In this episode, Randi Deckard, BESLER’s SVP of Growth, provides us with a glimpse into BESLER’s upcoming Executive Reimbursement Roundtable that she’s hosting live on Wednesday, June 18, at 1 PM ET.
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Learn how to listen to The Hospital Finance Podcast® on your mobile device.Highlights of this episode include:
- Topic of the upcoming roundtable
- The guests
- Most misunderstood aspects of the 340B drug pricing program
- The relationship between pharmacy and reimbursement teams
- How hospitals can turn regulatory requirements into an opportunity
- Tools and tactics that actually move the needle
- Hidden pitfalls that can jeopardize a hospital’s eligibility for critical programs
Kelly Wisness: Hi, this is Kelly Wisness. Welcome back to the award-winning Hospital Finance Podcast. We’re pleased to welcome back Randi Deckard, BESLER’s Senior Vice President of Growth. In this episode, Randi will provide us with a glimpse into BESLER’s upcoming Executive Reimbursement Roundtable that she’s hosting live on Wednesday, June 18, at 1 PM Eastern Time. Welcome back, and thank you for joining us, Randi
Randi Deckard: Thank you so much for having me again, Kelly.
Kelly: Well, let’s go ahead and jump in. So, what is the topic of the upcoming roundtable? Who are your guests, and who needs to make sure that they don’t miss this?
Randi: Yeah, so the topic is around 340B and DSH and why pharmacy and reimbursement really need to be besties. In other words; no more silos. And Jeff Davis, who is a nationally recognized healthcare attorney, he’s with Bass, Berry & Sims. He specializes in the federal 340B drug pricing program. In fact, he has spent I can’t remember how many years representing 340B Health. And it’s an association of over 1,400 hospitals and health systems that participate in the 340B program. So, he really has a lot of insight into the hospital side. And then Christina Brown, our Vice President of Reimbursement, is also going to join, and she’s going to represent reimbursement and how DSH impacts 340B.
Kelly: Love that. I think that’s going to be a really cool roundtable. So, what are some of the most misunderstood aspects of the 340B drug pricing program that hospital leaders should be aware of?
Randi: So, one of the biggest misses is, once again, silos and not using technology to track. And then also, like I said, reimbursement and pharmacy, not talking and understanding DSH, is there any risk of losing DSH, how it might impact the program, etc. So, there’s a lot of, unfortunately, silos because these systems may not be connected, but it’s an opportunity for better alignment and obviously driving the program and revenue.
Kelly: Yeah, it totally sounds like it. So why is the relationship between pharmacy and reimbursement teams often overlooked in hospital strategy? And what could happen if these departments were truly working in sync?
Randi: I think part of the reason that they’re separate is one is more on the clinical side and one’s more on the finance side. And maybe, instead of clinical, it’s more like operations. But the point is, oftentimes, these areas of the hospital don’t have a lot of opportunity to cross-functionally collaborate, or they’re collaborating through data polls. So, for example, reimbursement is looking at DSH. Do we qualify? And if you qualify for DSH, that is part of the 340B drug requirement is that you have to qualify for DSH, but are they really talking and do they understand all the things that impact? And so, I think that’s one of the issues is cross-functionally, are they talking? And if data is being pulled, are they talking about the data? And once again, technology, is there anywhere that that information is available to everyone? Or is it just like an IT analyst pulling that information for reimbursement as an example?
Kelly: No, that makes a lot of sense. So how can hospitals turn regulatory requirements like the Medicare Cost Report into an opportunity for financial and operational improvement?
Randi: So, there’s a lot of information in the Medicare Cost Report, but as it relates to this topic, it’s really about qualifying for DSH, and not only qualifying for DSH, but where is there opportunity in their population? Have they done an audit? Are they missing any patients? One of the areas that is often missed when we do audit DSH is in the OB/GYN, new babies, moms, just as an example. So that’s a huge opportunity to hike up the DSH is by doing an audit and looking at that information and making sure that that the 340B program, is not at risk by monitoring that because if you don’t have DSH and you lose that, the 340B program stops immediately. And to restart it, it’s a lengthy and costly process, and a hospital could lose out on significant amount of reimbursement.
Kelly: Definitely. Technology is changing the way hospitals manage drug pricing and reimbursement, but what tools and tactics actually move the needle?
Randi: Yeah, so I think it’s a combination of having dashboards and/or reports that are shared. So, technology is great, but if one department has a technology, let’s say maybe reimbursement has a way to monitor the DSH, but they’re not sharing it, that’s the challenge, right? So, it really needs to be technology and then also communication to moving the needle and ensuring that a program is not at risk.
Kelly: Right. What are the hidden pitfalls that can jeopardize a hospital’s eligibility for critical programs like 340B? And how can proactive collaboration help avoid them?
Randi: Yeah, so hospital files their cost report based on their fiscal year end. And it’s really critical that a hospital is monitoring its DSH throughout the year, especially if it’s close to the number for qualifying, because if for any reason, they get to the end of the year, and they no longer qualify for DSH, like I said, that program is at risk. So, you want to be monitoring that and making sure the programs and services offered at the hospital don’t put DSH number at risk because that ultimately puts your 340B program at risk.
Kelly: Right. Well, thank you so much for joining us, Randi, and for sharing this sneak peek into your upcoming Roundtable that you’re presenting live on Wednesday, June 18, at 1 PM Eastern Time. Thanks again, Randi.
Randi: Thank you.
Kelly: And thank you all for joining us for this episode of The Hospital Finance Podcast. Until next time…
[music] This concludes today’s episode of The Hospital Finance Podcast. For show notes and additional resources to help you protect and enhance revenue at your hospital, visit besler.com/podcasts. The Hospital Finance Podcast is a production of BESLER | SMART ABOUT REVENUE, TENACIOUS ABOUT RESULTS.
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