Developing A Community Pharmacy Practice Site

1. Developing A Community Pharmacy Practice Site Pharmacy Management

2. 2 Working Definitions of ‘Developing a Practice Site’ • Starting from scratch and creating a practice environment that does not exist. • Taking a practice site that already exists and growing or shaping it into “your” ideal practice site. • From your perspective – what you want to do – we will address consumer demand in the next lectures. Pharmacy Management

3. Possible Practice Sites & Activities • Traditional sites: • chain, independent or hospital setting • staff to ownership positions • Non traditional opportunities: • CVS Pharmacare (formerly ProCare), Krogerinitiatives • Head to Toe Wellness and Research • APC Pharmacy Care Clinic • Cherokee Pharmacy • Terry Forshee at the Pharmacy Clinic (and related businesses) • http://www.cherokeepharmacy.com/ • Barney’s Pharmacy; coumadin clinics; kinetics; long term careNuclear pharmacy; Government; Insurance industry (ESI, Medco); Pharma, VA, etc. Pharmacy Management

4. Possible Practice Sites & Activities • Specialty compounding • Oncology • Board certification, specialized practice sites • Wellness • Workplace interventions such as Asheville project - http://theashevilleproject.net/ • Fitness, lifestyle management • Immunizations • Long term care consulting Pharmacy Management

5. Decide: Does your ideal “practice site” exist? If not, then: Pharmacy Management

6. Thinking about your ideal practice site, could you actually create it? • What is your “mission?” • What services will you offer? • Are you clinically competent? • Are you competent in terms of management, accounting, marketing, advertising and promotions? • Is this a new idea, or is there already competition? Pharmacy Management

7. Thinking about your ideal practice site, could you actually create it? • Location? • What will you need in terms of: • Cash / Loans • Staff • Equipment • Lawyers, builders, insurance agents… • How does the State BOP / Pharmacy Practice Act view your idea? • How will you get paid? • Is there sufficient demand? Pharmacy Management

8. APC Pharmacy Care Clinic Pharmacy Management

9. Pharmacy Management

10. Balancing Clinical and Business Interests Business Clinical Pharmacy Management

11. APC Pharmacy Care Clinic • APC Pharmacy Care Clinic • Disease management programs • Smoking cessation, asthma, lipids, coumadin, diabetes, HTN, general medication use. • Clinical Trials • Pharmacotherapy Reviews • Immunization programs • Payment / Reimbursement • Billing incident to physician • National HC Provider ID Number • Contracts with insurers • Direct payment from patients Pharmacy Management

12. Current status of APC • Independently operated • Clinical trials & clinical services • Drs. Aull, McElhannon, Cook, Johnson, Herist have created similar-expanded service sites • Monroe, Clinton SC, Raleigh NC, Athens Pharmacy Management

13. Getting Started at the PCC • Develop physician relationship • Identify needs: • space • equipment • personnel (not just clinical) • Billing and reimbursement • Develop clinical protocols • Must have MD input and approval • Legal: • Develop the collaborative practice agreement • Develop the annual operating plan • Check in with State BOP • Take good care of patients Pharmacy Management

14. Important Documents: • The collaborative practice agreement • Usually, required to be on file at State Board of Pharmacy • Annual operating plan or business plan • Clinical protocols • Note: these documents will be very different for the many types of practice sites Pharmacy Management

15. Collaborative Practice Agreement • Spells out the legal issues between the providers (pharmacists and physicians) specifically, the boundaries of care are, and how care will be monitored. Pharmacy Management

16. Annual Operating Plan • Defines the financial arrangements: • For APC, it was: • MD handles all billing (insurance and cash payments) • First $2,000 goes to APC for their cost of operations • For each $1 over $2,000 revenues are split 65% to PCC and 35% to APC • When payments will be made • Financial controls to be used • Could be between you and a physician group, pharmacy, other retail establishment, etc. Pharmacy Management

17. Clinical Protocols / Care Tools • Detailed documentation of the specific procedures as to how care will be provided. • From a patient care perspective, these are the most important documents. • Clearly delineate the parameters of the providing care. Pharmacy Management

18. Success Metrics • How will you define success? • Satisfaction • You • Your patients • The professionals you work with • Revenue / salary • Student training site • Pharmacy students • Pharmacy residents • Scholarship • Dissemination of the practice concept; Clinical / economic / outcomes studies Pharmacy Management

19. What about developing more traditional practice sites? • Are these kinds of practice environments possible? • Will you be able to find a practice site that you will truly like? Pharmacy Management

20. Your ideal practice site could be right in your own back yard. Pharmacy Management

21. So remember (from first year): If you don’t want to be replaced by a robot, don’t act like one. Find or create the kind of practice site where you will be happy. This strategy is also known as success. Pharmacy Management