Brand preservation: Part A in skilled nursing facilities
Medicare & Reimbursement Advisor Weekly, September 25, 2009
The formulary savings table (below) is an example of how Omnicare® promotes its formulary and how, in some cases, the long-term care facility goes against Omnicare to stay with hospital orders or chooses facility preferences for managing rehab/short stay, acute and longer-term chronically ill patients. In total, the pharmacy provider says McLean Healthcare missed out on $3,940 for the second quarter.
The drug class-product column denotes McLean’s preferred formulary drugs.
Preserving it or regaining a script is possible as patients enter their Medicare Part A benefit in skilled nursing facilities (SNF). For example, a significant number of SNF residents come from hospitals. Some SNFs prefer to maintain continuity for shorter-stay patients and keep them on the regimen they were used to at home, although in many cases they may not know what this is. The majority follow hospital orders, which can be favorable if the orders are for a branded product, but many hospitals, as I’ve reported, are moving patients to generics for economic reasons during their short hospital stay and then writing the generic into discharge orders. Success with a product in Part A can have a ripple effect into Part D and the patient’s next level of care, since SNF nursing staff members can influence discharge instructions into a homecare/community setting. As a result, messaging to SNF decision-makers involved in transitions (i.e., the director of nursing) is important to regaining scripts lost in the hospital for both short- and long-stay patients. —BC
- Differentiate between types of wound debridement
- Complications from immobility by body system
- OB services: Coding inside and outside of the package
- Don’t forget the three checks in medication administration
- Note similarities and differences between HCPCS, CPT® codes
- What does case-mix index mean to you?
- Pneumonia with a negative chest x-ray: Clinical diagnoses, physician documentation, and coding guidelines
- ICD-10 tip: Coding for infectious and parasitic diseases
- ICD-10-CM coma, stroke codes require more specific documentation
- Fracture coding in ICD-10-CM requires greater specificity
- Initiative launched to prevent physician, medical trainee suicides
- I Have to Learn This, Too?
- How surviving a disaster changes the disaster plan
- Gap analysis: Three big issues
- Ensure compliance when reporting cirrhosis and alcoholic hepatitis with an MCC
- CMS seeks comment on Medicaid HCBS
- CMS launches new online tool to make Quality Payment Program easier for clinicians
- Assessing weapons in your healthcare facility
- Analyzing nurse staffing: Understanding FTEs
- A clarification on billing for CAH swing bed services