The concern about early 2024 is slightly overstated. The only player that recoups DIR post hoc is the ♥️ company. Minimizing exposure to that company’s performance networks will mitigate the cash flow crunch to almost nothing, as the other companies take DIR at the time claims are paid.
The crunch in cash flow will be from March-April 2024, when DIR from the ♥️ Company for claims from Sep-Dec 2023 is recouped.
Thank you for the comment and agree with your thoughts. The bottom line (which is the bottom line) is that community pharmacists have time between now and 2024 to monitor and manage their cash flow while optimizing opportunities for non-dispensing revenues--something I will address in my next post. Knowing that the CMS final rule will go into effect in January 2024 provides us a small window of opportunity to prepare our practices.
Yesterday I received a notorious contract amendment via certified mail. As you are familiar, the "amendment" is actually a new contract booklet with no indication as to what actually changed from the previous version. It is a 2-3 hour project for me to uncover what is changing and calculate how it impacts practice.
The amendment states vaccine administration will be reimbursed "up to $20." How does anyone sustain a business, any business, when they have no means of forecasting revenue?
Serious question, when did this become standard, widespread practice in pharmacy?
That has been the issue for community pharmacies for a long time--it is difficult to forecast revenue when contracts change and terms are nebulous. As we prepare for the future of of practices, we are involved in a variety of new business models that provides us more control of revenues including direct contracting, cash-based practice (services and products), partnering with physician concierge practices, and optimizing revenue from all non-dispensing clinical services (both cash and payer-based).
Your comments highlight the need for community pharmacists to advocate collectively on the need for fair reimbursement--both for dispensing (with services to ensure medication optimization) and provision of enhanced clinical services. Community pharmacist DO MAKE A DIFFERENCE in helping patients achieve positive health outcomes which was highlighted even more during the COVID-19 Pandemic.
The concern about early 2024 is slightly overstated. The only player that recoups DIR post hoc is the ♥️ company. Minimizing exposure to that company’s performance networks will mitigate the cash flow crunch to almost nothing, as the other companies take DIR at the time claims are paid.
The crunch in cash flow will be from March-April 2024, when DIR from the ♥️ Company for claims from Sep-Dec 2023 is recouped.
Excellent article though!
Benjamin,
Thank you for the comment and agree with your thoughts. The bottom line (which is the bottom line) is that community pharmacists have time between now and 2024 to monitor and manage their cash flow while optimizing opportunities for non-dispensing revenues--something I will address in my next post. Knowing that the CMS final rule will go into effect in January 2024 provides us a small window of opportunity to prepare our practices.
Great points, Randy.
Yesterday I received a notorious contract amendment via certified mail. As you are familiar, the "amendment" is actually a new contract booklet with no indication as to what actually changed from the previous version. It is a 2-3 hour project for me to uncover what is changing and calculate how it impacts practice.
The amendment states vaccine administration will be reimbursed "up to $20." How does anyone sustain a business, any business, when they have no means of forecasting revenue?
Serious question, when did this become standard, widespread practice in pharmacy?
Casey,
That has been the issue for community pharmacies for a long time--it is difficult to forecast revenue when contracts change and terms are nebulous. As we prepare for the future of of practices, we are involved in a variety of new business models that provides us more control of revenues including direct contracting, cash-based practice (services and products), partnering with physician concierge practices, and optimizing revenue from all non-dispensing clinical services (both cash and payer-based).
Your comments highlight the need for community pharmacists to advocate collectively on the need for fair reimbursement--both for dispensing (with services to ensure medication optimization) and provision of enhanced clinical services. Community pharmacist DO MAKE A DIFFERENCE in helping patients achieve positive health outcomes which was highlighted even more during the COVID-19 Pandemic.