At the end of September, CMS finally approved and released the roll-out schedule for the long- awaited Final Rule, which includes some regulations related to LTC pharmacy services. Phase 1 was effective on Nov. 28, 2016, and Phase 2 will be effective on Nov. 28, 2017.
The Final Rule encompasses the first major revisions to the Nursing Home Requirements for Participation since 1987, and it touches on essentially every aspect of our scope of practice, including long term care pharmacy.
Grane Rx has been reviewing the new regulation changes and is prepared to accommodate all of the required changes and to support Skilled Nursing Facilities during this transition. Read on for a look at the upcoming changes as they relate to post acute care pharmacy.
Long term Care Pharmacy & Monthly Medication Regimen Reviews
With the new regulations, monthly medication regimen reviews must include a review of the resident’s medical chart. Grane Rx consultant pharmacists are already reviewing the resident’s medical chart and documenting the review accordingly in the chart on a monthly basis. There will not be changes to this practice.
Any irregularities identified during the pharmacist’s monthly medication regimen review are to be reported in a separate report to the resident’s attending physician and the facility’s Medical Director and Director of Nursing. A new process and report was implemented by Grane Rx consultant pharmacists on Nov. 28, 2016, which will provide the aforementioned report to the identified parties. This change was in addition to our previous processes and methods of communication for recommendations and reports.
As a reminder, all residents’ medication regimens must be free from unnecessary medications. An unnecessary medication is any medication that is being utilized in excessive dose (including duplicate therapies), for excessive duration, without adequate monitoring, without an adequate indication for use, or in the presence of adverse consequences—or any combination of these reasons.
Additionally, when an irregularity has been identified by the consultant pharmacist, it is the responsibility of the resident’s attending physician to document that the irregularity has been reviewed and what action has been taken. Even if the attending physician disagrees with the recommendation and no action is taken, documentation must be provided for the rationale. This documentation should be part of the resident’s medical record.
While changes to the Monthly Medication Regimen Review are not effective until Phase 2, Grane Rx is prepared to be in compliance at this time.
Long term Care Pharmacy & Psychotropic Medications
The definition of psychotropic medication has been changed and expanded to include any medication that affects brain activities associated with mental processes and behavior. This includes the following medication classes—antipsychotics, antidepressants, anxiolytics, and hypnotics. During medication regimen reviews and data reporting, Grane Rx consultant pharmacists are presently including and considering all of the above identified medication classes.
Additionally, as regulated, consultant pharmacists monitor that psychotropic medications are being used to treat a specific condition that is diagnosed and documented in the resident’s clinical record. We also monitor and intervene to ensure residents who are receiving psychotropic medications receive gradual dose reductions and behavioral interventions, if appropriate, in an effort to discontinue these medications when possible.
For Phase 2, specific focus and processes will be developed for PRN psychotropic medications. Beginning in Phase 2, the following conditions must be met for PRN psychotropic medications:
More information will be coming in the future on the PRN psychotropic regulation change.
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- Residents do not receive a PRN psychotropic medication unless that medication is necessary to treat a diagnosis-specific condition that is documented in their clinical records.
- PRN orders for psychotropic medications are limited to 14 days.
- If an attending MD or prescriber feels it is appropriate for the medication to be used longer than 14 days, rationale must be documented in the resident’s medical record and the duration of the PRN order must be indicated.
- PRN orders cannot be renewed unless the attending MD or prescriber evaluate the resident for appropriateness of the medication.
Long term Care Pharmacy & Medication Errors/Influenza and Pneumococcal Immunization
The requirements of the medication error and influenza and pneumococcal immunization tags are moving to the Pharmacy Services area.
Skilled Nursing Facilities are still required to maintain a medication error rate below 5 percent and to ensure that residents are free from significant medication errors.
The influenza and pneumococcal immunization tags also remain unchanged and continue to include proper education, vaccination, and documentation of immunizations of eligible residents.
Long term Care Pharmacy & Antibiotic Stewardship
As we progress into planning and implementation of Phase 2, attention will be given to the Antibiotic Stewardship Program. Your consultant pharmacist is already a required part of your facility’s Infection Control Committee but will also be an integral part of an Antibiotic Stewardship Program. Grane Rx consultant pharmacists are presently undergoing education and training to support you in this area.
