The importance of pharmacists in today’s healthcare continuum is undeniable. A January 2022 study called “Pharmacists as accessible health care providers: quantifying the opportunity,” published in the Journal of Managed Care & Specialty Pharmacy, reported that patients “visit their community pharmacies almost twice as often as they visit their physicians or other QHP [Qualified Healthcare Professionals].”
For independent pharmacies, however, competing against national pharmacy chains — whether they’re stand-alone stores or located within big-box retail locations — can be tough.
Sandra Canally, RN, founder and CEO of The Compliance Team, identified the ways that accreditation can potentially strengthen independent pharmacies.
Accreditation As a Competitive Advantage
Asked about the strengths of an independent neighborhood pharmacy, Canally referenced the collegial atmosphere personified in a beloved ’80s sitcom. “It reminds me of Cheers, where everybody knows your name,” she said of independent pharmacies, adding that these businesses are healthcare leaders in their communities. “The pharmacist and local pharmacies see those [patients] in the community much more than the physicians,” she explained.
The true superpowers of independent pharmacists, Canally added, are their ties to their communities.
“It’s so important to utilize the relationships to the nth degree,” she noted, adding as an example, “They know Mrs. McGillicutty. Mrs. McGillicutty is diabetic, and not only does she get her diabetic supplies [at the independent pharmacy], but typically a diabetic has, on average, five other prescriptions. And then there’s all the over-the-counter foot care, and it just goes on and on. It’s that relationship that I believe is stronger in the small-to-medium-sized provider pharmacy in the community.”
And how can accreditation further empower these pharmacies?
“Accreditation obviously strengthens through consistency,” Canally said. “You can apply that even if it’s one location: You can have a couple of pharmacists and a couple of techs doing things the same way, with that consistency of practice, with your policies, with your process, with how you fill the script. And certainly, you want to keep your [Medicare] Part B number, because you don’t want to lose Mrs. McGillicutty’s [diabetic supplies purchases]. Even though you don’t make any money on the [diabetic test] strips, you make money on the prescriptions. That can keep Mrs. McGillicutty from going to the big-box store, and staying with ABC Pharmacy, the local provider that she’s been dealing with for 40 years.”
That advantage extends beyond relationships with customers, Canally added. “They’re more likely to have a relationship with a prescriber as well,” she said of independent pharmacies. “So because they’re the local pharmacy, they know Dr. Jones down the street, and they get all the patients from Dr. Jones because he’s more likely to say, ‘Oh, do you want to go to Joe’s Pharmacy?’
“If Mrs. McGillicutty comes in and says, ‘I really didn’t feel well after my last fill,’ and [the pharmacy] knows Mrs. McGillicutty — ‘Oh, okay, that does seem like that shouldn’t have happened, and maybe we need to contact Dr. Jones,’ and bring Dr. Jones into the mix.”
What to Ask a Potential Accrediting Organization
What should an independent pharmacy staff look for as they consider accreditation — or when an accredited pharmacy is looking to possibly change its accrediting partner?
“I would ask them about the various touch points and what the business model is,” Canally said, in suggesting what questions the pharmacy should ask. “In other words, what is your process for getting accredited?”
In examining that process, Canally recommended asking about the accrediting organization’s (AO) standards.
“There are many AOs that have far more complicated, obtuse standards,” she noted. “That’s where [the pharmacy] would have to hire somebody to interpret the standards. That’s never a good thing. If you need to hire an outside person to tell you what that sentence says, that’s not good.
“Can everybody in your organization understand the standards? We recommend that you make copies and — with equipment management or with supplies or with pharmacy — you give it out to the people in those departments so they can see what their responsibility is and what it entails. That way, everybody can understand what it’s all about, and how it’s been simplified.”
Also, make sure you understand any additional costs you might incur as part of the accreditation process. Marilyn Bullock, The Compliance Team’s Communications Advisor, said, for example, “Some AOs give you one set of standards, and then they charge you for additional sets.”
Canally also advised pharmacies to ask about accreditation timelines. “How long does it take?” she asked. “There are some [AOs] that take a year or more in order to get through. And when you’re talking about a small- to medium-sized provider, that’s a long time to dedicate [to the accreditation process].”
Choosing a Good AO Partner
A critical part of choosing a good AO for your pharmacy is knowing your business and determining ahead of time the level of support you’ll need.
