AHCA/NCAL Gold Quality Award Achievers Talk Strategy, Sacrifice<p>​A quartet of providers has received the preeminent Gold National Quality Award designation from the American Health Care Association/National Center for Assisted Living (AHCA/NCAL) for 2020 and was honored for their achievement during the association’s annual convention, which ran on a virtual basis through the month of October.</p><h2>Starting With Bronze</h2><p><img src="/Monthly-Issue/2020/December/PublishingImages/Treutlen.jpg" alt="Treutlen Health and Rehabilitation" class="ms-rtePosition-1" style="margin&#58;5px;width&#58;232px;height&#58;303px;" />Jane Martin, RN, director of nursing, Treutlen Health and Rehabilitation, Soperton, Ga., says for her 50-bed facility in rural Georgia, the latest attempt to achieve Gold started five years back when the organization earned Bronze from AHCA/NCAL, then Silver in 2017.<br></p><p>“That is when we decided to go for the Gold,” she says. “We [earned] a site visit last year, and then this year got the Gold award.”<br></p><p>Going for the top honor and going for the Bronze or Silver are worlds apart, Martin notes. “The Gold is so much different, and you really need to dedicate time to it.” This work includes copious writing down to report quality-based outcomes for residents, since getting positive results is what the award process is all about, she says.<br></p><p>“Probably the most difficult things is collecting the data. Everything has a different measurement time frame, so I really rely on LTC Trend Tracker [from AHCA/NCAL], NursingHome Compare… You need to know all of these data today on a regular basis.”<br></p><p>Once all the hard work resulted in the Gold, Martin says sharing the good news, in a COVID-sensitive manner, was a great feeling for staff and residents alike.<br></p><p>“We were in a huge open area when we told them, and it was a lot of yelling through masks,” she says. “It was kind of sad that we could not hug or have family there, but we did our best.”<br></p><p>As for what she would tell fellow providers about the award program, Martin says facilities should do it; even though it is not easy, it is well worth it. “We all learned so much through the process, and there were so many little things along the way, it has changed the way we live and work here.”</p><h2>Driven by Necessity</h2><p><img src="/Monthly-Issue/2020/December/PublishingImages/Burgess.jpg" alt="Burgess Square Healthcare and Rehab Centre" class="ms-rtePosition-2" style="margin&#58;5px;width&#58;414px;height&#58;308px;" />Kristin Thrun, administrator, Burgess Square Healthcare and Rehab Centre, Westmont, Ill., says her nursing home got into the quality award world because back in 2012 when accountable care organizations and other value-based care entities emerged in her area, it became imperative for her facility to set itself apart.<br></p><p>“The focus became even more pronounced on overall performance outcomes and quality measures, and becoming part of the AHCA/NCAL award process helped us to do this in a systematic way,” she says.<br></p><p>After receiving some local awards for their work with residents, the facility earned Bronze from AHCA/NCAL in 2017 and then eyed going for Gold after that.<br></p><p>“I think the biggest challenge is continuing to push forward in terms of meeting the criteria and putting our programs in place and sustaining them despite the external challenges brought on by things like changes in payment models [Patient-Driven Payment Model] and keeping pace with those,” Thrun says.<br></p><p>An example she gives is the challenge it was to make the systemic change on medication reconciliation when a resident moved from the hospital to the nursing home. <br></p><p>“We worked with the hospital to change the process and reduce errors tied to these transitions of care and created a pharmacy position that just does admission reviews for new patients coming in,” she says.</p><h2>New Skills Help Staff Adapt</h2><p><img src="/Monthly-Issue/2020/December/PublishingImages/Applewood_cupcakes.jpg" alt="Applewood Center" class="ms-rtePosition-1" style="margin&#58;5px;width&#58;262px;height&#58;383px;" />The third achieving group says its journey to Gold began 18 years ago, according to Gail Cushing, RN, executive director, Applewood Center, Winchester, N.H.<br></p><p>“It has been a long journey for sure, but we continued to forge on throughout the time, but it did not prevent us from getting to where we wanted to go,” she says.<br></p><p>The greatest thing about the Gold process, Cushing says, is that it gave Applewood Center and its staff new skill sets to be able to adapt to new demands. “We can take new problems and adapt very quickly. An example is with COVID-19; I have said handling the pandemic was made more manageable because we went through a dress rehearsal with the Gold awards.”