As we embark on this journey together, we look forward to continued partnership and collaboration to ensure on-going success.
Grane Rx pharmacy providers partner with Skilled Nursing Facilities to understand and implement regulatory changes like the Final Rule. Get started working with our team today by calling (866) 824-MEDS (6337).]]>
The admission process for Skilled Nursing Facilities is multifaceted and can be challenging. Timeframes for reviewing and accepting new admissions are becoming tighter, making timely pre-admission medication cost estimates vitally important.
Pre-admission cost estimates help admissions coordinators gain a complete understanding of the costs of the medication regimen for a prospective resident. Through a comprehensive cost estimate, providers can ascertain areas where a medication regimen could be optimized to remain clinically effective while benefiting from cost reduction.
While medication pricing is available through many long term care pharmacies, very few offer the level of sophistication that Grane Rx offers. The Grane Rx MedExpense Evaluation Tool benefits admissions coordinators in three key ways:
The MedExpense Evaluation Tool Is Easy
Grane Rx utilizes a simple user interface to allow non-clinical admissions coordinators to quickly and easily search for medications and the associated costs. The system is customized for each Skilled Nursing Facility, integrating the center’s therapeutic interchanges and preferred medication programs built into the MedExpense Evaluation tool.
Because of this level of customization, when users input a medication, they are guided to the center’s preferred clinical and cost-effective treatment options.
Customization doesn’t end there. As time goes by and the MedExpense Evaluation tool is utilized within a SNF, the system acclimates to the most commonly used medication products. As a result, searches become smarter and easier for admissions coordinators.
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The MedExpense Evaluation Tool Is User-friendly
When working with any type of technology, you want the technology to be intuitive to operate. The MedExpense Evaluation tool fits the bill, providing admissions coordinators with a user-friendly experience.
When an admissions coordinator selects a medication within the system, the tool will provide a list of common order instructions for that particular medication. This helps minimize the amount of typing and manual calculation necessary for an accurate cost estimation.
In addition, for complex medications, such as compounded medications, the system steps users through the necessary information. Text within the system explains the information or calculation that is needed, which helps increase the number of successful quotes provided while minimizing the number of times the pharmacy needs to be contacted.
The MedExpense EvaluationTool Is Thorough
The MedExpense tool also provides admissions coordinators with thorough information. Using the depth of information provided, the team at each center is able to determine a clinically optimal and cost-effective medication regimen for each resident.
Within the system, users are notified if there are generic alternatives available for medications they’ve selected, so final cost estimates accurately reflect the medications that will be dispensed by the long term care pharmacy.
Cost estimates themselves are provided based on a daily, weekly, monthly and annual basis. Admissions coordinators are notified within the system if they’ve selected a medication that is packaged and dispensed only in a certain size or quantity.
Grane Rx is committed to providing optimal care and cost savings. Find out how we can help your Skilled Nursing Facility by filling out this quick form or calling (866) 244-MEDS (6337).]]>
Too often the image of the role of long term care pharmacies is limited. That means many care centers may not get all the benefits of partnering with long term care pharmacies. Far beyond making sure you have the right medication available for each patient, long term care pharmacies can also contribute to the team and to the organization’s financial picture. Take a look at three ways long term care pharmacies impact costs and care.
Long Term Care Pharmacies Take Part in Interdisciplinary Team Meetings
Long term care pharmacies can help physicians, nurses and pharmacy consultants collaborate in a team environment in an effort to provide improved care. When each of these disciplines work together in collaboration make a more meaningful contribution to the goal of improving care and outcomes.
This collaboration happens on an as needed basis, and ideally in interdisciplinary team meetings as well. Grane Rx understands the benefits of a collaborative interdisciplinary approach. To that end, Grane Rx integrates with our customers’ teams regularly. Through integrated partnerships, we have tackled critical issues, such as:
- rising medication costs
- changing regulations
- government-driven quality initiatives
- prevention of hospital readmissions
- technological advances
- resident-centered care
Do you think of your long term pharmacy provider as part of your team? If not, it may be time to invite them to the table.
