The Biden Administration’s recently announced minimum staffing rule will require nursing homes to hire an estimated 102,000 nurses and nurse aides, costing approximately $6.5 billion per year. While AHCA/NCAL and other organizations are fighting to prevent the mandate from taking effect, long-term care providers across the country are readying themselves for the additional pressures it will place on their operations.
As a trusted partner to thousands of providers across the country, PharMerica understands that filling prescriptions is just one small part of its role. Its dedicated local account management teams, consultant pharmacists, and nurse consultants provide hands-on support for each client, offering training and resources, conducting monthly medication reviews, participating in QAPI meetings, and integrating themselves into their communities. PharMerica is well prepared to help providers contain costs, enhance efficiencies, and mitigate the negative impacts of new hiring requirements.
Streamlining Onboarding and Training
PharMerica has streamlined its client onboarding process and offers a comprehensive training program. “We not only engage direct stakeholders but also unit-level staff to ensure they understand how to order medications, use the EMR platform, communicate with the pharmacy, refill orders, and manage IVs,” Dale Padgett, senior vice president, client strategy and partnerships, explained.
“We provide essential training,” added Rebecca Wingate, vice president of clinical operations, “especially about pharmacy processes and medication management, policies and procedures, and compliance requirements with regard to anything from high-risk medications to specific disease states like diabetes, CHF, and hypertension.”
This training is especially important for facilities dealing with staffing shortages whose clinical infrastructure may be more interim or transitional in nature. PharMerica also enables facilities to address skills gaps among new hires with standard educational offerings that ensure inevitable workforce turnover doesn’t come with negative impacts.
Identifying Savings Opportunities to Reduce Operational Costs
Meeting new staffing requirements will force facilities to look at other areas to cut costs, and many could save up to 20 percent on pharmacy spend annually. PharMerica’s goal is to explore lower-cost alternatives that maintain equal efficacy, optimize medication usage in terms of dosage and duration, and design specific interventions based on its clients’ referral sources’ prescribing trends.
PharMerica achieves this goal by developing a personalized approach for each partner facility, recognizing there is no one-size-fits-all approach. “We partner directly with the medical director and the prescribers in the facility, with our consultant pharmacist working hand-in-hand on ordering labs, recommending medication adjustments or gradual dose reductions, and providing education to nursing staff on whatever they may be challenged with,” Wingate said. “Since we’re a guest in that facility, we really try to build that trust and that ongoing collaboration.”
PharMerica develops customized solutions based on a client’s unique circumstances and other relevant factors. “We have a very robust therapeutic interchange program that we administer—where allowed by pharmacy rules and regulations—in which we’re looking for equally efficacious alternatives to higher-cost medications,” Stephen Creasy, senior director, clinical services, explained. “We’re constantly evaluating and looking for new opportunities because we do know how expensive some of these medications are.”
An important part of this approach is identifying and addressing a facility’s unique pain points. In one recent case, a client had a high number of residents using IV medications. “We needed to understand how they train their nurses, and they needed to understand how our nurses help support residents that have IVs,” Padgett recalled.
With 80 percent of nursing homes expected to have to hire more RNs to meet the 24/7 RN requirement, PharMerica’s cost-saving measures can be instrumental in enabling facilities to redirect funds to hiring to comply with the mandate. “By spending less money on medications when there are therapeutic equivalents or other alternatives, they can free up cash flow and regain efficiencies with the nursing staff,” Creasy concluded. “It’s about doing more with less.”
An Eagle’s Eye for Compliance Issues
In cases where facilities have larger staffing gaps at the nursing or unit levels, PharMerica steps in to help fill them. “We provide a variety of resources to make sure that the facility is able to continue operating compliantly,” said Padgett.
These resources include compliance recommendations, survey preparation and support, and detailed action plans to ensure compliance during transitions and turnover. Then there’s Illuminate, the online educational platform that PharMerica maintains for its partners. “We have webinars where we provide continuing education, clinical resources, quality digests, podcasts, newsletters, bulletins, guides, and comprehensive resources for compliance,” Wingate explained. “We’re very adept at staying ahead of the latest CMS changes and ensuring the success of our customers in regard to compliance changes.”
The regulatory landscape is in constant flux, forcing providers to navigate a complex and ever-changing web of rules and requirements. Last October, for instance, CMS imposed new requirements on the MDS coding of some high-risk medications—and it’s already updating these requirements effective this coming October. “We’re already modifying our reporting that will be available to our client facilities, so they will be able to do that portion of the assessment much quicker,” Creasy said.
By keeping abreast of developments at the state and federal levels, PharMerica helps ease the burden on its partners—an especially valuable level of support as they deal with the additional pressures of the new staffing rule.