LTC Pharmacy Continues Fast Growth With Back Office Solution

LTC pharmacies must dispense the correct medication to the correct patient at the correct dose, time and location. This requires them to be particularly diligent in keeping medication and census information accurate and current. Serving a very large senior population of tens of thousands, they are often dealing with frequent changes of medications, diagnoses, rooms and locations. Incorrect or questionable claims can trigger an audit or denial, resulting in a lack of payment and even audit fees.

One LTC pharmacy group based in the Northeast was scrambling to stay abreast of medication order entry and billing as they expanded. Despite being in the industry for just four years, this LTC pharmacy had acquired facilities quickly and was responsible for 25,000 nursing facility beds. It had aggressive plans to continue to add pharmacy locations and more nursing home groups. This pharmacy provides quality medication management solutions for LTC partners as well as a software solution that facilitates nursing home workflow by intelligently streamlining the medication lifecycle.

Pharmacy Outsources Administrative And Billing Operations

To streamline operations, this LTC pharmacy had already secured a business process outsource partner (BPO) that was located in the Philippines.

This partner was helping to translate the medication order input details from the electronic medication administration record (EMAR) filled out by the nurses and doctors into a format the pharmacy’s information system could read accurately. In conjunction with those records, they would call the nursing homes for clarifications in cases of unclear, discontinued or duplicate orders. In this clean- up process, medication records are transitioned properly into the pharmacy’s information system.

Medicaid And Medicare Complexities Cause Confusion

On the billing side, this partner was also handling claims going to the payers. Most patients for this client are on Medicaid or MediCare Part D – a prescription plan that involves over 20 different payers. Each payer decides its own formulary each year based upon deals they strike with manufacturers and medication providers. These formulary differences and changes create a lot of work between the pharmacy and the doctor in trying to provide appropriate medications that are covered by their plan’s formulary. Often, the prescribed medications either require prior authorization or are not unapproved, requiring order changes. All of these rejections generate a lot of work for the pharmacy.

Another issue the pharmacy struggled with was keeping patient census data updated. LTC patients often move from unit to unit or in and out of the hospital. When errors occur with patient location, claims may be denied. Careful attention is required to keep claims going through.

Inefficient BPO Causes Management Challenges

After working with the Philippine partner for several years, they recognized the overall benefit and saw that remote work can be an effective tool for growth. Still, they saw several items of concern that impeded complete satisfaction in remote work.

First, there was significant turn-over. Within a few months of training the first group and seeing their improvements in understanding and production, they soon would discover a new operator had been added and was making beginner mistakes. While turn-over is part of any business, this became an all too often occurrence, which resulted in additional training and lower production each time. This ended up costing the pharmacy in both training oversight and production loss.

BPO Presses LTC Pharmacy To Cover Sick and Vacation Days

Second, in order to handle sick days and vacation days, the pharmacy was forced to hire “buffers”, additional operators that would help and cover. This cost ended up adding over 20% over the standard production operators, once again impacting savings.

BPO Lack Of Experience And Capacity Constrains Pharmacy

Third, because the BPO had limited managerial oversight with LTC pharmacy experience, they were forced to oversee all management and QA for the remote team. This is very time-consuming and expensive.

Lastly, there were times where expansion was hindered due to the size of the BPO and how quickly they could add team members and get them trained.

These limitations prompted the LTC pharmacy management to seek what other options there were for remote assistance in the LTC pharmacy space. They were looking for a partner who could provide skillful management, higher quality, lower turnover and be more scalable, to grow with them.

Infinx Chosen For Order Entry, Billing And Census Updates

Soon, the pharmacy heard from several established large LTC pharmacies about a different provider of data entry and billing solutions. This company was led by a LTC pharmacist, had been doing it for over 15 years and had hundreds of employees that worked just for LTC pharmacies. When speaking with the management team of these other pharmacies, they were impressed to hear about this other company’s quality, stability, knowledge and management. The pharmacy decided to contact us and learn more.

Infinx was able to walk the pharmacy through how they as a company have seen those obstacles the other providers have, and have implemented solutions which overcome each concern. The pharmacy was happy with the answers provided and the testimonials from the other pharmacies and chose to move forward.

Work began in billing / rejected claims, medical records and order entry all at the same time. The feedback from the pharmacy management team was the same from each department. That communication, understanding and management during the training and onboarding was much better than with their other vendor’s and made the process go smoothly and instilled confidence.

Infinx’s Clear, Frequent Communication Prompts Pharmacy To Add FTEs

Quickly the pharmacy increased from 5 to 10 to 20 and now 30 of our employees. The billing department has even begun expansion into prior authorizations, which was seen as much too complicated for the other companies.

To price fairly, we only charge when collective production exceeded the billable amount. So whatever level of production overall was being done by the team, that is how many FTEs were billed. The result is very simple. They pay for the work provided and don’t get stuck paying for slow-producing new employees, or “buffers.” As a result, they don’t have to micro-manage the individual operator productivity. Instead, they can just watch the total produced and the quality. Management loved having that additional work and stress taken off their plates.

Skilled LTC Services Lead To Expanding Back Office Partnership

After several months working with us, the client is highly satisfied with our medication order input, calling, and billing services. They were impressed with how quickly we onboarded them and began work. They have been happy with communication management, production tracking, and transparency. They also appreciate the payer and nursing home calls we make to resolve medication, patient data, and payer changes. We provide this client’s operations people with a daily summary of work done. Each week, we send a weekly summary to the pharmacy’s management and owners. ​Impressed with our accuracy and speed of processing the medication order entry, patient data, and billing, within just a matter of weeks this client has been adding operators 5 and 10 at a time, bringing us to 30 within just a few months of starting. They are already committing to add Infinx operators in the new year to cover the additional work brought on by their planned new pharmacy locations and new homes. Infinx will help onboard the patients and help take care of them each day. They are confident that, with our partnership, they can continue on an aggressive growth trajectory that doesn’t overburden their own staff or threaten their growing revenues.

If you are looking to achieve similar results at your organization, contact us at www.infinx.com/request-a-demo.