This time of COVID-19 has brought us to a scenario of scale and scope that most had never planned for. Whether you are at a small practice or a large one, you are likely looking for ways to rapidly evolve your business and patient care processes to survive this global pandemic. Many physician practices are trying to do more with less in terms of how and where they are spending their time, adapting to different patient experiences, and, now more than ever, keeping patients safe. There are new things you have to do, new costs, new burdens, and of course, new cash flow issues. As you think about how to adapt during the greatest healthcare challenge of our time, here are some tools that can make a noticeable difference for you, your patients, and your staff. All these tools exist today and are available in most EHRs with no additional cost unless otherwise noted: 1. Adapting to new realities for patients The need for medical treatment for patients has not changed; what has changed is the “how” to safeguard patients so they can safely obtain their medications and maintain adherence. It is more important than ever to ensure a patient can afford their medication and to prevent surprises when the patient arrives at the pharmacy. Those surprises lead to the patient staying longer in the pharmacy to wait for approval for an alternative therapy or returning to the pharmacy on a different day, leading to increased opportunities for community exposure to COVID-19. To minimize that risk, most EHRs display real-time, patient-specific medication out of pocket cost information and, when applicable, less expensive alternatives based on the patient’s plan, deductible, and other factors. This information, which is displayed during the prescribing process, can facilitate a shared decision-making conversation between the patient and prescriber to choose a medication the patient can afford and achieve an optimum outcome. By having this discussion during a visit, whether the visit is in-person or via telemedicine, the patient avoids surprises at the pharmacy and can quickly fill their prescription. Alternatively, providers can determine, with the same set of information, if the patient is eligible for a mail-order benefit or a 90-day supply, allowing the patient to minimize pharmacy visits or avoid traveling to the pharmacy altogether. 2. Reducing faxes During this crisis, one of the primary reasons that staff have to go to the office is to pick up the stack of papers that pile up on their fax machine or to send new faxes. Much of a physician’s ongoing fax communications is with pharmacies, whether it is for renewals, clarifications, therapeutic substitutions, or refills. Most pharmacies and EHRs have embraced industry-standard methods of electronically communicating medication information between the pharmacist and the prescriber. Electronic renewal requests from the pharmacy to the prescriber in the EHR have widespread adoption. Newer communication standards can further alleviate the faxes to and from the pharmacy, such as CancelRx, which allows the physician to electronically notify the pharmacy that a medication is discontinued in the EHR, eliminating future automated refills and renewal requests. RxChange is another new communication standard that allows the pharmacy to request prescriber approval for a therapeutic substitution, to notify a physician about the need for a prior authorization, or to ask for clarification about a prescription. The message arrives directly in the EHR, and the physician can quickly choose to accept or reject the request or clarification. As of December 2019, 47% and 34% of pharmacies (and growing) are enabled for CancelRx and RxChange, respectively. 3. Doing more with less The post-COVID-19 reality means more time between patients to sanitize rooms, more tasks to check for active infections at patient visits, and more costs for gowns, masks, and other supplies. At the same time, other burdensome tasks remain, such as prior authorizations for medications. While pharmacy benefit managers have relaxed some requirements for prior authorizations during the COVID-19 pandemic, many prescriptions still require prior authorization. Most EHRs can flag a medication if a prior authorization is needed and can sometimes provide alternatives from pharmacy benefit managers that do not need prior authorization, avoiding the prior authorization completely. When the prior authorization is still required, most EHRs can initiate the prior authorization, automatically complete patient demographic and payer information, and then present clinical questions to the prescriber or staff. Once answered, the prescriber will often receive an approval or denial within a matter of minutes. Overall, completing the prior authorization in the EHR can shave precious minutes from the tedious task. 4. Streamline opioid prescribing and eliminate paper prescriptions Opioids remain a challenge for many reasons. A common frustration, especially when the patient is not in the clinic, is the additional requirements for prescribing opioids, such the requirement to print on special, tamper-resistant paper in some states. Today, all states allow for electronic prescribing of controlled substances (EPCS), and many already or will soon require it; for the prescriber, this saves time to print and, when the patient is not in the clinic, the time to send opioid prescriptions. During the COVID-19 public health emergency, the DEA has waived the in-person medical evaluation requirement for both EPCS via telemedicine and telemedicine prescribing of buprenorphine for opioid use disorder. It’s also worth noting the SUPPORT for Patients and Communities Act (H.R. 6) requires the use of EPCS for all controlled substances under Medicare Part D by January 1, 2021. To enable EPCS, prescribers can work with their EHR to add the appropriate level of additional authentication required by the DEA, which may have an additional cost. The world has changed, at least for now. While there’s no easy fix, I hope these small suggestions help you and your staff get back some valuable time, enable you to keep your patients (and yourself) safe, and allow your practice to continue to thrive. Andrew Mellin is chief medical information officer, Surescripts. Source
