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Ep. 5: Amy Jones – Best Practices for Managing Your Medication Room | This Week in Surgery Centers
Here’s what to expect on this week’s episode. 🎙️
From national drug shortages to supply chain issues to drug diversion, managing a medication room in a surgery center can be super complicated.
Amy Jones, Pharm.D., BCSCP, Owner of Jones Premier Pharmacy Consulting, is passionate about making sure ASCs have full control over their med rooms and joins us to discuss best practices and where to start.
The three most common mistakes ASCs are making today?
• Not determining a process to collect surgeon orders or preferences in advance
• Not identifying dedicated staff to handle all the moving parts
• Not following standard protocols
💊 Another key topic that cannot be ignored is the importance of Controlled Substance Diversion Prevention. What are the steps ASCs should take to reduce drug diversion? According to Amy, here are a few suggestions for implementing a structured process:
• Lock your med room and the cabinets inside and provide limited access
• Have one staff member that orders the meds
• Have a second staff member that receives the meds
• Task a third staff member or pharmacist with verifying the orders as they come in
• Limit the areas you have controlled substances stored in
• Pre-build standardized anesthesia kits and seal them
Find the full episode on Apple Podcasts, Spotify, or YouTube to hear all the details!
In our news recap, we’ll cover a new law impacting Virginia ASCs, declining physicians pay, the latest acquisition, and OTC hearing aids.
Episode Transcript
0:00
welcome to this week in surgery centers if you’re in the ASC industry then
0:05
you’re in the right place every week we’ll start the episode off by sharing an interesting conversation we had with
0:11
our featured guests and then we’ll close the episode by recapping the latest news impacting surgery centers we’re excited
0:18
to share with you what we have so let’s get started and see what the industry’s been up to [Music]
Agenda
0:28
hi everyone here’s what you can expect on today’s episode we are talking with Amy Jones owner of Jones Premier
0:35
Pharmacy Consulting all about managing your med room Amy shares with us common
0:40
mistakes how to choose vendors overcoming Med shortages and supply chain issues and so much more about how
0:47
you can have full control over your bedroom and know exactly what’s coming in and what’s going out
0:53
we’ll close the episode with a few news stories we’ll start with the new price transparency law in Virginia talk about
1:00
how declining pay is pushing more and more Physicians to ASCS look at the
1:05
latest industry acquisition and of course and the new segment with a positive story about a recent executive
1:13
order that will allow hearing aids to be sold over the counter hope everyone enjoys the episode and here’s what’s
1:20
going on this week in surgery centers thank you
Introduction
1:27
awesome all right how’s it going everyone I am your host here at this week in surgery Center’s Raphael akinsby
1:33
and this week we have an amazing episode I am super excited for this one we’ve
1:38
had this on our calendar for a bit so excited to jump in here we are joined
1:44
today by Amy Jones of the Jones Premier Pharmacy Consulting Group she’s got some
1:50
amazing insights and today we’re actually going to be walking through a really cool topic around the best practices for managing your med room so
1:57
Amy’s got a ton of years of expertise and knowledge on this but I couldn’t do her introduction justice so Amy I’m
2:04
going to turn it over to you for anyone who hasn’t heard of you or doesn’t know about your Consulting practice can you
2:10
share a little about yourself and kind of what what you guys offer yes thank you thank you for including me
2:17
in this uh Surgery Center podcast my name is Amy Jones and as Raphael
2:25
mentioned the company is Jones Premier Pharmacy Consulting and I handle you can
2:30
kind of think of any medication management related items so traditionally it has been for surgery
2:36
centers or ASCS but also includes freestanding emergency rooms micro
2:42
hospitals as well as hazardous medication Consulting sterile
2:47
compounding Consulting and that can range from physician clinics ASCS even
2:54
smaller hospitals that need assistance with their medication practices
Amys Background
2:59
awesome that that’s fantastic and I know you’ve been in the space for a while
3:04
um you know how how long have you been in this Consulting space and um and kind of what inspired you to get started here
3:11
yes so I’ve been a pharmacist for 17 years now um the time has flown whenever I say
3:17
that number uh and I started Consulting in 2009
3:23
um and then started my own business in 2016. I realized that I enjoyed had a
3:30
passion for assisting facilities with their medication processes whether it’s
3:36
everything from the architecture and design of the med rooms and Med storage
3:42
places throughout the facility licensing facility licensing DEA
3:47
licensing and then Regulatory Compliance and then especially you know just
3:52
choosing their medication formulary as well as what is the organizational
3:58
structure that they will use for nursing Physicians to order administer and
4:06
document their medications awesome that that well that’s one some really great background seems like
Top 3 Mistakes
4:12
you’ve got years of of expertise there that are going to be super insightful for for our guests and let’s excuse me
4:18