<br></p><p>For her, the award application has taught her and her people to communicate better, get feedback, educate, teach, and fix pitfalls. One example is that during the pandemic, her staff came up with a way to clean their goggles when there was no water source in an area where people were working.<br></p><p>“The whole Gold process is a concept really that provides a facility&#160;with new means to achieve success, and the more you practice, the better you become and the more ingrained it all becomes,” Cushing says.</p><h2>Pride for the Gold</h2><p><img src="/Monthly-Issue/2020/December/PublishingImages/Heritage_EuniTami.jpg" alt="Heritage of Bel-Air" class="ms-rtePosition-2" style="margin&#58;5px;width&#58;351px;height&#58;237px;" />Katie Frederick, administrator, Heritage of Bel-Air, Norfolk, Neb., started out talking about the end game of achieving Gold, which was the joy she, her 160-strong staff, and residents felt at accomplishing so much. Even though the pandemic has made a true celebration difficult, she says the pride all in the community feel about making Gold is real.<br></p><p>For her, making changes to be more efficient and better at evaluating results and outcomes is the lasting impact going through the award process will have.<br></p><p>“Evaluating and learning are what this has all been about. And, really getting better at communicating, listening to each other, and putting ideas into practice. That has all worked for us,” Frederick says. <br></p>2020-12-01T05:00:00Z<img alt="" src="/Monthly-Issue/2020/December/PublishingImages/1220_gold.jpg" style="BORDER&#58;0px solid;" />Quality AwardsPatrick Connole​A quartet of providers has received the preeminent Gold National Quality Award designation from AHCA/NCAL for 2020.
COVID-19 Vaccine Promises New Day for America’s Seniors<p><strong class="ms-rteForeColor-8" style="">ADVERTORIAL</strong></p><p>America’s seniors are waiting eagerly for positive news on the development of a vaccine for COVID-19 and subsequent information on how they can receive the inoculations, searching for that proverbial light at the end of the tunnel and deliverance from the long and challenging months of coping with a once-in-a-lifetime pandemic. <br></p><p>Standing ready to help deliver this hope to seniors and specifically to those residing in seniors’ housing are national leaders in vaccine delivery and distribution, Walgreens and PharMerica. These two organizations believe firmly that safe and effective vaccines offer the path forward for nursing homes and assisted living communities, and they have a plan in place to get the vaccine to those most in need of it in a rapid and safe manner.<br>Seniors-Directed Efforts<br></p><p>T.J. Griffin, senior vice president of long-term care operations and chief pharmacy officer for PharMerica, is also a member of the Operation Warp Speed program to bring one or more COVID-19 vaccines to market as soon as safely possible. <br></p><p>He says vaccine makers are doing their work with the most vulnerable populations in mind—seniors—and have increasingly included older participants in clinical trials still taking place, which will drive the data “to make us all feel comfortable.”<br></p><p>These data will inform how PharMerica educates its long term care clients on the vaccine, with pharmacists and doctors in the lead on ensuring communities grasp the importance of getting what will amount to safe and effective protection from COVID-19.<br></p><p>“I believe in vaccines, and I believe the way we help our skilled nursing and assisted living partners get back on their feet and make it safe for the public and our frontline staff is through this process,” Griffin says. <br></p><p>“The sector needs it, society needs it, and we need to get back to when folks stop going without health care and rehabilitation and feel safe to send moms and dads to these facilities. This is a real group effort by many, many stakeholders. No one is looking out for their own interests here, this is about saving lives. For us, this is about America, not PharMerica.”</p><h2>Good News </h2><p>And, if recent news on vaccine development is any indication, there is going to be a real push to implement the Walgreens and PharMerica plan to get seniors living in nursing homes and assisted living and related care facilities inoculated at the earliest feasible time.<br></p><p>“On Nov. 9, Pfizer labs announced that their vaccine in Phase 3 trials was producing a 90 percent efficacy rate. While we will need further data, this level of efficacy is on par with our highly effective measles vaccines,” Griffin says.&#160;“This gives us hope that we can have a vaccine for our frail elderly and their heroic health care workers who care for them.”&#160; <br></p><p>A safe and effective vaccine is a big step to putting the long term and post-acute care sector back on its feet in many ways, starting with the health and wellness of the staff and their residents, he says.