Pharmacy services.

With the coming of the Medicare are Prospective Payment System (PPS), facilities are faced with the task of making pharmacy services an integral part of their service package rather than just a pass-along cost center. And pharmacy service providers are eager to help.

Barry Schepp, senior vice-president for sales and marketing, NeighborCare, says that his firm's QUEST product, an acronym that stands for Quality Care, Utilization Management, Education, Services and Teamwork, is "meant to help facilities approach PPS rationally." Tested in 40 facilities, QUEST is not a standard product, but rather a service that can be customized to meet the unique needs of each facility.

"We send trained teams to each facility to analyze their procedures and see if and how we can help them," he says, "not just to predict their costs for PPS, though that is vital, but to actually help them become cost-effective. Our philosophy is that discounting has limits, and that a better way to control costs is to look at such things as utilization and formulary management, targeting high-cost areas."

After an analysis, he says, NeighborCare makes recommendations based on its assessment of such operational segments as pharmacy services, MDS assessments and medical supplies, with special attention to wound care and incontinence. QUEST also recommends clinical programs and best-practice alternatives designed to improve quality. Because it's a multifaceted company, says Schepp, "we take an integrated view, so our recommendations are based on overall economic performance and will not result in mere cost-shifting."

For instance, the formulary is not just a list of drugs, but a specifically geriatric formulary implanted in the operating system itself, "even into an admissions screening procedure that can pinpoint potential opportunities within 20 minutes, and make recommendations for changes," says Schepp. NeighborCare's QUEST program also enables effective management of infusion therapy, so that a facility can position itself to accept a broader range of referrals.

Ron Kokot, CEO of KVM Technology, notes that the firm's Envoy Automated Medication System eliminates much of the potential for medication error and saves labor for the nursing staff. With a working inventory of 176 drugs plus backup, it allows for remote operation with no outages. The machine is loaded by the pharmacy, and medication orders are validated by pharmacists and then scheduled into the machine. It selects the right drugs for each patient before med passes and packages them in an envelope labeled with the patient's name, the name of the drug and other information. "The Envoy automated system thus minimizes nurse decision making, eliminates shift counts of narcotics and offers 100% perpetual inventory of all drugs," says Kokot. "And in situations when a patient is admitted in the middle of night, it eliminates waiting for delivery of meds for that patient from a pharmacy, making the first dose immediately available."

The Envoy also addresses cost and time pressures of PPS, according to Kokot. In long-term care facilities, up to a third of drugs packaged and billed are not consumed by the patient, he says, and in a prospective-pay world, "those returns are coming out of somebody's profit margin." The system also encourages adherence to a formulary, which helps lower drug costs. By maintaining full transaction records, it facilitates mandatory PPS record keeping.

Facilities coping with the challenges of managed care and PPS, says John Kernaghan, CIO, PharMerica, can use his firm's Life Cycles suite, "a complete interdisciplinary family of information management systems that helps them benefit from our technological know-how while strengthening the ties between us and our clients." Life Cycles includes a preadmission screening software program that helps facilities determine the case mix of residents they can accept to remain financially productive, giving "a snapshot of costs vs. revenues associated with caring for a prospective resident before admission." In addition, a daily case manager program called Pursuit CM lets a facility recalculate costs when a resident's condition changes, so that the financial effects of changes in therapy and services can be reviewed daily. Life Cycles also contains a financial A/R package that supports data resulting from differing payers for a single therapy or medication, such as might be found in a managed care setting.

Another piece of software, MediQuick Plus, is an electronic pharmacy ordering system that manages pharmacy data, allowing a facility to process DUE and DUR information before the order is processed. According to Kernaghan, this reduces the potential for medication errors and alerts caregivers to possible interactions and use of nonformulary drugs. "The system also helps staff and pharmacies alike eliminate phone tag and lost faxes," he says.