for our listeners and um you know as we kind of jump into it thinking about this you know there are a lot of topics we
4:23
wanted to cover with you but you know today we’ll just focus on the best practices for managing um your
4:29
medication room in an ASC and um I think this is an area that’s pretty common for a lot of our listeners out there in
4:36
terms of the opportunities within their medication room but for you as someone who’s worked with so many different
4:41
surgery centers what are kind of the top three like common mistakes that you see in terms of how surgery centers manage
4:48
their their medication rooms yes yes I think that’s an important
4:54
topic I would say I would categorize them in three sections one is determining a medication process two is
5:02
having dedicated staff so either that’s having a consultant pharmacist on board
5:07
having a dedicated nurse to the process and then following standard protocols so
5:14
I’ll dive deeper into each of those three so for medication processes it’s
5:19
you know determining a standard way of getting the surgeon orders or the
5:25
surgeon preferences for cases prior to the schedule knowing what those
5:33
medications would be and also being able to troubleshoot if that’s not a
5:39
medication that’s normally on their formulary or has very complicated Administration practices and being able
5:47
to Hash that out before the case you know is scheduled
5:52
um and that also will reduce the amount of high dollar what we call non-formulary medications being
6:00
requested for cases if you have a pretty structured way of getting those surgeon
6:05
orders knowing what those medications will be ahead of time and uh
6:10
troubleshooting that you know let’s say several days before the case
6:16
um other things that happen is just um being able to list what your formulary is ahead of time so the
6:23
expectations are clear on both ends right surgeons that are scheduling cases at the facility as well as the nursing
6:31
staff if they get questions for an add-on case or any type of new surgeon
6:37
coming on board they will have an idea okay this is a medication we have never
6:42
had to use before is this something we are going to carry is this something that’s feasible
6:48
Administration wise for our facility to do right there are there are medications
6:54
that can be really complicated where they’re frozen they have to be defrosted in a certain period of time then they
7:01
have to be put in a certain applicator before administered and so those would be situations where you as a facility if
7:09
you are going to go that route at least you plan ahead do nursing education and know before the
7:17
day of the procedure because what can happen if those are not in place is what
7:23
um you kind of have a more stressful environment where errors can be made
7:29
right so maybe the wrong medication is ordered to the wrong dose is ordered or
7:34
it’s prepared incorrectly and puts the patient at risk because we’re trying to
7:40
do that very quickly with items that are unknown that makes sense and then the second
7:46
yeah so um the second item that you know I see many mistakes with is having dedicated
7:52
staff so if there are some surgery centers in the US that do not have a
7:58
consultant pharmacist and so one of the suggestions that you’ll hear me talk
8:03
about throughout this would be to have a consultant pharmacist maybe even if your State Board of Pharmacy rules don’t
8:10
require it or your um your Department of Health doesn’t require it to work out some sort of
8:17
procedure where you have a consultant on board that can help you with these decisions that we’re going to go through
8:23
throughout this podcast um that’s the very minimum having a dedicated nurse so they’re you
8:33
know if so if there’s not someone that volunteers to kind of handle the medication processes in the med room
8:39
trying to get someone assigned to that area the reason why you know I I say
8:45
that as a mistake is what can happen is um folks don’t realize how time
8:51
consuming the medication process can be for surgery centers in other facilities
8:57
and so if there’s no one really a sign no one really takes ownership of that area so you have things that are not
9:05
ordered you don’t have an organized process of where the medications go in
9:11
the med room you don’t have an organized process of documentation and then also
9:16
just follow up let’s say a medication is a multi-dose vial and you can use
9:23
additional doses is somebody making sure those things are getting those vials are
9:28
getting dated and that they’re stored appropriately so that it can be used safely for the other doses
9:36
awesome awesome and then the third yeah the the third item um in that same question of
9:43
the the common mistakes would be having standard protocols um standard protocols and what we call
9:50
order sets and or standard orders this is um been integrated into healthcare
9:56
for many decades now but what I see is sometimes ASCS do not have them in place
10:03
so having structured standard orders or standard protocols where the nursing
10:10
staff can all be educated anesthesia staff can all be educated and know what
10:16
those are so examples would be your pre-operative antibiotic dosing having a
10:23
structured weight-based dosing and the type of antibiotics you use for which
10:30
cases and then if the these cases are a
10:35
long case they will actually have to give additional doses of antibiotic 6 in the case and many times that is not
10:43