&#160; </p><h2>Experience in Delivering Vaccines</h2><p>Walgreens is a leader in providing immunizations to protect communities from vaccine-preventable diseases. Now, on the cusp of a breakthrough in the development of a safe and effective vaccine for COVID-19, PharMerica has joined with Walgreens to support and accelerate the administration of a vaccine.<br></p><p>Walgreens is working at the broadest level to support and accelerate the administration of COVID-19 vaccines, once available, collaborating closely with the Centers for Disease Control and Prevention (CDC), Department of Health and Human Services (HHS), and the administration as part of Operation Warp Speed.<br></p><p>The pharmacy provider believes pharmacists can play an important role in helping increase vaccine distribution reach and capacity for an epidemic. <br></p><p>“With our nationwide footprint, trusted community presence, deep history in vaccine administration, and pharmacist expertise, Walgreens pharmacies will be critical to accelerating access to COVID-19 vaccines once they become available,&quot; Griffin says.</p><h2>Sharing Duties</h2><p>This expertise in delivering vaccines and ability to collect individualized data are part of the reason PharMerica has such great expectations from its partnering with Walgreens, says Griffin. <br></p><p>This trust in what Walgreens can deliver, combined with PharMerica’s knowledge of the senior housing business, is a combination that is poised to help deliver nursing homes and assisted living communities from the COVID-19 crisis and start the road to recovery.<br></p><p>“I look at their 10 years of experience in stores and delivering clinics and our connection this fall with some 200 flu clinics, and it all comes back to their professionalism. They do a really good job,” he says.<br></p><p>“We have years of experience sending flu vaccines to facilities, but they have not been patient-specific. Because of the speed at which this vaccine [multiple vaccines] is being developed, the vaccinations have to be individually recorded so that any adverse events get reported by the facility. This will all be recorded in the CDC system, and this is where Walgreens’ abilities will come to bear.”</p><h2>Strong Network of Workers</h2><p>Griffin notes that Walgreens has some 20,000 staff around the country delivering vaccinations to the public, and PharMerica has 250 consultant pharmacists to manage the 325,000 patients the company takes care of every day.<br>“We could not get it done by ourselves, and the federal government wants a one-stop shop for the administration and reporting of the vaccine and take on the responsibility for the product they have paid for. Remember, there is no cost for the vaccine itself, the government is paying for it,” he says.<br></p><p>In turn, the PharMerica role when the vaccine or vaccines are approved for distribution will be to help schedule clinics, the events in which residents and staff of facilities receive the shots. Likely, there will be one vaccine to start with in 2021, and gradually a second and third added. Griffin thinks the entire long term care sector can be taken care of with the first vaccine, but that will all be determined by operational issues, like if there are enough doses manufactured.<br></p><p>“Walgreens will take the lead most times, and we will schedule directly with the facilities, coordinating consent forms, and organizing the day of clinics and work to supplement their staffing. Consultant pharmacists may be present, depending on the size of the clinic,” Griffin says. &#160;<br></p><p>PharMerica is also developing an outreach and education effort as well to inform families, residents, and staff of the safety and efficacy of the vaccine being given and has worked with Walgreens on understanding the unique aspects of long term care, like the fact residents often have to be immunized in their rooms and cannot come to a central location like a dining hall.</p><h2>All Need the Vaccine</h2><p>Griffin says it is important that all residents and staff be vaccinated for the process to work and noted that this includes the entire breadth of residential living in senior housing. An example he gives is that a woman resident in an independent living arrangement may have a husband in a neighboring complex housing people in memory care.<br></p><p>“She will still need to get the vaccine, even though she is not in the assisted living part” of the continuing care retirement community, Griffin says.<br></p><p>Even though there is no word yet on how and when a vaccine will be approved for use, he says the design of the overall program is that there will be three clinical visits to a facility to take care of all the immunization needs. <br>“There will be three clinics. So, one today on the day chosen to start, then one 21 days later, and then a third clinic at a later date to capture new admissions, new employees. The federal response will include these three distinct clinics,” he says.​</p>2020-12-01T05:00:00Z<img alt="" src="/Topics/Special-Features/PublishingImages/2020/1220_Pharmerica.jpg" style="BORDER&#58;0px solid;" />COVID-19;Infection ControlAmerica’s seniors are waiting eagerly for positive news on the development of a vaccine for COVID-19 and subsequent information on how they can receive the inoculations.