PharMerica's LifeStory MDS product organizes resident information and automatically forwards it to the central system for facility use. It also allows the creation of reports and care plans electronically.

LifeStory Assisted Living, developed specifically for this marketplace, reduces paperwork and manages resident information and service plans electronically.

The Life Cycles family of IT products can be used together or separately, depending on the facility's needs.

According to Jeff Gyursik, director of Technology Marketing, NCS HealthCare is entering the PPS lists with a complete post-acute patient information system called ASTRAL. A major component of this is NCS OnLine, an electronic connection to the pharmacy that gives facilities immediate service when new residents are admitted. It also allows pharmacy orders, physician orders and medical records to be viewed and printed, and all interactions tracked to ensure timeliness and allow instant updating.

"This software lets you track cost-specific medications for both private and managed care payers," notes Gyursik. ASTRAL, he says, is built on an open system. This allows facilities to go beyond simple MDS care plans and use MDS data to develop a full range of applications. For instance, he says, "ASTRAL's ProView helps facilities meet PPS demands by giving them comparisons between the cost of providing care and the estimated RUGs-III reimbursement prior to admission."

ASTRAL's Survey Advantage, says Gyursik, "helps to create mock surveys to prepare for the real thing." Meanwhile, OSCAR, an on-line survey and certification program, uses HCFA's data formatted as an easy-to-use database sorting tool to give customers access to facility, regional and national survey results.

The ASTRAL suite is rounded out with LiveWell, a wellness management system that provides needed clinical information on assisted living residents.

According to Timothy Bien, senior vice-president of professional services at Omnicare, many long-term care facilities are now able to save up to 35% on their pharmacy bills by using Omnicare's Geriatric Pharmaceutical Care Guidelines. Savings, says Bien, come from switching to more efficacious drugs or to more cost-beneficial drugs within the same therapeutic class. "The guidelines are proprietary, not boilerplate," says Bien. They were developed through a partnership with the Philadelphia College of Pharmacy and Science and are fully referenced to the literature. Drugs are grouped as "preferred," "acceptable" or "unacceptable," and they are listed by disease state, as doctors actually prescribe them. A new 1999 edition offers the latest in approved drugs and the most recent references to the literature, says Bien.

NEW PRODUCTS

Health Outcomes Management Program

An innovative disease-state management tool has been introduced by American Pharmaceutical Services (APS). The APS Health Outcomes Management Program (HOMP) consists of disease-specific clinical interventions accompanied by a continual outcomes monitoring program and a preferred drug list.

Targeted diseases include hypertension, depression, diabetes, Alzheimer's disease and osteoporosis. To date, outcomes data have been collected on approximately 15,000 patients in five disease areas.

The program was developed with the assistance of Applied Health Outcomes, Inc. (AHO), a nationally recognized health outcomes research and consulting firm.

Reimbursement Software

NCS Healthcare, a provider of pharmacy and related services to long-term care facilities, serves over 245,000 residents of long-term care facilities in thirty-four states and manages hospital pharmacy businesses in nineteen states. The company recently released ProView, a Prospective Payment System (PPS) reimbursement software product for long-term care and subacute nursing providers. ProView assists facilities in calculating probable Medicare PPS reimbursement rates, and the related costs of care based on patient-specific data obtained during the preadmission process. In addition, ProView assists facilities in proactively calculating the costs of care for specific residents, which is essential to developing and negotiating profitable contracts in the managed care environment.

NEW PRODUCTS

Automated Dispensing System

KVM Technologies, Inc., has created the Envoy[TM] Automated Medication System, which tackles the entire drug-dispensing process - from packaging to administering. Pharmacists stay in control from miles away with the system's remote capability.

The system securely stores drugs as bulk inventory in convenient refill cartridges and containers, and labels specially designed MedView[TM] envelopes with resident- drug-specific information. Envoy packages each routine med pass on demand, right at the nursing stations, and organizes residents' envelopes into convenient MedTote[TM] carriers.