be the ones providing care today. I think pharmacies need to think about how they can help address that. It may make the pharmacy feel it’s leaving some money on the table, but you have to consider the long-term benefits from the relationship with that facility.  Demonstrate that you looked out for them in an aggressive way.

Admirably, I think facilities are more open to any and all information opportunities. As an example, more and more facilities are taking a hard look at genetic testing to identify their residents’ ability to metabolize certain of their medications.

CT: Are you saying that the data is a big driver in client retention?

Brubaker: Absolutely. Again, in the early days of facility medical records the emphasis was on charting. Now it’s so much more sophisticated. It’s caused the creation of data analytics companies that do nothing but interface with facilities’ software to identify potential missed documentation in the Minimum Data Set that could impact case mix index. That’s the multiplier used with the base rates within physical and occupational therapy, speech-language pathology, nursing/social services, and pharmacy to determine the per diem. This is incredibly useful information.

CT: What needs to happen regarding pharmacy software development?

Brubaker: I think that pharmacy operators have been doing a great job working with software companies to provide feedback. I hope they’ll continue to relay the changes or stress points they’re seeing in their client facilities and how that should drive new pharmacy software capability. What matters is the enabling of real-time decision opportunity. If everything that I am doing is based upon the retrospective, I’m always going to be late to the correction. Highlight for me sooner an uptick in certain types of medications’ use. There’s a ton of scrutiny on psycho-tropics and the like. Provide information to my Infection Preventionist regarding antibiotics and vaccines. Software needs to help the pharmacy share information with the facilities that can more instantly impact both their financial and compliance success.

I remember working with a small chain of nursing facilities that were struggling financially. Part of what hampered more timely solutions was the delay in them getting their monthly operating statements. They weren’t available until 45 days after the close of the previous month which meant they went two and a half months blind to finding a problem’s root cause.

I’m very encouraged by the robust conversations occurring between pharmacy and their software vendor.  Post acute care is a dynamic industry — the only constant is change. This means the pharmacy’s resources need to evolve as well. I’m impressed by how certain software companies are intently listening to their pharmacy’s marketplace observations and their continued investment in the next needed solution. Everybody’s got skin in the post-acute care game. Collaboration is the only way to win. CT

Lou Ann Brubaker welcomes comments and conversation. You can reach her at

Read more about the current LTC pharmacy environment in further coverage from ComputerTalk’s September October 2020 issue online at