How Northwest Georgia Oncology Centers increased its script capture rate by more than 50 percent
That was the question facing Northwest Georgia Oncology Centers, P.C. (NGOC), the largest, community-based independent cancer practice in the state. The 10-location practice has had a retail dispensing pharmacy since 2008. A major challenge was improving the pharmacy’s script capture rate, which was hovering in the 20-30 percent range.
"We wanted to find out which scripts we were losing to other pharmacies and why,” said Stacy McDaniel, Pharm.D., Pharmacy Director.
To help answer the question, The NGOC management team created a drop-down menu in the practice’s EMR. For each prescription that would be filled at another pharmacy, the nurse had to indicate why: was it a patient request, payer mandate or physician preference?
The practice then took an additional, major step to increase its script capture rate: hiring a full-time patient advocate to manage several key responsibilities:
In the first three weeks alone of taking these measures, the practice increased its script capture rate to 60 percent.
How did Northwest Georgia achieve such success?
In the past, nurses weren't accustomed to automatically thinking about the in-house pharmacy as an option for filling prescriptions. So the nurse would simply enter the prescription into the EMR and indicate whatever outside pharmacy was typically used.
McDaniel and the NGOC pharmacy team began to change that mindset by adding a new step to the prescription filling process. Now, before the prescription itself can be written, the physician must complete an oral treatment plan. There's a different version for each disease state (for example, a version unique to ovarian cancer and one for lung cancer).
The oral treatment plan is the trigger that notifies the patient advocate that there’s a new prescription to be filled, so she can begin evaluating whether it's a good “fit” for the in-house pharmacy.
At the same time, the practice’s physician leadership reinforces the quality of the in-house pharmacy and recommends using it when appropriate. “We make sure our physicians know that when patients can fill their prescriptions at our own pharmacy, they tell us they’re happier,” McDaniel said. “Taking the extra step of completing an oral treatment plan is in our patients’ best interest. Physicians can be confident that it’s another important key to quality patient care.”
First, the patient advocate receives the oral treatment plan from the prescribing physician and performs a test claim. Next, she informs the pharmacy staff if prior authorization or patient funding assistance—or both—is required. “Most patients require both,” McDaniel said.
The patient advocate then communicates with the prescribing physician or nurse regarding whether the prescription can be filled in-house—or if the payer requires that it be submitted to another pharmacy. She also lets the patient know the co-pay amount and whether the prescription can be filled at the practice. If not, the patient advocate streamlines the submission of the prescription to the pharmacy mandated by the payer.
When it’s time for a refill, the patient advocate informs the nurse. If appropriate and the prescribing physician approves, the refill can then be handled by the practice pharmacy.
If an outside pharmacy is required by the payer, the patient advocate puts a note to that effect in the EMR—including any relevant information regarding prior authorization or patient assistance funding—to help ensure refills are managed smoothly and there’s no interruption in care.
“The Patient Advocate is definitely a full-service resource, from the time the oral treatment plan is written to managing prior authorization and patient funding assistance to monitoring and managing refills,” McDaniel said.