written down there’s not a protocol in place and so patients may not get those additional doses for a very long
10:50
surgical cases and now you potentially have put them at risk for not giving
10:56
them additional dose another um yeah so in again this is something
11:02
that I see regularly and can easily be you know addressed ahead of time
11:10
another standard protocol that I haven’t seen in full practice and ASCS is
11:17
multimodal pain management that has been put into place in many of our Hospital
11:22
systems but in your surgery centers I have not seen that routinely in place so
11:28
what I mean by that is having a structured giving patients pain
11:34
medication that’s not just your opioids um you know that that we can give
11:39
multimodal giving them your Tylenols or your NSAIDs which is ibuprofen or maybe
11:47
Celebrex prior to surgical procedures so that we
11:53
can reduce the amount of opioid analgesics that we give patients after
11:59
the surgery or even maybe not having to prescribe those when they’re leaving the
12:05
the surgery center that makes a ton of sense and I I think you nailed kind of a number of things
Vendor Selection
12:12
there that happened directly within a surgery center that with the right protocols and kind of structures around
12:17
the team uh you’re able to manage one of the things that kind of comes to mind is as a part of that is thinking about some
12:23
of the elements of what kind of happens outside of the surgery center in terms of kind of vendor selection what are
12:30
some of the recommendations that you have around kind of vendor selection and like ways that ases can can approach
12:36
that sure yeah that’s a great question and I think that is something even for
12:44
established ASCS that can come up as a point especially if they have not had a
12:49
consultant pharmacist in place but for your newer ASCS um determining a vendor on all vendors
12:56
are not created equal some vendors are focused more on your supply chain so you
13:03
know your needles your syringes IV tubing Etc and then you have vendors
13:09
that do have a pharmaceutical Division and that is one of their major divisions
13:14
of that company so you want to look for those vendors and even if what what I
13:21
commonly see is you have an ASE that’s just opening up and they’re not doing
13:27
any cases at that time because they’re still waiting for either CMS certification or any of their other
13:34
regulatory certifications and they have been able to get by with the vendor that
13:40
they chose but that vendor doesn’t have a strong pharmaceutical division so then
13:46
when they start to do more and more cases they realize that that vendor is not able to keep up with the medication
13:53
Supply so what I always try to choose is a vendor that has a large pharmaceutical
13:59
division is able to keep up with the drug Supply especially with the amount of drug
14:06
shortages that are out there you definitely want them to have a large
14:11
Warehouse or multiple warehouses across the country and just be aware of that
14:16
some other items to think about is in that initial contract what are what is
14:23
going to be the delivery process some vendors will actually restrict you to
14:28
one delivery day a week which can get really tricky is as you get busier right
14:34
so as you add on cases there’s going to be things that come up where you need
14:39
additional medications and if your vendor is only one day a week that’s
14:44
going to put you um you know in a situation where you’re going to have to pay additional fees to
14:50
get an additional delivery so maybe negotiate at the beginning to have a
14:55
multiple day a week delivery schedule to account for the volume that you plan on
15:01
having at your surgery center that that makes a ton of sense there and
Drug Shortages
15:07
you know in terms of just kind of that vendor piece you know you mentioned a couple things there around kind of the supply factors and their ability to meet
15:14
the the supply needs and I know we’ve probably all been hearing a ton in that regard in terms of kind of things that
15:20
have happened during kind of the covet and the pandemic in terms of impact on supply chain um but you know based on just some of
15:26
the things you mentioned there it seems like Supply and kind of managing and preparing ahead
15:31
um for any potential shortages is something that seemed like even past covet or even before covet was a factor
15:37
that that was important you know are there any kind of insights that you or background you can kind of share there
15:43
in terms of just how centers should be thinking about managing for shortages or kind of how those um how those different
15:49
shortages can impact a center sure and so you know just to explain a
15:56
little bit about why drug shortages exist there are multiple factors and I
16:01
think that um it’s worth describing because there are some misconceptions about why drug
16:07
shortages exist so um just with anything right if you’re having a computer made or a car made
16:14
there’s multiple pieces to that production and I think that there are
16:20
misconceptions that that all happens in one place right like one plant in the United States but it doesn’t with drug
16:27
Supply what happens is they will have pharmaceutical companies will have
16:32
plants throughout the world and each of those plants May provide a different
16:38
portion of that production so you may have a plant in India that’s
16:44
making the actual product ingredient or the powder of the drug which we refer to
16:50
