Nursing homes, said Roderick Halbert
, aren't what they used to be.They used to be pretty static places-quiet, predictable environments where elderly and ill people would go to spend their last days.Folks moved in during normal business hours, and discharges were rare. Roderick HalbertPartners Pharmacy - Health Executive - RedCoat Publishing
nursing homes are dynamic care facilities where guests might stay for a few weeks or months as they recuperate or rehabilitate, or they might stay much longer.Admissions occur at all hours as patients are transported from hospitals or other healthcare facilities.
That means vendors such as pharmacies must be on-call at all hours too.Halbert, an advocate for not trying to fit the new nursing home model into the old pharmacy model, realizes the industry is changing.As COO of Cranford, NJ-based Partners Pharmacy, he insists on keeping up with these changes and encourages his staff to anticipate what those changes may be. Halbert
said Partners' clients are often required to admit patients at 10:00 p.m., 11:00 p.m., or later.In the past, the last delivery from Partners would go out the door at 7:00, so changes have obviously been necessary. Halbert's
strategy is to give his
staff the freedom they need to experiment as they face increased challenges from Medicaid changes, advancing IT, and the healthcare crunch.
"I'm not a micro-manager.
Among the company's greatest challenges are policy changes brought on by Medicare Part D. "The logistics are impractical for the nursing home resident," Halbert
explained.This program, designed to subsidize prescription drugs for Medicare beneficiaries, has complicated the reimbursement process for nursing homes. Halbert
pointed out that before Part D, the prescription drug reimbursement formula was the same for the majority of nursing home residents in any given state, and it was a fairly simple process to determine whether or not a medication was covered.Today
, with more than 25 plans, each with different criteria dictating how a medication is approved, reimbursement has become a labor-intensive process.
"Long-term care patients are among the frailest and are almost always dependent on medication," said Halbert
."This makes them vulnerable to the limitations set forth by Medicare Part D, which dictates limited hours of operation for authorizations and overrides, sometimes resulting in medication not being available." Partners Pharmacy
created a Medicare Task Force
program consisting of 13 professionals working to solve the problems created by Medicare Part D. "We are on all the coalitions involved in Medicare Part D reform, as well as the state Medicaid program," said Halbert
."We are proactively involved in addressing this challenge, which has no direct solution."
Part of the solution lies in technology.When physicians can enter a prescription order for a patient into their PDA and get an immediate response as to whether that medication will be covered, they can adapt to better serve their patients, said Halbert
Electronic medical records will also help improve overall patient care through more consistency and better safety oversight."We receive a paper chart from the hospital, but do we really know the last time a patient got a dose of their pain meds?With EMR, we will be able to close some of the gap
and have a better continuum of care," Halbert
To facilitate the transition to electronic records, Partners has adopted Health Level 7 (HL7) standards for electronic interchange of clinical, financial, and administrative information among healthcare oriented computer systems."We are actively looking at several different systems, some standalone and some much more integrated," Halbert
Partners assigns an account manager to each facility that comes on board to act as a technical liaison.The representatives visit regularly (every day at first) and return phone calls within two hours of receiving them.
"In nursing homes, next to payroll, pharmacy is probably the largest cost for them," Halbert
said."It's a big part of who they are and what they do."When things do not go smoothly, Partners is committed to resolving the problem quickly.It's an approach that Halbert
believes will serve Partners' clients as they face healthcare's increasing challenges and serve his
company as it expands into new markets.
"We're progressive, we're growing, we're looking at technology, and we're looking at reimbursement.We are synonymous with pharmacy in New Jersey," said Halbert