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Developing A Community Pharmacy Practice Site
2 Working Definitions of ‘Developing a Practice Site’
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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
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Traditional sites: chain, independent or hospital setting staff to ownership positions
Non traditional opportunities: CVS Pharmacare (formerly ProCare), Kroger initiatives 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 care Nuclear pharmacy; Government; Insurance industry (ESI, Medco); Pharma, VA, etc.
Possible Practice Sites & Activities
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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
DOES YOUR IDEAL “PRACTICE SITE” EXIST? IF NOT, THEN:
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Decide:
Thinking about your ideal practice site, could you actually create it?
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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?
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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?
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APC Pharmacy Care Clinic
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Balancing Clinical and Business Interests
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Clinical
Business
APC Pharmacy Care Clinic
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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
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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
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Develop physician relationship Identify needs:
space equipment personnel (not just clinical)
Billing and reimbursementDevelop clinical protocols
Must have MD input and approvalLegal:
Develop the collaborative practice agreement Develop the annual operating plan Check in with State BOP
Take good care of patients
Important Documents:
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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
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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
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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
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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
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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?
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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.
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THIS STRATEGY IS ALSO KNOWN AS SUCCESS.
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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.