The Pharmacy Hospice Connection: Delivering Care to the Patients Who Need It Most
By Mark Pilkington, MS, RPh |
Hospice is a Medicare-supported model for providing compassionate care to people facing a life-limiting illness. Hospice patients have fewer than six months to live, so the focus is on caring, not curing. Pharmacists can get involved in serving hospice patients as part of an interdisciplinary team that delivers expert medical care, pain management and emotional/spiritual support tailored to the patient’s requirements and wishes.1
Independent community pharmacies are uniquely positioned to work with local Medicare-certified hospice agencies, which number more than 4,500 across the country.2 Over 60 percent of these hospices have an average daily census of 50 or fewer patients,3 which means they serve a modest geographic footprint as a local business. Chances are, your store covers a geographic range of 50 miles or less, setting the stage for a natural sharing of community-centric values with local hospice agencies. You both are compelled to help your neighbors and their families in times of need.
Serving hospice patients is undoubtedly vital to your community and is meaningful work on many levels; moreover, partnering with a hospice company is a practical way to support your pharmacy business. Medicare paid out $19 billion in hospice claims in 2017, which represented a 6 percent increase over the prior year and a 17 percent upward trend since 2012.4 Overall, the U.S. hospice market is predicted to expand by 4.5 percent per year for the next five years.5 Here’s what you should know about providing hospice pharmacy services.
Gaining understanding in hospice care
Above all, partnering with a hospice company isn’t about how to increase prescription volume; that’s just a fortunate secondary benefit. The real reward is having a powerful impact on peoples’ lives. Caring for hospice patients is a unique calling that requires specialized training. While many community pharmacies have supplied medications for hospice patients, getting contractually involved in the hospice business goes well beyond filling prescriptions.
For instance, you have to be ready to review an admitting physician’s care plan within the context of palliative care. In a formal hospice-pharmacy partnership, you may be asked to conduct a clinical review of medications upon a patient’s enrollment. A further clinical review may be mandated every 15 days during the hospice stay. In addition, you may be required to attend interdisciplinary team meetings each month and provide clinical input to the hospice, individual patients and their families.
Although your overall knowledge of drug therapies and potential interactions will serve you well, you’ll need to obtain specific competency in hospice care before launching a plan of action. To build foundational awareness, consider the St. Louis College of Pharmacy’s online hospice and palliative care training program. This 16-hour online certification program gives pharmacists grounding in end-of-life issues, covers working within a hospice team and explains how to manage patient symptoms and pain.
Reaching out to hospice agencies
Once you feel confident in your ability to offer hospice pharmacy services, the next step is to get in touch with potential partners. Again, you’ll likely find one in—or close to—your own community. If you already have a relationship with hospice leadership, request a meeting to discuss how you can deliver a high level of clinical and operational support. If lacking a personal connection, try to identify the decision-maker within the hospice or find an influencer to make introductions.
Keep in mind that both you and the hospice will be seeking fair, standard and transparent reimbursement for pharmaceuticals and services. You’ll be able to address pain points in the hospice’s business by asking questions during face-to-face meetings, such as:
- How are you acquiring your drugs?
- Are you happy with the drug-acquisition process?
- Do you run into any difficulties in obtaining medications?
- How do you manage your drug formulary?
- Who handles the filing of required reports to the federal government?
- Do nurses have to take time away from patient care to pick up medications?
- How do you handle controlled substances?
These types of discovery questions will reveal ways in which your pharmacy can solve problems for the hospice. For example, you may have the ability to provide unit-dose packaging of medications to simplify adherence to drug regimens for the patient and his or her family. You may also provide drug delivery to patients’ homes, adding an extra layer of convenience and reliability—not to mention a personal touch.
In a recent real-world case, a hospice reported dissatisfaction with using a mail-order pharmacy. The hospice manager felt that having to wait a day or two for vital medications was undermining clinical support for his nurses at the local level. He’s now turning to a community pharmacy to ensure his patients’ needs are being met by like-minded people who will go the extra mile to deliver a higher standard of care.
Developing a mutually beneficial business relationship
If a hospice and an independent community pharmacy can develop a seamless partnership, everyone stands to benefit, including the patients enrolled, the patients’ families and the other caregivers on the interdisciplinary team. Assuming you’re able to reach common ground on how to proceed, all details would be formalized in a pharmacy service contract with the hospice. All responsibilities on either side of the contract would be spelled out, along with mutually agreed-upon payment terms for medications and pharmacy services.
Note that hospice patients take, on average, eight prescription medications and five non-prescription medications, filled twice per month.6 Of all the different ways to increase revenue for the pharmacy, this is certainly one of the most fitting and fulfilling. Your role in a hospice partnership will be to stay actively involved, manage those medications and optimize their clinical use with the utmost compassion, which is perfectly aligned with the ethos of independent pharmacy.
Secondarily, securing hospice business will organically increase prescription volume and is likely to create new pharmacy revenue streams from hospice pharmacy services such as clinical review of patient therapy upon admission and team meeting participation. To quantify the business impact, serving a medium-sized hospice with 100 patients has been shown to generate $175,000 per year in new revenue.7
All benefits aside, it’s important to remember that any pharmacy entering a hospice partnership should recognize that almost 100 percent of hospice patients arrive via referral. You have to be prepared to fully support the hospice and help sustain its reputation. And that’s why hospice matches up so well with the general mission of independent community pharmacy. As patients transition into the final phase of their life, they need and deserve truly personal care. That’s what your pharmacy is known for, and that’s what hospices want for their patients.
Do you think serving hospice patients is right for your pharmacy?
1. National Hospice and Palliative Care Organization. NHPCO Facts and Figures (2019 Edition). https://www.nhpco.org/research
5. AmerisourceBergen. Internal data.
6. AmerisourceBergen. Internal data.
7. AmerisourceBergen. Internal data.