Antimicrobial Alternatives Help Improve Outcomes<p style="text-align&#58;left;"><strong class="ms-rteForeColor-8">ADVERTORIAL</strong></p><p style="text-align&#58;left;"></p><p><a href="http&#58;//www.essity.com/" target="_blank"><img src="/Topics/Special-Features/PublishingImages/2020/essity.jpg" class="ms-rtePosition-2" alt="" style="margin&#58;5px;" /></a>Wounds are a pernicious threat in long term care, directly impacting quality of life, undermining health, and attacking the bottom line.</p><p style="text-align&#58;left;">A recent study by the Healthcare Industry Distributors Association revealed that long term care providers see a direct correlation between achieving quality outcomes and medical product selection, including the area of wound care. In this rapidly evolving field, products are being introduced that can improve the rate of wound healing and help improve outcomes while maintaining costs.</p><p>One of these products is Cutimed Sorbact, a nonmedicated treatment for colonised and infected wounds. Sorbact® Technology uses a simple physical bonding process to slough away bacteria without disturbing the cells. </p><p>There's nothing else like it in today's wound care market, said Nancy Morgan, RN, WOC, co-founder of the Wound Care Education Institute. </p><p>“It is easy to use and remove. The bacteria cling to the product and are removed each time the dressing is changed,&quot; Morgan noted.</p><p style="text-align&#58;left;">“I think it's fantastic technology, but too few people know about it, especially in post-acute settings.&quot;</p><p style="text-align&#58;left;">Available in a variety of applications and sizes, Sorbact products are embedded with dialkylcarbamoyl chloride, or DACC.</p><p style="text-align&#58;left;">They rest against a wound bed, displacing water and irreversibly binding bacteria through hydrophobic interaction.</p><p style="text-align&#58;left;">Essentially, DACC's fatty acids attract and hold onto other fatty acids. Think of it like oil droplets clinging to other oil droplets in water, said Amy Gray, RN, BSN, CWS, a wound care clinical leader for Essity.</p><p style="text-align&#58;left;">Bacteria adhere to the dressing, and all of the bonded microbes are easily removed from the wound along with the dressing.</p><p style="text-align&#58;left;">“Unlike bacteriocidal products, Sorbact doesn't kill the bacteria, thereby leaving cellular debris in the wound bed,&quot; Gray said. “With Sorbact, we catch it and remove it. It's truly a physical mode of action.&quot;</p><p style="text-align&#58;left;">That means Sorbact can improve the rate of wound healing over traditional methods—by as much as 40%, according to one randomized clinical study.1</p><h2>Antimicrobial Alternative</h2><p style="text-align&#58;left;">A 2019 study published in <em>Internal Drug Resistance</em> found silver-resistant bacterial isolates in 12.6% of samples—among them <em>klebsiella, Staphylococcus,</em> and <em>E. coli.</em>2</p><p style="text-align&#58;left;">Many providers have been reticent to recognize the resistance threat associated with some care products, focusing their stewardship efforts largely on prescribing practices. Swapping antimicrobial-containing dressings for a physical barrier may be an effective alternative for those looking to reduce reliance on drugs and impact patient and regulatory outcomes.</p><p style="text-align&#58;left;">Sorbact also may be a tool more providers want to consider as they ramp up antimicrobial stewardship efforts.</p><p style="text-align&#58;left;">Its effective, alternative mechanism—proven safe for more than two decades in Europe—may help reduce reliance on common broad-spectrum antibiotics while still providing an effective means of removing bacteria from the wound.</p><p style="text-align&#58;left;">Sorbact Technology can be an effective alternative to those dressings containing antimicrobials, which may exhibit resistance to common bacteria found in the wound.</p><p style="text-align&#58;left;">“Sorbact has been demonstrated to be effective, and it's priced competitively,&quot; said Tony Forsberg, RN, WCC, Essity's national clinical director. “It only makes sense that skilled nursing providers would want to try it.&quot;</p><p style="text-align&#58;left;">Sorbact products are available through all national suppliers and are now supported by Tena's wound care-certified nurse advisers, who can demonstrate use and efficacy onsite.</p><p style="text-align&#58;left;">An extensive product line includes pads, swabs, ribbons, hydrogel, foam and super-absorbent dressings, and more.