How RxPertise Can Improve Patient Care and Reimbursement in the Changing LTC Pharmacy Landscape

By Heather Butler

 

With changes brought about by the CMS Final Rule and the impending changes being introduced with the new CMS case-mix classification model, the Patient-Driven Payment Model (PDPM), set to go into effect October 1, 2019, the role of the consultant clinical pharmacist in the LTC setting is becoming even more critical in optimizing patient outcomes, ensuring regulatory compliance, and obtaining reimbursement.

The PDPM will adjust Medicare payments for SNF patients in a covered Part A stay from quantity of services or therapies provided to an outcomes-based reimbursement structure based on patient diagnoses, characteristics and needs.

Payments will be based on each aspect of patient care including non-therapy ancillary services (NTAs) which includes medications and medical supplies. 

The PDPM shifts the payment incentive for facilities from the volume of services to the complexity of the patient.

With these proposed changes to reimbursement, it is likely that SNFs will be caring for more medically complex patients.

The changing payment model is an opportunity for consultant pharmacists, who will be relied upon to use their expertise to optimize drug therapy for an increasingly-complex patient population.

SoftWriters’ clinical consulting software, RxPertise, is a highly configurable and customizable tool designed for Medication Regimen Review (MRR).

RxPertise provides timely and efficient solutions for creating and monitoring pharmaceutical care recommendations, as well as tracking of medication utilization and patient assessments.

RxPertise allows the consulting clinical pharmacist to meet CMS guidelines and document compliance with required MRRs, Antibiotic Stewardship, psychotropic use, and recommendation follow-up.

Customizable reporting and graphing functions allow for the tracking of metrics and quantifying the impact of pharmacist interventions through resident assessments and recommendations.

FrameworkLTC and RxPertise users benefit from FrameworkExchange, an interface that allows for near real-time reporting of data from FrameworkLTC to RxPertise.

The easy-to-use FrameworkExchange provides a critical connection of data from the FrameworkLTC pharmacies to the consulting clinical pharmacists who are assessing and managing patient medications onsite in the facilities.

At SoftWriters, we are devoted to keeping our software products and pharmacies compliant with the ever-changing federal and state regulations as well as the business needs of our customers and the well-being of their patients.

We continue to focus on the integration of care across the continuum of LTC pharmacy. With RxPertise and FrameworkLTC, managing the needs of patients and meeting regulatory requirements while maximizing reimbursement and patient outcomes is a streamlined and manageable process.

 

Heather Butler is a Clinical Quality Assurance Analyst at SoftWriters, a Pittsburgh-based company that offers pharmacy management software solutions to pharmacies serving the long-term care community. Heather has over 17 years of experience as a pharmacist and applies her knowledge in pharmacy workflows and quality measures to building pharmacy software products that facilitate excellence in patient care and user experience.