“No plan, no progress!”

Posted by Michelle at Friday, June 08, 2012

Salvete omnes! (That would be Latin for “Hello all!”)  My first rotation is an administrative one at UM’s home infusion service, HomeMed.

First, I will engage in a short digression. After arriving early for my first day of rotation, I waited in the lobby before meeting my preceptor(s) and discovered the delightful coffee table tome The Art of JAMA II. This book is a collection of some the fine art pieces published on the cover of JAMA over the years, and as a small-time art enthusiast, I was intrigued. Why am I telling you this? In one of the author’s accompanying essays, she noted something to the effect of, “Learning to look at your patient is like learning to look at a painting.” I thought this was a lovely simile. I encourage you to think about it. :)

Back to the topic at hand. For those not familiar with home infusion, it is a branch of pharmacy that furnishes intravenous drug therapy to patients for administration in their own home. Some examples of the treatments HomeMed provides include antibiotics, total parenteral nutrition, hydration, IVIG, clotting factors, chemotherapy, and pain management. Generally speaking, HomeMed receives referrals from the hospital, compounds the medications in the clean room, and then sends them out via driver to the patient.  On administrative rotation, I spend the lion’s share of my time in meetings with my preceptor, Dr. Chris Maksym, or other leadership staff members. These meetings cover a vast array of topics: vendor RFP presentations, software transition & development, patient care quality, accounts receivable, fiscal year goals, workflow optimization, payor audits, personnel management and process improvement. Suddenly, I am glad that I took accounting as an elective P1 year.

One of the most significant things I’ve learned about home infusion so far is that REIMBURSEMENT IS KEY! I’ve met a hospital staff pharmacist or two who left retail to escape the insurance burden; if that is so, then home infusion is not your cup of tea. Because home infusion is a (relatively) new kind of service when compared with traditional settings like inpatient hospital or retail pharmacy, avenues for reimbursement are convoluted. Some products are covered under Medicare Part B, but they must meet highly specific requirements. If not, the drug may be covered under Part D, but a patient’s supplies and nursing likely won’t be reimbursed. Medicaid has yet different stipulations. Myriad documentation will be required should either of these entities or other insurers like BCBS appear for an audit. The pharmacists at HomeMed must maintain acute awareness of the current billing rules in addition to their clinical knowledge so as to prevent major problems in the remuneration arena.

It has been extremely interesting to work with Dr. Maksym; you can tell his brain is always calculating and problem-solving. As an administrator, he is exquisitely concerned with A) metrics and B) vision. You yearn for another full-time employee in your department because business has increased and it will improve patient care? Excellent, now back it up with data. How can HomeMed increase efficiency so that the hospital receives its first-dose chemo on time and patient satisfaction is enhanced? If we’re changing that assessment form, why don’t we make it electronic now so it doesn’t need conversion in two years? As he is wont to say, “No plan, no progress!”