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Improving Ambulatory Pharmacy Charges
Shawn Wood CPhT, Pharmacy 340B and Inventory Supervisor; Tiffany Truong, Pharm D Candidate; Parth Patel, BSN, RN Senior Data Analyst
Beth Israel Deaconess Medical Center- Boston
Introduction/Problem
Most charges for medications at BIDMC are captured automatically whenever a medication is dispensed or
administered to a patient via our electronic physician order entry and pharmacy processing systems.
Charges for medications dispensed or administered in outpatient units or clinics are entered manually by staff
who may not understand how to enter the charge. Such errors could impact the revenue cycle, and if part of
the 340B program also affect drug supply costs and compliance.
Further, pharmaceutical costs at BIDMC clinics alone have grown from approximately $2 million in FY12 to an
expected $11 million in FY18. The potential implications associated with charging errors increases when even
more dollars are anticipated. With 100,000 pharmacy charges per week across the medical center, a manual
audit to ensure capture of all pharmacy charges is labor prohibitive.
Importantly, success of the hospital’s internal 340B program depends on accurate charging for medications
dispensed so that pharmacy can continue to make purchases at the best contract prices through this
program. It is critical that we work toward creating a system that will accurately and reliably allow us to
capture charges for all doses dispensed to our clinic patients.
Aim/Goal
To reduce medication billing errors, increase awareness how pharmaceutical charges affects drug costs,
and highlight the nuances to clinic’s pharmacy charge entry that may not be intuitive.
The Team
Shawn Wood CPhT
Tiffany Truong, Pharm D Candidate
Parth Patel, BSN, RN
The Interventions
Completed a database of clinic charge codes, each with charge logic for the dosing range of the
medication it is charging
Created a process to automate a comparison of this charging logic against weekly dispensation
reports to identify errors
Collaborate with Revenue Cycle to correct billing errors
Increase awareness to Directors, Practice Managers and front line staff in Clinics for improvement
opportunities
Results/Progress to Date
OCTOBER 2017- JANUARY 2018 Results
9K
$3.6M
149
$22K
$56K
$236K
Number of Dispensations Reviewed
Total Cost of Pharmaceutical Dispensations Reviewed
# Charge Errors Identified
Increased Pharmaceutical Expense due to Errors
Cost of Pharmaceuticals Undercharged
Cost of Pharmaceuticals Overcharged
Pharmacy Inventory Supervisor
Pharmacy Intern
Senior Data Analyst
For more information, contact:
Shawn Wood, Pharmacy 340B and Inventory Supervisor, swood1@bidmc.harvard.edu
�Improving Ambulatory Pharmacy Charges
Shawn Wood CPhT, Pharmacy Inventory Supervisor; Tiffany Truong, Pharm D Candidate; Parth Patel, BSN, RN Senior Data Analyst
Beth Israel Deaconess Medical Center- Boston
More Results/Progress to Date
70
66
60
50
37
40
30
24
22
Dec-17
Jan-18
20
10
0
Oct-17
Nov-17
Charging errors identified over time.
•
•
•
•
Botox 100unit vial charges per unit
• Charges are incorrectly entered per vial
Xolair 150mg vial charges per 5mg
• Charges are incorrectly entered per mg
Makena 250mg vial charges per 10mg
• Charges are incorrectly entered per vial
• Charges are incorrectly entered per mg
Depo-Provera 150mg vial charges per mg
• Charges are incorrectly entered per mg
Description of Frequent Charging Errors
# of Billing
Errors
# of Errors
47
25
20
20
14
8
4
4
Medication
Omalizumab Inj. (Xolair)
Medroxyprogesterone Acetate Inj. (Depo-Provera)
Hydroxyprogesterone Caproate Inj. (Makena)
Mepolizumab Inj. (Nucala)
Onabotulinum Toxin A (Botox)
Ketorolac Inj. (Toradol)
Betamethasone Inj. (Celestone)
Aflibercept Inj. (Eylea)
Number of instances of charging errors for each medication identified. Medications with only 1 or 2
charging errors were not listed.
Lessons Learned
Improving charges across the institution involves a great deal of reinforcement making 100% adherence
difficult
There are limitations to this review; While we can identify charges that fall outside dosing ranges, we can not
automate the review to determine if the correct medication was charged or if a charge was not entered
Our expectation starting this review was for billing errors to be predominately undercharges but results
showed errors are just as likely to be an overcharge
Next Steps
Continue the review of clinic charges to encourage the downward trend for charge errors
Update logic periodically to include any newly added charge codes and medications
Focus improvements for clinics with continued pockets of billing errors
For more information, contact:
Shawn Wood CPhT, Pharmacy 340B and Inventory Supervisor swood1@bidmc.harvard.edu
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Silverman Symposium
Description
An account of the resource
Each year the Silverman Symposium poster session offers BIDMC staff and affiliates the opportunity to share experiences and learn about efforts to improve Quality and Safety.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Silverman Poster
Primary Contact
If you would like more information about this project, contact this person. Make email address clickable.
Shawn Wood (<a href="mailto:swood1@bidmc.harvard.edu">swood1@bidmc.harvard.edu</a>)
Department
Any departments listed on the poster or identified in the spreadsheet.
Pharmacy
Data Analysis
Project Team
Shawn Wood
Tiffany Truong
Parth Patel
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Improving Ambulatory Pharmacy Charges
Date
A point or period of time associated with an event in the lifecycle of the resource
2018
Format
The file format, physical medium, or dimensions of the resource
pdf
Compliance
Effectiveness
Efficiency