as API and if that plant has some issues whether they were shut down or had all
16:58
their staff out for covid or whatever it is you don’t have the actual powder to
17:05
finish the production so maybe your other plants are doing fine but you don’t have these the initial product
17:12
um and then your glass files may be made at a different plant that may all be brought together at one plant and then
17:19
they prepare the final product and so if you know one of those plants goes down
17:25
it can cause a problem or delay some other things that can cause a delay would be if that plant is inspected by
17:33
FDA and the FDA finds some concerns there and that can they can be inspected
17:40
by the FDA in other countries as well I think people don’t realize that but if if a product is being used in the United
17:47
States the FDA or I’m sure they send some a representative to go into another
17:53
country’s plant and do that inspection so if the FDA determines that their
17:59
concerns whether it’s in documentation or their production process or
18:05
contaminants the FDA can actually shut that plant down and so that would cause
18:11
and that’s that’s you know very frequently what you see is you know you have a pharmaceutical company
18:18
who produces let’s give you know we’re going to give lidocaine his example because lidocaine is on shortage right
18:24
now but let’s say that plant um is the only plant that produces
18:29
lidocaine and the FDA comes in and says we we don’t agree with your
18:34
documentation you’re not taking enough samples or these samples appear to be
18:40
contaminated they will shut that plant down until they see resolution in
18:46
whatever the issue is that the FDA has found well now that company is left
18:53
spinning right because that’s their plant to make lidocaine and they don’t always they’re not always able to Pivot
19:00
very quickly because what these pharmaceutical companies do is they will
19:07
allocate a certain line you can eat kind of all kind of kind of picture a
19:12
manufacturing plant you have you know lines of production in a car factory you’ve got you know several lines making
19:19
different pieces of the car so they’ve dedicated let’s say one one or two lines to making lidocaine
19:27
um and then the rest of the lines are making you know if you pivot cane Republican Etc
19:32
they are not always able to Pivot quickly and say okay we can shut down
19:37
the pupificaine line for three weeks and make lidocaine because of the shortage a
19:45
lot of times they just keep on going and they go they go based on the quota of
19:50
what they’ve produced in the last year in the usage numbers for that year so
19:56
that leads us to another reasons why why shortages happen if let’s say two
20:02
companies in the world make this drug and one of those companies gets shut
20:07
down for whatever reason or the company decides not to make that drug ever again
20:15
like they they can um you know internally determine is this
20:21
something we want to continue making a lot of times it’s a cost versus Revenue
20:26
type scenario and for our generic drugs that many of those we use in our Surgery
20:33
Center so you’re you’re your anesthetics are all generic many of your antibiotics that we use in
20:40
surgery centers are generic um you are also using items for nausea
20:47
that are generic so many of these items are not what we call brand name or first
20:52
to the market items and so those particular products are the first
20:58
where a manufacturer might decide to discontinue it and so if you’re two
21:04
companies making it and one company goes down that other company is now kind of
21:09
trying to address the the whole United States production or even worldwide
21:17
production of that drug and again they may not necessarily be able to Pivot
21:22
that quickly and so that leads to a drug shortage they you know they make it you
21:29
know A month’s notice or a little bit of a notice to say hey this other company has decided they’re no longer going to
21:35
make this but that doesn’t give them enough time to ramp up that production yep
21:43
yeah those are those are the predominant reasons for drug shortages another one
21:49
um is you know kind of self-explanatory but your natural disaster so there was
21:55
hurricane Irma the one that hit Puerto Rico
22:01
um several years ago and that was in 2000 oh no it had been 2014 2015. there
22:09
was a hurricane that hit Puerto Rico and there was one manufacturer in particular that made much of the IV fluids for the
22:17
United States and their plants were there on that island and so that totally destroyed their plants and that
22:25
particular company was left reeling to to now figure out where they were going
22:30
to produce IV fluids at a different plant that doesn’t typically make it for
22:36
that company but that caused a worldwide shortage on your IV fluids at that time
Guiding Tips
22:44
that that makes sense and they’re you know they’re kind of direct relationship there between kind of the supply and demand factors in terms of a lot of
22:51
those shortages being being caused by just a simple lack in supply for a variety of reasons it seems like those
22:58
are things that can directly impact the center um when those things occur and I guess I just would follow that on you
23:03
know in the event of a shortage do you have any kind of guiding tips for surgery centers to kind of um be able to
23:09
leverage to to kind of navigate those situations right so um that’s a great question and
23:17
I think that um folks maybe don’t plan ahead for that so having again