</p><p style="text-align&#58;left;">Most have a seven-day wear time but can be replaced for prolonged treatment of chronic wounds.</p><h2>Dignity on Delivery</h2><p style="text-align&#58;left;">Wound care nurses are looking for proven products that do what they say they are going to do so they can provide residents with quality care. Sorbact offers a dependable solution that works throughout the dressing's assigned wear time.</p><p style="text-align&#58;left;">As fatty acids build up on the dressing, they continue to attract other fatty acids, accommodating layer upon layer of removable bacteria.</p><p style="text-align&#58;left;">“You're constantly removing bacteria with each dressing change while maintaining a moist wound environment,&quot; Gray said. “It really addresses dignity issues. Staff and residents love that—and the atraumatic removal.&quot;</p><p style="text-align&#58;left;">With some 15% of Medicare beneficiaries diagnosed with a wound each year—and mounting pressure to reduce the incidence rate in nursing homes—it's time more providers know about alternative approaches.</p><p style="text-align&#58;left;">“We need to get this information out to all the clinicians so they can use the technology to help their patients heal and make a difference in their lives,&quot; Morgan said.</p><p style="text-align&#58;left;">For more information, email <a href="mailto&#58;woundcare@essity.com" target="_blank">woundcare@essity.com</a>.</p><ol><li><p><span class="ms-rteFontSize-1">Corsi, Alessandro. Comparison of a novel non-mediated bacteria-binding dressing to silver dressings in the management of acute and chronic skin lesions. Poster presentation SAWC 2012.</span></p></li><li><p><span class="ms-rteFontSize-1">Infection and Drug Resistance,&#160;July 8, 2019, pp. 1985-2001.</span><br></p></li></ol><p><img src="/Topics/Special-Features/PublishingImages/2020/Essity1.jpg" alt="" style="margin&#58;5px;" /><br></p><p><strong>Ljungh, A., Yanagisawa, N., and Wodstrom, T. Using the principle of hydrophobic interactions to bind and remove wound bacteria. </strong><em><strong>The Journal of Wound Care</strong></em><strong>, April 2006, Vol. 15, No. 4.</strong></p>2020-11-25T05:00:00Z<img alt="" src="/Topics/Special-Features/PublishingImages/2020/Essity2.jpg" style="BORDER&#58;0px solid;" />CaregivingWounds are a pernicious threat in long term care, directly impacting quality of life, undermining health, and attacking the bottom line.
Automating LTC Pharmacy Spend is the Future <style> p.MsoNormal, li.MsoNormal, div.MsoNormal { margin:0in; line-height:115%; font-size:11.0pt; font-family:"Arial",sans-serif; } .MsoChpDefault { font-size:11.0pt; font-family:"Arial",sans-serif; } .MsoPapDefault { line-height:115%; } div.WordSection1 { } </style> <p class="MsoNormal"><span class="ms-rteForeColor-8" lang="EN" style=""><strong style="">ADVERTORIAL</strong></span></p><p>​</p><p>Pharmacy spend is the second largest cost center for skilled nursing and long term care operators, second only to overhead.<strong> </strong></p><p>The complexity involved in calculating and reviewing monthly pharmacy bills is significant. Combined with the amount most facilities are spending on medication for Medicare Part A residents, this represents an area ripe for errors, unnecessary costs, and waste. </p><p>SRX offers a software solution that automates the review of monthly pharmacy bills, reconciles pharmacy pricing and contract discrepancies, and identifies and submits all eligible rebates. As Scott Taylor, chief executive officer explains, “Technology and automation are the only way long term care operators can fully take control of their pharmacy spend. This is a critical cost-control opportunity for any operator interested in embracing innovation and having the tools needed for competing in this industry.&quot; At SRX, this is accomplished by integrating pharmacy invoices with pricing databases (AWP/WAC), electronic health and medical records (EHRs/EMRs), pharmacy contracts, facility formularies, and more. </p><p><img src="/Topics/Special-Features/PublishingImages/2020/SRX_Advertorial_2.png" alt="2019 Pharmacy Drug Spend" class="ms-rteImage-1 ms-rtePosition-2" style="margin&#58;5px;width&#58;612px;height&#58;439px;" />By using automation to manage this process, operators can realize significant cost savings, improve rebates, and save considerable time reconciling monthly bills. </p><p>On average, SRX customers are able to achieve 11 percent in cost savings. </p><p>Those savings represent valuable dollars that operators can use to improve patient care, compensate and hire staff, and upgrade facilities. In short, SRX software improves the bottom line for long term care operators. </p><p>Properly managing drug costs requires insight and management of the following areas&#58;</p><h2>Drug Utilization</h2><p>Many operators are unaware of the significant cost savings that result from carefully considering their drug utilization. </p><p>Helen Halchuck, director of client services at SRX, explains, “An effective DUR begins with a thoughtfully designed formulary that outlines the drugs that best meet the financial and clinical needs of facilities and patient populations. Once this formulary is in place, you can integrate additional rules to help contain costs and build accountability into the relationship with your pharmacy.