For example, with The Compliance Team, “Our business model is different than the other accreditors in that there’s a preparation/education phase where they’re assigned an advisor one on one,” Canally said.
“They go through a series of conference calls [to] review standards, reviewing what they have in place that they may need to step up their game. They have all these educational conference calls in advance to help prepare.
“We give them tools to gauge their progress on their end, and then when they’re ready, somebody else [from The Compliance Team] goes on site to verify and validate that they actually meet those standards.”
While The Compliance Team is not involved in the pharmacy’s implementation of standards, “We give you the guidance and the roadmap, and self-assessment checklists and templates of policies and forms and so forth that you may not have on your end,” Canally said. “You don’t need to hire an outside [advisor] or bring anybody else in because we’re meeting your needs along the way.”
The accreditation time investment, Canally added, is “about four hours a week to prepare over a four-month period” for The Compliance Team clients. “That’s a good average for a small- to medium-sized provider,” she said.
Another tip: Consider not only the current services and product lines you provide in your pharmacy, but also any expansion plans you have. Then share that information with the AOs you’re considering.
“Our community pharmacy program is DME [durable medical equipment] and community pharmacy together, because if they only get accredited for the DME part, it’s like getting accredited for [only a part] of your business when you’re known in the community as a pharmacy,” Canally said. “So we rolled the DME and bundled it into the community pharmacy accreditation umbrella.
“We only evaluate you on the services you provide. So even though we’ve got a whole laundry list of areas and programs and certifications that we offer, you may not be doing infusion. You may not be doing long-term care with assisted living, in which case, okay, we obviously are not going to look at those standards because they don’t apply. So that’s where we adapt according to what your model is, not the other way around.”
And if you do expand your service or product offerings, Canally said it’s crucial to work with your AO to make sure you’re appropriately accredited before you start billing.
“We’re building the foundation with the community pharmacy,” Canally explained, “and then it’s easy to add on because everything relates to those basic pharmacy standards. Whether you’re doing long-term care, whether you’re doing infusion or specialty or value-based, you need to be doing the basic things, such as how you store and handle the drugs appropriately.”
Keeping your AO in the loop as your business plans evolve is the most efficient way to grow — “As opposed to two years later, we find out when they’re up for a renewal that ‘Oh, we added this,’” Canally said. “Well, okay, so you need to get accredited. If it’s home infusion, they’re required to get accredited if they want to bill Medicare, because that’s a fairly new benefit. So whenever they change business models, they should tell the accreditor, because more than likely it’s going to impact something in our relationship.”
Keeping the Communication Flowing
The evolution of a business, of course, is a dynamic process. For example, maybe a pharmacy decides to take on a new service or product line because of a steady stream of requests from referral sources or customers.
That could be a tremendous business opportunity to provide responsive customer service. Just remember to keep your AO apprised, or if you’re shopping for an accreditation partner, make sure they can accommodate your future plans.
Otherwise, trouble can arise.
“They may drop some products on the DME side or add products,” Canally said of how a pharmacy can evolve. “Sometimes they forget that the accreditation is linked directly to billing of the Part B items with the product category. So they’ve had nebulizers, and all of a sudden they decide, ‘I have this one doctor that really wants us to do CPAP, even though we’ve never done it before.’ And they say, ‘Yes, we can do that’ to the doctor.
“And they submit a claim. We report to CMS [Centers for Medicare & Medicaid Services] every week with regard to providers who are accredited, and for what products, and for what length of time. All of a sudden, ABC Pharmacy submits a claim for CPAP.”
What happens next: CMS pulls up ABC’s information, sees that the pharmacy is a client with The Compliance Team, who does not have CPAP listed as an accredited category for that company. CMS contacts The Compliance Team.
“We in turn go after the provider and say, ‘You can’t do that. You need to get accredited first,’” Canally said. “And then they have to do a corrective action to put something in place.”
So ideally, no matter who you choose as your AO, the process will likely work better for you, your customers, your referral sources, and your payers if your relationship with your AO is an ongoing one, with regular communications as needed… rather than just talking with your AO every few years when it’s time to renew…?
“Right,” Canally said. “Exactly right.”
This story originally appeared in the eBook (digital) edition of DME Pharmacy. For a free subscription, sign up for HME Business’s e-Source newsletter; subscribers automatically receive DME Pharmacy editions.