23:24
having a consultant pharmacist on board that can help you with with navigating drug shortages
23:30
um but if if there isn’t um a consultant pharmacist on board keeping an eye out
23:36
on your Pharmacy organization drug shortages Pages because they will post
23:43
expected drug shortages now it goes back to that dedicated staff member that I
23:50
mentioned earlier many times asc’s may not have a dedicated staff member and
23:57
they certainly don’t have a dedicated staff member to be monitoring drug shortages and and addressing those so
24:04
but if they did and somebody was able to kind of anticipate um drug shortages coming up in either
24:12
you know a order additional Supply or B order additional supply of a easy
24:19
alternative and I say easy because there there’s always a plan B and a plan C but
24:26
the plan a is usually the easiest right you can just order up on Supply looking
24:32
at your usage for 30 days and ordering you know let’s say you know that there’s
24:38
going to be a drug shortage for two months ordering a two-month Supply and that would be again the easiest you’ve
24:44
got additional Supply maybe you spent a little bit more on your drug budget budget but you’re going to prevent any
24:52
um time spent on that drug shortage in the future awesome
24:58
um you’re playing yeah your plan B and C would be determining what is an easy
25:03
alternative and so that would be something you would communicate with your pharmacist uh but if not your
25:10
providers your surgeons your anesthesia team to see what would be a plan B that
25:15
we could use as an alternative and order that instead sometimes Plan B can be
25:21
just ordering different sizes or different preparations of that drug right maybe you’re used to always
25:28
ordering a 30 ml bile and you know what that looks like you know it has a green
25:34
cap and it looks like this but you may have to order a smaller vial or a larger vial drawing that drug shortage
25:42
um and then as I mentioned using Alternatives that are in the same drug class you can get those particular drugs
25:50
and use those so a good timely option right now though that everyone is
25:56
dealing with is your local anesthetics your lidocaine and your bupivacaine can
26:01
be very difficult to find so maybe you transition to ropivicane and you make
26:07
sure with your anesthesia team all we can get right now is repivacaine
26:12
are you all you know okay to use this everyone is familiar with ropivacaine
26:18
and the dosing and then you roll that out during this shortage so that would
26:24
be a plan B a plan C would be where you would have to make a drastic change let’s say
26:31
you um typically give a certain medication pre-op well now you’re saying
26:38
to yourself on every case which patient type really needs this pre-op and if
26:45
they really need it we have it available to them but the rest of the patients maybe don’t get this medication pre-all
26:52
so that would be kind of your plan C that makes a ton of sense and I think that gives our listeners some really
26:58
good options on kind of how to approach that and how to be prepared for those scenarios so you know I want to Pivot us
27:04
a little bit on this because I know there’s some areas that your consultancy really specializes in and I want to give
27:10
us some time to be able to talk through that and one of those topics is around controlled substance diversion
27:16
prevention and that’s an area that I want to make sure our listeners get a chance to kind of understand and also
27:22
understand some of the approaches that you recommend around that so for any of our listeners who aren’t necessarily
27:28
familiar with what that is can you kind of explain that a bit and also maybe talk a little bit about kind of some of
27:33
the processes and steps that that you tend to recommend sure of course so Controlled Substances
27:40
you know most people are familiar but these are the medications that have
27:45
restricted ordering based on their DEA schedule and as well as we need to
27:52
clearly document that inventory usage wastage and destruction so the DEA
28:00
classifies those between a schedule one through five in our surgery centers
28:06
we’re using schedule two which can be you know of the one of the highest
28:11
controlled substance levels that has medical use so you’re scheduled to
28:17
medications for example or your fentanyl your morphine your Hydromorphone and
28:22
those have to be ordered um very specifically with a DEA form or
28:29
through an electronic ordering system which we refer to as csos and then your
28:34
schedule three through fives are still feel of medical use they have some
28:40
addictive potential but they are not as structured in their ordering process as
28:46
those scheduled two medications so yeah so so my recommendations would
28:53
be to have a structured process in place going back to the organization of your
29:01
med room your many of your state boards of Pharmacy have very particular rules on
29:08
where controlled substances can be stored as well as the DEA they want a
29:14
very limited access to where those are stored so simple explanation would be
29:21
having a locked bedroom and that bedroom has a numerical code that’s used or
29:29
maybe a badge code that’s used and that’s very limited to who can get in
29:34
that med room and then you have a locked cabinet again where those controlled
29:40
substances are stored and whether that’s a key code or a badge code again with
29:46
limited access and then having a very structured way of
29:52