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Long Term Care Pharmacies Optimize Costs
As noted above, long term care pharmacy partners can help address the rising cost of medication. Balancing costs with clinical appropriateness and outcomes is never easy. With medication costs ever on the rise, this is a constant challenge.
Long term care pharmacies can help develop solutions to optimize medication costs where clinically appropriate. Developing plans to contain medication costs involves constant review to make sure the most cost effective and clinically appropriate medications are included in the program.
Therapeutic interchange and preferred medication programs focus on costs and clinical appropriateness, while also making it easier for nursing to administer and monitor medications. Again, the interdisciplinary team approach pays off in cost savings and quality care.
In a Team Approach, Long Term Care Pharmacies use Technology to Simplify the Process
Technology is supposed to simplify our lives, but integrating existing technology with a new partner can be challenging. Grane Rx simplifies the the process by using software to communicate between a variety of software solutions their clients are already using. This leads to a smoother start in getting up and running with a new pharmacy provider.
For clients who haven’t yet chosen an eMAR, Grane Rx can help identify a solution to streamline the pharmacy process. Simplifying processes pays off in reduced staff time for particular tasks, reduced risk of errors, and often cost. Long term care pharmacy partners offer expertise in successful systems and solutions, but reaping benefits from simplified processes takes a team approach.
If you still think of pharmacy as outside of the team or separate from your organization, you’re missing out. Today’s long term care pharmacies bring a lot to the table to help centers excel at patient care and should be part of a team approach in connecting costs and patient outcomes. ]]>
Long-term Care Pharmacy Solutions Should Look at Your Cost Breakdowns
You’re focused on the bottom line. The big picture is important, but with all the costs that add up to your total pharmacy total, you also need to look at each component to optimize savings. Grane Rx can show you the PPD for meds both by payer and across the board. By getting costs based on payer, you have the data you need to make more informed decisions. With multiple providers ordering meds for each patient, you need some oversight too. Grane Rx provides the level of financial detail you need to understand where you can reduce spending.
Great Long-term Care Pharmacy Solutions Provide Consulting Services
Before meds are ordered, someone needs to be looking at the meds the patient is taking. Are there too many? Are they the right ones? Are they too expensive? Are there better options? While a clinical specialist should monitor this constantly, too often a pharmacy consultant isn’t involved until there’s an issue with a medication, which can factor into readmissions. Grane Rx has pharmacy consultants who provide this service for your facilities, from the get go, to assist with earlier decision making support and interaction.
Improved Long-term Care Pharmacy Solutions Save Nurses Time
If you can make med passes more efficient, you free up nurses to have more time for patient care. Long-term care pharmacy solutions like Grane Rx’s Simple-Packs do just that. Each patient’s medication is prepackaged based on the time of day the medication is administered — pre-breakfast, morning, mid-day and evening and a variety of other time options. This makes for neater, easier-to-access med carts and allows nurses to find each patient’s medication quickly. Not only do prepackaged medications make med passing more efficient, but they reduce errors and waste as well. All these factors add up to better outcomes and lower costs.
Partner Long-term Care Pharmacy Solutions Help You Navigate Change
Your pharmacy provider needs to adapt to changing technology and regulations. Grane Rx is a leader in the field with automated medication dispensing cabinets and other automated systems that improve outcomes and reduce costs. At the same time, our consulting and training programs provide education on changes in the industry—including the ever important regulatory and reimbursement changes.
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The Right Long-term Care Pharmacy Solutions Offer Smooth Transitions
Everyone dreads transition. How much down time will we have? How much training will staff need? Will the new system integrate with our old one? While staff can be resistant to change, as they adapt to a streamlined process, they’ll wonder how they ever managed before. Grane Rx reduces paperwork and headaches for administrators and provides greater efficiency for nurses. We start by adapting to your current electronic medication administration system to provide seamless transfer of data from your facility to our pharmacy.
In the changing world of reimbursement for Skilled Nursing facilities, you need more than long-term care pharmacy solutions. You need a long-term care pharmacy partner. Grane Rx partners with SNFs to lower costs, improve care with quality initiatives and adapt to changing regulations. If you’re not getting the support you need to save money, reduce waste and improve patient care from your pharmacy provider, we can help.]]>