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As a user works through the Clinical Pharmacy Services Planning Tool, there will be several data elements that will be required in order to create an estimate of the fiscal outcome of this program. While the tool asks for key inputs as the user works through the program, we have listed each of the data elements here so users can gather some information before working with the tool. Depending on your program design, payer mix and patient populations, you may not need to provide information for all of these items. Tutorial assistance is provided within the tool to describe key information related to several of these elements; however, we also anticipate that full use of this tool likely will require collaboration between an entity's pharmacy and financial staff. Some data elements may be unfamiliar to pharmacists who do not have experience with financial operations in a federally qualified entity. Similarly, financial staff will likely be unfamiliar with some aspects of payment for clinical pharmacy services because they may differ from traditional payments for medical services.
Please note that once you begin to input data into the tool, you will be able to save your information and return to the tool at another time, thus allowing you to add data later if it is not readily available to you when you initially begin to use the tool. You will not need to collect all of the information listed below before starting to use the tool – this list below is provided simply to give users an overview of the types of data that will be requested.
Program start-up expenses
- Construction costs/capital improvements
- Acquisition of “point of care” therapeutic monitoring equipment
- Costs associated with use of an electronic medical record by a pharmacist practitioner within the organization
- Costs associated with recruitment of staff
Recurring expenses for program delivery
- Cost of salary (annualized) and benefits for pharmacists and any support staff committed to the clinical pharmacy program
- General overhead expenses, if desired to allocate to the program
Estimating direct revenues that can be captured from various payers
- Anticipated number of clinical pharmacy encounters for Medicare, Medicaid, Commercially insured and private pay/uninsured patients
- Anticipated average fee-for-service compensation per encounter, where appropriate
- The encounter rate for clinical pharmacy services if paid via a prospective payment system
Estimating other revenues that may be available to the organization secondary to the work of a clinical pharmacy practitioner
- Partnerships with health professions education programs
- Potential “pay for performance” bonus payments
- Potential increased revenues secondary to improved medical provider efficiency
- Improved fiscal performance of an organization’s 340B pharmacy program
- Acquisition of grants related to delivery of clinical pharmacy services
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