As we gear to welcome another year, altercation in the field healthcare especially Pharmacy practice and management of medical billing and coding for the prescriptions is going to be a daunting task. Evolvement in terms of monetary gains, structured revenue cycle and speed of reimbursement shall be dealt with precision and by the hands of experts.
In the recent past one the biggest change and challenge pharmacies are facing is the establishment of performance provider networks and the contraction of these networks, where insurance plans are giving their beneficiaries access to a more select network of pharmacies.
Until sometime back, healthcare plans wanted to have broad coverage with as many pharmacies as possible. But now there’s the focus on value-based care rather than fee-for-service models, so health plans are narrowing with fewer pharmacies, particularly those that can prove they are addressing quality measures, delivering care that’s improving the lives of patients, and reducing the overall total cost of care.
- Is Evolvement An Opportunity For Pharmacies In 2018?
In the short-term the changes will be seen as challenges, but in the long term, they are certainly opportunities to evolve. Pharmacy facilities almost always view these changes and initiatives as an additional luggage on their shoulders, with every new program seeming like a heavy weight.
However, these changes can provide pharmacists a clear path to truly changing their practice.
- What Will Happen To Pharmacies That Don’t Start Evolving To Meet Changing Demands?
The cost of running the pharmacy practice and profit margin pressures are going to continue to create real difficulty in the standard pharmacy practice model. As the margins continue to shrink, the pharmacies will be working harder, rather than smarter.
Certainly, there’s always a need for medications to be dispensed, but pharmacies must evolve and be centered on patient-care model.
- Is It So Critical To Achieve Provider Status For Pharmacists?
The goal of provider status is to enable the pharmacist billing to practice at the top of his or her license. Pharmacists are trained for six or seven years on appropriate medication use, but they do so much more than just counting pills, putting them in a bottle, and handing them across the counter.
Pharmacists are the ones who ensure patients are on the right medications, are using them legitimately, and are achieving the desired results with those medications.
Getting provider status passed, and building an effective infrastructure will give pharmacists the ability to use everything in their arsenal to improve patient care. Also, with this evolvement their pharmacy billing structure and medicare part b billing pharmacy shall also improve.
Over and over, we see patients needing access to more comprehensive services. The consequences of suboptimal medication use are astounding right from hospitalizations, to readmissions, to even death.
Pharmacists, who want to evolve in 2018, must understand and change their mindset beyond just filling prescriptions. They should rather move to a patient-centered view where they are looking at all of the patient’s needs when they fill prescriptions. Each prescription fill/refill provides an opportunity to more meaningfully engage the patient.