one person ordering a different person receiving those medications and then a
29:58
pharmacist or another person coming back and verifying this is what was ordered
30:04
this is what was received and this is what our Perpetual inventory is
30:10
that will identify simple things such as just counts were incorrect but
30:18
potentially any diversion that’s happening if you have the same person
30:23
doing every step there’s definitely an opportunity where diversion could occur
30:28
right if that person you know had a situation where they were addicted or
30:35
they were selling those medications they could order they could receive they
30:40
could modify the inventory if there are not multiple people involved in that
30:47
process so that that would be kind of the easiest recommendation is to Define what that process is Define who is going
30:55
to do each set of those processes and that somebody’s coming back and just verifying yes this is what we ordered
31:02
this is what we received and this is what was put onto the inventory some other processes to have in place
31:09
would be to really limit the areas that you have your Controlled Substances
31:15
stored in and go throughout your surgery center what I will see if I walk into a surgery
31:22
center that I’m adopting from someone else is that you’ll have medications
31:27
stored in multiple areas of the center and some of them are not secured some of
31:34
them are not maintained so trying to limit the areas where those medications
31:39
are stored and especially those Controlled Substances four surgery centers many of those do
31:47
not have automation so in our Hospital Systems we have automation where we
31:52
store those medications in what we call dispensing cabinets and there’s a process for pharmacy to load them
32:00
nursing to pull them and it’s all recorded electronically
32:05
but in surgery centers typically that’s all done manually so you do want to have
32:12
a process in place where medications are put into what we call Anesthesia kits those kits are
32:19
um standardized we know what we’re going to put in a teach kit the the kit is
32:26
numbered the kit is sealed we know if we give that kit to an anesthesia Personnel
32:32
for the day that it’s also returned that day so having a process in place that
32:39
you know who’s going to fill the kit who checks the kit and who is making sure
32:45
that they all the kids get back into that bedroom at the end of the day and someone you may maybe didn’t walk out of
32:51
the center with it or that any of the medications not missing from the kids
32:56
so those are pretty easy I mean they sound pretty easy but I do see that that
33:02
those processes are not in place in some surgery centers those are all really good insights and
33:08
it seems like there’s a lot of easy and kind of straightforward steps but I can see how you know when it comes to change
33:13
management and and kind of making new processes on any team a surgery center or otherwise it can be tough for people
33:19
to kind of adopt some of those changes but considering the risk factors there it seems like you know taking those
33:25
steps would be a slam dunk for any surgery centers so that that’s super helpful I know we’re we’re kind of
33:30
pushing up against our normal kind of time here but there is something that we do every single episode with every
33:36
single one of our guests and we always ask our guests what is one thing our listeners at their surgery centers can
33:43
do this week to improve their Surgery Center yeah I think that’s a great topic to
33:50
have you know for every speaker that’s coming on so I love that um one thing from a medication
33:55
management perspective is having a consultant pharmacist and whether you have a consultant pharmacist at the very
34:02
minimum having a dedicated staff member that can help you with your medication management that will lead to standard of
34:10
care best practice preventing drug errors uh having you know a safe
34:17
effective way to give medications in your surgery center and you know
34:22
allocating the staff to that so if the consultant is coming in and helping with those processes or the dedicated staff
34:30
member is is given time to work on those I think that’s the simplest you know
34:36
answer to walk away with and and for people whether that is the owners of the
34:42
surgery centers or the providers knowing how important and how time consuming the
34:48
medication process can be that that’s super helpful and I I feel like this episode’s got a ton of really
34:54
good nuggets in it you know we try and make some Great Clips coming out of every episode so we can kind of share some of them in addition to the whole
35:01
episode and it’s going to be tough for us to choose which which parts to use as Clips but Amy it has been fantastic
35:06
having you on I know our listeners are going to really enjoy this one thank you so much for your for your time and for
35:12
your insights thank you so much for having me and I wish every ASC the best awesome
ASCs in Virginia
35:19
good night [Music] as always it has been a busy week in
35:25
healthcare so let’s Jump Right In in our first story today Virginia ASCS are to
35:30
be included in the implementation of the state’s Hospital price transparency laws this story comes from asca’s government
35:37
Affairs update so major shout out to Stephen abrush of ASCA for summarizing this so clearly for us
35:44
on April 11th Virginia governor Glenn youngkin signed into law House Bill 481
35:50
