Pharmacists Objectives

Be able to determine the feasibility of a particular location for establishing a telepharmacy remote consultation site. Be able to discuss the most important considerations in establishing a remote consultation site. Understand the implementation steps required in setting up a remote consultation site. Be able to create a basic break even projection for a particular location. Be able to explain what scenario may be the most efficient for establishing a remote consultation site. Understand those parts of the Illinois Pharmacy Practices Act and the associated rules that affect telepharmacy. Know how a remote consultation site differs from a remote dispensing site and be able to discuss at least three main differences. Be able to list and discuss the functions performed by a tech in a remote consultation site.

Establishing and Operating a Remote Consultation Site

One Pharmacists Experience
by Marlin Weekley R.Ph.

Technician Objectives Telepharmacy Discussion Points

Understand those parts of the Illinois Pharmacy Practices Act and the associated rules that affect telepharmacy. Know how a remote consultation site differs from a remote dispensing site and be able to discuss at least three main differences. Be able to list and discuss the functions performed by a tech in a remote consultation site.

Rules and regulations Business considerations Implementing a Remote Consultation Site (RCS)

Illinois Pharmacy Practices Act

Telepharmacy in Illinois
http://www.idfpr.com/profs/info/Pharm.asp Adopted 2009 Rules and regulations
Hint: goto ipha.org. Links to IPPA are on the home page.

Illinois Pharmacy Practice Act Rules Established April 2010

http://www.ilga.gov/commission/jcar/admincode/068/06801330sections.html

Telepharmacy Rules: Section 1330.510

Telepharmacies Types
Remote Dispensing Site (RDS) Remote Consultation Site (RCS) Remote Automated Pharmacy Systems (RAS aka vending machines)

Remote Dispensing Site (RDS) Rules (slide 1 of 3)

RDS Rules (slide 2 of 3)

RDS Rules (slide 3 of 3)

Remote Consultation Site (RCS) Rules

Remote Automated Pharmacy Systems (RAPS)

RCS Key Features Remote Consultation Sites (RCS)

Audio-video online patient consulting Private consultation room

Private Consultation Room

Not required to be a particular size Must allow wheelchair access Seating for caregiver Monitor and speakers only Controlling computer from tech side second monitor.

A/V Consulting Link: Skype

We use Skype to create our A/V consulting link Free program at Skype.com Use good sharp monitors and speakers

Omnibus Reconciliation Act of 1990

The U.S. Congress enacted the Omnibus Budget Reconciliation Act of 1990 (OBRA '90) on November 5, Section 4401 of OBRA '90 directly affect Medicaid pharmacy programs and Medicaid pharmacy providers. OBRA '90 requirements make pharmacists responsible for the following, effective January 1, 1993: Prospective Drug Use Review (ProDUR) Patient Counseling Maintaining Proper Patient Records

Patient Counseling
OBRA 90
(Omnibus Reconciliation Act of 1990)

Patient Counseling: IPPA Rules Section 1330.700

Patient Counseling: IPPA Rules

f) When a patient or patient's agent refuses to accept patient counseling as provided in this Section, that refusal shall be documented. The absence of any record of a refusal to accept the offer to counsel shall be presumed to signify that the offer was accepted and that counseling was provided. g) A pharmacist operating a remote pharmacy shall comply with the requirements of this Section. Counseling in those circumstances shall be done by both video and audio means.

Patient Counseling

Telepharmacy
When it come to counseling take the lead. Attach counseling required tags to prescription bags. Business Considerations

Business Considerations
Profitability projection Location (town and building) Staffing Equipment setup and training Delivery process Workflow

RCS Startup Advantages versus RDS

No drug inventory Less complicated A/V link and workflow processes Shorter setup time No direct RPh monitoring Tech certification not required

Projecting Profitability:
Break-even (B-E) Calculation Formula
B-E Calculation Monthly Expenses Gross profit/RX Number Rxs/Month No Days Open/Month No Rx/Day to B-E $ 6,000.00 $ 10.00 600 25 24

Gross Profit per Rx

Use home pharmacy average gross profit/Rx. Gross profit /Rx is trending between $9.50 and $11.50 in my stores. Use lower range: most Rxs will be lower margin generic maintenance drugs in a RCS.

Total Monthly Expenses

Salary: include payroll taxes, vacation time, insurance costs, others benefit costs. Delivery costs: 55 cents/mile plus payroll. Rent / lease costs Utilities, phone, internet Supplies

Demands on Home Pharmacy Personnel and Payroll

Remember: all the Rxs coming from the RCS will have to filled by staff at the home pharmacy. How will the increased volume affect the work flow? Will scheduling have to rearranged or staff increased?

