Healthcare reform has driven payment reform, which means that hospitals, pharmacists and healthcare informaticists need to update the metrics and schedules used as the foundation for billing to protect revenues. Increasingly, fee-for-service contracts have been replaced by value-based systems that bundle payments and includes quality and risk components.
To respond to the new requirements, pharmacists “must develop metrics to show the value of what we do, what would happen if we didn’t do it, and the true costs of healthcare,” said Philip E. Johnson, RPh, FASHP, in an article in Pharmacy Practice News.1 Those metrics must be tied to all aspects of pharmacy operation, from training and quality metrics to charge description masters and billing formulas to conform with contracts.
On September 30, Mr. Johnson will lead a webinar on “Healthcare Reform and the Financial Impact on Pharmacy Billing and the Electronic Medical Record” to help pharmacists and informaticists understand the changes in the pharmacy business model related to the Affordable Care Act. By better understanding the shift in payment structures, pharmacists and healthcare informaticists can move from simply reacting to payer demands for greater accountability to leveraging the new structures to better reflect the value provided by pharmacist and drug therapies.
With drug costs rising for many medications, pharmacists need to focus on maintaining revenue integrity. Mr. Johnson will discuss the importance of a systems-based approach to continually updating pharmacy information systems to ensure they reflect changing costs. He will also provide strategies for maintaining accurate charge description masters and billing formulas so that pharmacies obtain full and appropriate payment.
About the Speaker
Philip E. Johnson, MS, RPh, FASHP was the oncology director for Premier, Inc. until his retirement in 2015. Prior to that, he served for 26 years as the founding director of pharmacy, and later the pharmacy advocacy director at the Moffitt Cancer Center in Tampa, FL.
During his career he has opened three new hospitals where he developed patient-focused, multidisciplinary services that focus on quality, safety and financial outcomes. Phil received a BS in pharmacy at the University of Illinois and a MS in Administration and Organizational Development at George Williams College. Phil has numerous publications and was a contributing editor to AJHP.
He has served on more than 40 advisory boards and committees of professional organizations. He was a founding Director of the Florida Cancer Pain Initiative (FCPI), and the Hematology Oncology Pharmacy Association (HOPA), which he served as President. Phil has also served on guidelines committees for the Association of Community Cancer Centers (ACCC) and HOPA, has chaired the NCCN Taskforce on REMS as well as the ISMP international taskforce to develop an Oncology Medication Self Assessment Tool.
Birk S. Reimbursement and Revenue Integrity. Pharmacy Practice News. December 2013. http://www.pharmacypracticenews.com/ViewArticle.aspx?d=Policy&d_id=51&i=December+2013&i_id=1022&a_id=24564 Accessed September 14, 2015.