1. 8/9/2015 Pharmacy Management 1 Developing A Community Pharmacy Practice Site

2. 2 Working Definitions of ‘Developing a Practice Site’ 8/9/2015 Pharmacy Management 2  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.

3. Possible Practice Sites & Activities 8/9/2015 Pharmacy Management 3 Traditional sites:  chain, independent or hospital setting  staff to ownership positions Non traditional opportunities:  CVS Pharmacare (formerly ProCare), Kroger initiatives CVS Pharmacare Krogerinitiatives  Head to Toe Wellness and Research Head to Toe Wellness and Research  APC Pharmacy Care Clinic APC  Cherokee Pharmacy Terry Forshee at the Pharmacy Clinic (and related businesses) http://www.cherokeepharmacy.com/  Barney’s Pharmacy; coumadin clinics; kinetics; long term care Nuclear pharmacy; Government; Insurance industry (ESI, Medco); Pharma, VA, etc.

4. Possible Practice Sites & Activities 8/9/2015 Pharmacy Management 4  Specialty compounding  Oncology Board certification, specialized practice sites  Wellness Workplace interventions such as Asheville project - http://theashevilleproject.net/ http://theashevilleproject.net/ Fitness, lifestyle management  Immunizations  Long term care consulting

5. DOES YOUR IDEAL “PRACTICE SITE” EXIST? IF NOT, THEN: 8/9/2015 Pharmacy Management 5 Decide:

6. Thinking about your ideal practice site, could you actually create it? 8/9/2015 Pharmacy Management 6  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?

7. Thinking about your ideal practice site, could you actually create it? 8/9/2015 Pharmacy Management 7 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?

8. 8/9/2015 Pharmacy Management 8 APC Pharmacy Care Clinic

9. 8/9/2015 Pharmacy Management 9

10. Balancing Clinical and Business Interests 8/9/2015 Pharmacy Management 10 Clinical Business

11. APC Pharmacy Care Clinic 8/9/2015 Pharmacy Management 11 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

12. Current status of APC 8/9/2015 Pharmacy Management 12 Independently operated  Clinical trials & clinical services Drs. Aull, McElhannon, Cook, Johnson, Herist have created similar-expanded service sites  Monroe, Clinton SC, Raleigh NC, Athens

13. Getting Started at the PCC 8/9/2015 Pharmacy Management 13 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

14. Important Documents: 8/9/2015 Pharmacy Management 14  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

15. Collaborative Practice Agreement 8/9/2015 Pharmacy Management 15 Spells out the legal issues between the providers (pharmacists and physicians) specifically, the boundaries of care are, and how care will be monitored.

16. Annual Operating Plan 8/9/2015 Pharmacy Management 16 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.

17. Clinical Protocols / Care Tools 8/9/2015 Pharmacy Management 17  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.

18. Success Metrics 8/9/2015 Pharmacy Management 18 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

19. What about developing more traditional practice sites? 8/9/2015 Pharmacy Management 19 Are these kinds of practice environments possible? Will you be able to find a practice site that you will truly like?

20. Your ideal practice site could be right in your own back yard. 8/9/2015 Pharmacy Management 20

21. THIS STRATEGY IS ALSO KNOWN AS SUCCESS. 8/9/2015 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.