Wyoming RCS Projection

Remote Consulting Pharmacy Projection: Wyoming 09/13/2010 average gp/rx no rx/dy Monthly OTC Sales $ 25 $ 68.04 11.34 60 1,701.00 1500 $ 25% $ 17,010.00 Monthly Rx Gross 425.25 Monthly OTC Gross

Consideration in Selecting an RCS Location

Market demand(*): Do they really need you? Distance: from the home pharmacy Location: The town, the building Competition: larger towns, mail order Staff: the tech(s) available in the local area

$ Tech rent utilities phone supplies misc tax delivery office overhead advertising delivery Total Expenses rxs/dy TBE Monthly net profit Annualized Net Profit $ 25.00

17,435.25 Monthly Total Gross

42 $ 4,515.00 (one full time @$22/hr & 1 part-time @ $10/hr & 1 part time in home pharm to fill rxs) $ 600.00 $ 400.00 $ 300.00 $ 100.00 $ 400.00 $ 300.00 $ 400.00 $ 300.00 $ 1,500.00 (2 deliveries/day) $ 8,815.00 31 $ $ $ 8,620.25 Monthly Net Profit per location 8,620.25 103,443.00

(*)Critical point

Market Demand
WikiPedia: demographic data Population mix : % seniors Prescribers: number and type Warning: Be skeptical of what you hear on the street.

Distance
From the home pharmacy: 20-25 miles is about right. From competition: minimum of 20-25 miles

Location The Building

Visibility Accessibility Condition of building / remodel costs Lease / rent options

The Building - Visibility

The Building - Accessibility

Parking Drive-up window Wheelchair access all doors and bathroom

The Building - Condition

Most buildings in smaller towns are old and require remodeling to make them practical for use as a pharmacy. These costs can be significant.

The Building Remodeling Issues

Plumbing and wiring Restroom(s): ADA Accessible Lighting Carpeting Signage Equipment and fixture installation

The Building - Lease

Prefer month to month rent Include option to purchase Avoid standard triple net leases

Competition
Other communities (with more to offer) Other pharmacies Mail order pharmacies

Change an Existing Store to a RCS

Many of the location issues go away Customers and cash flow immediately Profitability usually quicker
Critical point

Telepharmacy implementation Telepharmacy

Hire staff Acquire location Implement remodel plan Make applications to the State Setup equipment Staff training Pass inspection

Implementation

Staffing the RCS

Hiring the right tech might take some time but hiring the wrong tech could doom your business from the start. It is critical you have the right person otherwise dont bother!
Critical point

RCS Tech Qualities

Attitude: a people person Ability/desire to work full time Local resident preferred Techno skills: at least trainable Willing to work alone

Install Equipment File Your Apps with the State

Youve done your research, located the perfect town, building and tech. While the tech is being trained and the building remodeled and setup is the time to get your paperwork filed with the State for your licenses. Yes you need controlled substance licenses. http://www.idfpr.com/dpr/who/phar.asp
Computer linked to dedicated computer at the home pharmacy for entering rxs (optional). Computer dedicated to counseling with dual monitors Fax machine for receiving rxs and sending to home pharmacy. Cash register and credit card machine Phone system

Tech Side of Consultation Room

The tech controls the A/V connection with the home pharmacy from outside the consulting room. The computer used has dual monitors.

A/V Consulting Link: Skype

We use Skype to create our A/V consulting link Free program at Skype.com Use good sharp monitors and speakers Offer patients headphones

Tech Training
Put your policy and procedures in writing. Have new tech(s) work in the home pharmacy for a period. Include training on how to maintain and operate all equipment.

Tech Functions
Ensure a good a/v connection Arrange consultation sessions Maintain all equipment Dispense filled prescriptions Enter prescriptions refills Maintain otc inventory Maintain store order and cleanliness Maintain all records

Workflow is Critical
Good well thought out workflow is essential to the success of any pharmacy practice. Workflow must be reduced to written policy and procedure, agreed upon by all and enforced.
Critical point

Workflow
Good workflow is a result of good work habits. Its just as easy to develop good work habits as bad.

RCS Workflow
Tech enters Rx data Work order label, Rx labels, stop label. Use Notepad to log communications Organize Rxs to be picked up in locked cabinet.

RCS Workflow

Tech enters prescription data

Notepad as Comm Log

Home Pharmacy Workflow

Place labels in work tray with work order label on top. Fill Rxs RPh checks Bag and place in totes Fax doctors for refills Send deliveries to RCS

Home Pharmacy Workflow

Dedicated monitor and label printer Labels are placed in work trays with work order label on top.

Home Pharmacy Workflow

Filled rxs waiting to be checked by a pharmacist. NDC numbers MUST match!

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Home Pharmacy Workflow

Home Pharmacy Workflow

At cut-off time a delivery log is printed and checked to ensure all orders are complete and in the deliver tote(s). Delivery log is dated and signed by both the delivery person and RCS tech then returned to the home pharmacy

Checked Rxs are bagged and placed in deliver tote(s).

Review of Implementation Steps

Create profitability projections Select location Identify staff Develop a remodel and setup plan File applications with the State Train staff Implement remodel and setup plan Pass Inspection Open Now go to work keeping thinking keep adjusting

Conclusion- Review of Critical Points

Choose location carefully: use conservative projection for demand and profitability for a given location. Hire the right tech(s). Create a workflow that works put it in writing insist it be followed. Convert existing pharmacy for optimal results.

Contact Information
Marlin Weekley R.Ph. President Dot Drug Inc. 309-369-2888 email: marlinweekley@gmail.com

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