the measure requires hospitals to make publicly available on their websites a machine readable file containing a list
35:57
of all standard charges for all items and services provided by the hospital now a lot of that language really isn’t
36:04
new but on September 7th a committee got together to discuss recommendations for
36:11
implementing the law now it’s important to note that in Virginia ASCS are actually referred to as Outpatient
36:18
Surgical Hospitals so if you look through the minutes just a heads up that that’s what you’ll be looking for not
36:23
Ambulatory Surgery centers by the end of the meeting though the committee unanimously recommended that
36:29
ASC should be subject to the state’s Hospital price transparency requirements as well
36:35
and according to the house bill the deadline to comply is July 1st 2023
36:40
which we all know will come up sooner rather than later so first for all the
36:46
ASCS in Virginia please make sure you check out the episode notes for all of the links so you can learn more and
36:52
start preparing for this and then for the rest of the states it’s important that we take what’s happening in Virginia as just another wake-up call
36:59
that more and more transparency requirements are coming your way
37:04
according to an article written by Becker’s ASC declining pay is pushing
37:09
more and more Physicians to ASCS CMS proposed a physician fika a 4.42
37:16
percent in 2023 and if that takes effect it will continue to sweeten the deal for
37:22
Physicians who may currently be on the fence about whether they should transition their cases to a surgery
37:27
center or not we already understand the value of working in an ASC over a hospital
37:34
higher efficiency safety better outcomes better work-life balance but declining
37:40
pay in a hospital setting will impact Physicians pockets and we all know that there is no bigger driver than that for
37:47
most of them so don’t hesitate to start networking and doing some marketing to your local Physicians and letting them
37:54
know the benefits of Performing cases at your surgery center especially if that
37:59
physician fee cut does does take place our third story comes from PR newswire
38:06
last week National medical billing services announced that they have officially acquired med tech Medtech was
38:12
founded in 2001 and offers medical transcription coding billing and other software products to ASCS and National
38:19
medical is one of the industry’s leading providers of revenue cycle Management Solutions so you can imagine the Synergy
38:26
here both companies have a goal of being able to one provide ASCS with a complete
38:32
end-to-end revenue cycle solution and two help ASCS get paid more and of course get paid faster so by acquiring
38:39
Medtech National medical will be able to move more quickly on both fronts and expand their product offerings we’ll be
38:46
keeping a close eye on how this develops and what it means for the industry but for now congrats to both companies and
38:53
excited to see where you go from here and to end our new segment on a positive
38:59
note while the story isn’t directly related to ASCS it’s a win for health for lowering health care costs which I
39:06
think everybody can get behind uh President Biden issued an executive order requiring the FDA to allow hearing
39:13
aids to be sold over the counter to anyone 18 or older in the next four months now this was something that was
39:20
actually signed into law four years ago but no action has been taken so
39:26
um President Biden issued that executive order to kind of get things moving and consumers with mild to moderate
39:33
hearing impairments can actually purchase these hearing aids without the need for a medical exam prescription or
39:39
a fitting and the FDA estimates that this could lower average costs by as
39:45
much as three thousand dollars per pair and you can get them at Walgreens CVS Walmart Sam’s Club and Best Buy and from
39:53
what I can tell the costs range from 199 to 9.99 and while conversations happen all the
40:00
time around lowering costs it’s really great to see something actually happening and for those of you who have
40:06
hearing impairments or know someone who does I’m excited that you now have this option available to you
40:13
and that news story officially wraps up this week’s podcast to thank you as always for spending a few minutes of
40:20
your week with us make sure to subscribe or leave a review on whichever platform you’re listening from I hope you have a
40:26
great day and we’ll see you again next week [Music]
welcome to this week in surgery centers if you’re in the ASC industry then
0:05
you’re in the right place every week we’ll start the episode off by sharing an interesting conversation we had with
0:11
our featured guests and then we’ll close the episode by recapping the latest news impacting surgery centers we’re excited
0:18
to share with you what we have so let’s get started and see what the industry’s been up to [Music]
Agenda
0:28
hi everyone here’s what you can expect on today’s episode we are talking with Amy Jones owner of Jones Premier
0:35
Pharmacy Consulting all about managing your med room Amy shares with us common
0:40
mistakes how to choose vendors overcoming Med shortages and supply chain issues and so much more about how
0:47
you can have full control over your bedroom and know exactly what’s coming in and what’s going out
0:53
we’ll close the episode with a few news stories we’ll start with the new price transparency law in Virginia talk about
1:00
how declining pay is pushing more and more Physicians to ASCS look at the
