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

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.

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)  Barney’s Pharmacy; coumadin clinics; kinetics; long term care Nuclear pharmacy; Government; Insurance industry (ESI, Medco); Pharma, VA, etc.

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 Fitness, lifestyle management  Immunizations  Long term care consulting

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

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?

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?

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

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

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

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

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

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

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.

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.

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.

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

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?

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

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.