6 Reasons A Home Infusion Pharmacist Feels Like A Private Investigator
Every day the home infusion pharmacist, AKA private investigator has to solve a multitude of problems.
I am going to walk you through a typical patient case in my pharmacy.
The pharmacy receives a fax at 4:30 PM with discharge orders from a hospitalist for a patient, let’s call her Jane Smith (JS). The discharge planner says that the patient’s primary care physician will follow up and verbally requests clinical services for vancomycin home infusion therapy with dose adjustments as necessary. The patient is ready to go home. The discharge planner urges the pharmacy to accept the patient as soon as possible.
The Investigation Begins.
1. Exploring Insurance Issues
Most insurance companies close at 5pm EST. But we still need additional information to determine coverage. Requirements vary with each company and diagnosis. After receiving additional documentation, we discover the patient has Medicare Part B and a supplement. JB can choose between a cash price, a daily trip to an outpatient clinic (if the dose stays once a day) or a skilled nursing facility.
Medicare Part B offers home infusion benefits for a select few medications. A lot of cases stop here. In fact, 23% of my patient referrals in 2015 were forced to choose a route other than home infusion due to lack of insurance coverage.
2. Scheduling Medication Deliveries
JS agrees to a cash price and the medication is ready to deliver. We wait to get an estimate of the patient’s arrival home in order to plan the delivery. It is finally delivered at 10 pm, a really late night for our driver and the home health nurse.
For the purpose of this story, this delivery goes smoothly. However, we often run into many problems on deliveries. Every situation has to be investigated and the problem solved.
3. Finding the Follow-up Physician
The following morning our intake nurse contacts JS’s primary care physician. He says “I do not know anything about his hospitalization -besides he goes to the Wound Clinic. They need to handle it.”
The nurse calls the wound clinic. They are also unaware of the hospital stay. She forwards the additional medical records, but they say they will not agree to follow the patient because they did not order it.
4. Pharmacokinetic Monitoring
In the meantime, JS’s Vancomycin trough results come back. It is sub-therapeutic. The pharmacist has the verbal authority to adjust the dose, but can’t bill the insurance without a doctor’s signature. The search continues for a follow-up physician.
The hospitalist cannot sign for orders outside the hospital. The surgeon who saw the patient in the hospital is no longer on the case. Finally, after contacting the Infectious Disease Specialist who recommended the treatment, we are able to get an agreement for a doctor to follow and sign future orders.
The dose is adjusted.