&quot; </p><p>Proper drug utilization planning plays a key role in managing costs and provides better therapeutic alternatives for patient conditions. SRX advisors work with facilities to assist in building out a formulary that achieves both these goals.</p><h2>Adjudication</h2><p>The sheer number of line items on a long term care pharmacy bill speaks to the heavy burden placed on administrators who are often charged with enforcing pharmacy contract terms and pricing. Some pharmacies can implement measures that prevent these rules from being broken in the first place. These “front-end&quot; adjudication options employ automation software to identify off-formulary drugs or establish quantity limits, for example, and prevent pharmacies from filling orders that violate these rules. With the right technology, alerts can also be sent to facilities, notifying clinicians when prescribing outside recommended parameters. </p><p>While front-end adjudication—or preventing unnecessary line items from ever appearing on a pharmacy bill—is considered best practice, this option is not always available. In this event, having robust reporting tools that provide reports that operators can use in recouping credits and holding pharmacies to account is the next best option. SRX reports analyze all drug claims, identify price discrepancies, prevent waste related to drug utilization, and detail transactions that need to be reconciled with the pharmacy.</p><h2>Identification of Credits, Errors</h2><p>To put some context behind the type of savings facilities and operators can expect in switching to an automated solution, SRX recently completed a case study of a 21-facility, multiregional operator with an average of 42 facility-billed (Medicare Part A) residents.</p><p>In 2019, after switching to SRX's solution, SRX identified over 18 percent in cost-saving opportunities through drug utilization improvements (formulary), contract-rate adherence, returns and credits, duplicate orders, orders filled after discharge, over-the-counter (OTC) opportunities, and orders refilled too soon. &#160;</p><p>Without accurate reporting, operators are left without the information needed to request credits that are rightfully theirs. The rate at which pricing fluctuates—combined with error potential on every bill—makes accountability and transparency a real challenge. Even when operators have good relationships with their pharmacy partners, there is a lot of room for error. Left unchecked, and without an automated solution to analyze every claim, those errors are likely to remain outstanding. </p><h2>Drug Manufacturer Rebates</h2><p>One of the easiest ways to impact the bottom line for facilities is to make sure they are correctly submitting manufacturer rebates. Due to the complexity of accurately analyzing bills and identifying rebate opportunities, many of these dollars go unrealized. SRX technology is designed to simplify this process, identify all eligible rebates, and submit them to the manufacturers so that these rebate dollars are guaranteed to be put back into facilities where they belong.</p><p>By implementing technology to manage the complexity of pharmacy spend, long term care operators have the insight required to make informed decisions and achieve greater control over this crucial aspect of operations. According to Taylor, “With all of the challenges long term care operators face, it will become increasingly critical to find the right technology partners and solutions that can add value. As one of the largest cost centers for operators, pharmacy spend represents a unique opportunity for facilities to take advantage of significant cost savings and rebates to impact their bottom line unequivocally.&quot; </p><p><em>SRX is a technology and advisory company that helps long term care operators realize the lowest net cost on pharmacy spend. We help our customers improve drug utilization, manage pharmacy relationships, reduce costs and waste, and maximize rebates. We are committed to transparency and accountability and guarantee our quarterly rebates are paid on time, every time. Contact us at 833-633-6833.</em></p><p><a href="https&#58;//srx-tech.com/#utm_source=AHCA&amp;utm_medium=advertorial&amp;utm_campaign=Automating%20LTC%20Pharmacy%20Spend" target="_blank"><em>Srx-tech.com</em></a></p><p><br></p>2020-11-23T05:00:00Z<img alt="" src="/Topics/Special-Features/PublishingImages/2020/1120_SRX.jpg" style="BORDER&#58;0px solid;" />CaregivingPharmacy spend is the second largest cost center for skilled nursing and long term care operators, second only to overhead.