If 2020 will be remembered as the year of COVID-19, 2021 is likely to be looked back upon as the year when a massive, coordinated vaccine campaign unlike anything the world has ever seen enabled us to creep back toward normalcy.
Because pharmacies will undoubtedly play an essential role in this mass vaccination campaign, they must seize the opportunity it will present. Pharmacies that rise to the challenge will cement their status as critical community health resources, leveraging technology to provide more holistic patient care and reaping the financial rewards of delivering a broader array of clinical services.
Community pharmacies are well-positioned to help the public get vaccinated; for many people, pharmacies are the only convenient access to care in their communities. However, to capitalize on this opportunity, many pharmacies will need to rethink and re-engineer how they do business in several areas, including technology requirements, billing, reporting via vaccination registries, and patient engagement.
The challenge: Scaling vaccine operations
In August 2020, the U.S. Department of Health and Human Services (HHS) issued guidance under the Public Readiness and Emergency Preparedness Act (PREP Act) to expand access to safe and effective COVID-19 vaccines when they are made available. This guidance authorizes state-licensed pharmacists to order and administer COVID-19 vaccinations to patients aged three years and older. It does the same for state-licensed or registered pharmacy interns acting under the supervision of the qualified pharmacist.
As pharmacists seek to accelerate their efforts to deliver much-needed vaccinations to their communities, they must consider several key factors:
- How to align their existing pharmacy management systems with expanded medical billing requirements
- How to perform reporting with state vaccine registries
- How to integrate vaccination-related clinical documentation into pharmacy workflows
- How to deliver efficient patient scheduling to optimize the patient experience
For pharmacies that get it right, the rewards are likely to be considerable. Here’s why: Medicare has set its per-patient billing rate for two-dose COVID-19 vaccination administration at $45.33, while Medicaid and commercial plans have been advised to set similar reimbursement rates. With the vaccine provided to patients at no cost through the federal government and a high percentage of the country expected to obtain it, vaccinations represent a massive revenue-enhancement opportunity for pharmacies.
The question is whether pharmacies have the technology, capacity and knowledge to quickly scale operations to snatch the opportunity in front of them. Here are three tips to get started.
Automate state vaccination registry reporting: Most states have established registries that require pharmacies to report certain vaccines, but manual reporting can be timely, costly and particularly burdensome during a public health crisis that has forced many organizations to adopt an “all-hands-on-deck” approach. Automated reporting solutions that work seamlessly with medical billing and PMS workflow can reduce steps and streamline reporting.
Identify immunization opportunities: Leading analytics solutions on the market can enable pharmacists to prospectively pinpoint immunization opportunities for patients who would benefit from a COVID-19 vaccination — and, for that matter, other vaccinations such as influenza and pneumonia. By leveraging data to help qualify patients as vaccine candidates due to pre-existing conditions, age of the patient, vaccine history, and other factors, pharmacies can take a strategic population health-based approach. Proactively identifying patients and contacting them to schedule vaccinations enables pharmacies to generate additional revenue while reducing staff members' administrative burden.
Medical billing opportunity: Over the years, pharmacists have developed a strong sense of comfort and familiarity with prescription billing, to the extent that some fear the prospect of confronting the unknown by adopting a different billing method. However, the COVID-19 pandemic has prompted many pharmacists to embrace and implement pharmacy-based medical billing, which has enabled them to obtain greater recognition as care providers. As a result of this shift, many pharmacists have begun to deliver an expanded set of clinical services, such as vaccinations and point-of-care testing.
Like virtually all healthcare service providers during the pandemic, pharmacists have experienced a host of new, sometimes-unforeseen challenges. Nonetheless, many have risen to the occasion to further entrench themselves as indispensable community resources while also enhancing profitability. There may be no better place to start than contributing to the nation’s historic effort to vaccinate its citizens as we overcome the most significant public health challenge in a century.