Should Community Pharmacy Transform For Revenue?

The U.S Healthcare industry at the moment is undergoing drastic changes, as the federal government gets ready with a new bill. Eying such a gloomy scenario is it the right time for community pharmacy billing to transform its business operating model for a higher revenue numbers? What impact will it have on the payer-provider front? How will the physician-patient economic communication get along? Will it be feasible to deal with third party players? And how will the medical billing and coding go about?

Well, Let’s Find Out…

In simple terms community pharmacy transformation does not mean moving from the core work undertaking of dispensing drugs/medicines and related products and services. Rather, it’s about incorporating professional medicinal services that supplement and add value to provide an integrated health solution.

In the United States, and also in many other developed markets, revenues are capped, as competition grows and pharmacies are increasingly projected to play a critical role in managing chronic conditions. Independent pharmacies for a long time now have been the backbone of community services but, just like post offices services before them, they risk of becoming obsolete as more nimble or better resourced players shape the market and capture its value.

The argument on long term sustainability of community pharmacy is not a new one. While everyone recognizes the important role that pharmacies play in delivering frontline care, but in reality the economics of community pharmacy are under pressure and the business module, particularly for independent pharmacists, is at a triggering point.

So, what’s In Store for Community Pharmacy?

Experts from the healthcare industry specializing in Pharmacy have come up with some interesting observations regarding the future of community pharmacy which is heading for a much needed period of restructuring as it attempts to respond to market forces:

  • Tightening Of The Health Care Budgets – Even as the demand and volumes are on the rise, market indications are that reimbursement will remain flat in real terms. This is the direct reflection on public funding, which stem from the current financial crisis and longer-term pressures. The proposed shift from simply dispensing medicines to providing frontline services is unlikely to bring with it net new monetary opportunities and will be financed by a restructuring of the existing settlement.
  • Market Competition – Pharmacy billing is a fiercely competitive marketplace and the industry continues to consolidate slowly. The nature of innovation is changing and, with it the pharmacy business terms. Community dispensing is already dominated by commodity generics. This competition will become even more prevalent as the higher-value biologic therapies that currently dominate industry pipelines move into hospitals, out-patient settings and even homes.
  • New modes of connection and communication. With Internet of Things (IoT), developing the overall industry, internet and mail-order pharmacies are gaining strength, and research suggests that it will only grow in future. The mail-order pharmacy, supported by regulatory change and sickness fund policies, has grown rapidly in most European nations. With the rise of the connected consumer, brick-and-mortar pharmacies will most probably witness a dip of around 20% in their sales.

The present day health consumer wants it all. Whether it is prescription services, personal care products or physician services, the priority is on expertise, convenience and accessibility.

Medical Billers and Coders hold 18 years of experience in pharmacy billing Revenue Cycle Management (RCM) as well as in medicare part b billing pharmacy with a skilled team coders and billers.