1:05
latest industry acquisition and of course and the new segment with a positive story about a recent executive
1:13
order that will allow hearing aids to be sold over the counter hope everyone enjoys the episode and here’s what’s
1:20
going on this week in surgery centers thank you
Introduction
1:27
awesome all right how’s it going everyone I am your host here at this week in surgery Center’s Raphael akinsby
1:33
and this week we have an amazing episode I am super excited for this one we’ve
1:38
had this on our calendar for a bit so excited to jump in here we are joined
1:44
today by Amy Jones of the Jones Premier Pharmacy Consulting Group she’s got some
1:50
amazing insights and today we’re actually going to be walking through a really cool topic around the best practices for managing your med room so
1:57
Amy’s got a ton of years of expertise and knowledge on this but I couldn’t do her introduction justice so Amy I’m
2:04
going to turn it over to you for anyone who hasn’t heard of you or doesn’t know about your Consulting practice can you
2:10
share a little about yourself and kind of what what you guys offer yes thank you thank you for including me
2:17
in this uh Surgery Center podcast my name is Amy Jones and as Raphael
2:25
mentioned the company is Jones Premier Pharmacy Consulting and I handle you can
2:30
kind of think of any medication management related items so traditionally it has been for surgery
2:36
centers or ASCS but also includes freestanding emergency rooms micro
2:42
hospitals as well as hazardous medication Consulting sterile
2:47
compounding Consulting and that can range from physician clinics ASCS even
2:54
smaller hospitals that need assistance with their medication practices
Amys Background
2:59
awesome that that’s fantastic and I know you’ve been in the space for a while
3:04
um you know how how long have you been in this Consulting space and um and kind of what inspired you to get started here
3:11
yes so I’ve been a pharmacist for 17 years now um the time has flown whenever I say
3:17
that number uh and I started Consulting in 2009
3:23
um and then started my own business in 2016. I realized that I enjoyed had a
3:30
passion for assisting facilities with their medication processes whether it’s
3:36
everything from the architecture and design of the med rooms and Med storage
3:42
places throughout the facility licensing facility licensing DEA
3:47
licensing and then Regulatory Compliance and then especially you know just
3:52
choosing their medication formulary as well as what is the organizational
3:58
structure that they will use for nursing Physicians to order administer and
4:06
document their medications awesome that that well that’s one some really great background seems like
Top 3 Mistakes
4:12
you’ve got years of of expertise there that are going to be super insightful for for our guests and let’s excuse me
4:18
for our listeners and um you know as we kind of jump into it thinking about this you know there are a lot of topics we
4:23
wanted to cover with you but you know today we’ll just focus on the best practices for managing um your
4:29
medication room in an ASC and um I think this is an area that’s pretty common for a lot of our listeners out there in
4:36
terms of the opportunities within their medication room but for you as someone who’s worked with so many different
4:41
surgery centers what are kind of the top three like common mistakes that you see in terms of how surgery centers manage
4:48
their their medication rooms yes yes I think that’s an important
4:54
topic I would say I would categorize them in three sections one is determining a medication process two is
5:02
having dedicated staff so either that’s having a consultant pharmacist on board
5:07
having a dedicated nurse to the process and then following standard protocols so
5:14
I’ll dive deeper into each of those three so for medication processes it’s
5:19
you know determining a standard way of getting the surgeon orders or the
5:25
surgeon preferences for cases prior to the schedule knowing what those
5:33
medications would be and also being able to troubleshoot if that’s not a
5:39
medication that’s normally on their formulary or has very complicated Administration practices and being able
5:47
to Hash that out before the case you know is scheduled
5:52
um and that also will reduce the amount of high dollar what we call non-formulary medications being
6:00
requested for cases if you have a pretty structured way of getting those surgeon
6:05
orders knowing what those medications will be ahead of time and uh
6:10
troubleshooting that you know let’s say several days before the case
6:16
um other things that happen is just um being able to list what your formulary is ahead of time so the
6:23
expectations are clear on both ends right surgeons that are scheduling cases at the facility as well as the nursing
6:31
staff if they get questions for an add-on case or any type of new surgeon
6:37
coming on board they will have an idea okay this is a medication we have never
6:42
had to use before is this something we are going to carry is this something that’s feasible
6:48
Administration wise for our facility to do right there are there are medications
6:54
that can be really complicated where they’re frozen they have to be defrosted in a certain period of time then they
7:01
have to be put in a certain applicator before administered and so those would be situations where you as a facility if
7:09
you are going to go that route at least you plan ahead do nursing education and know before the
7:17
day of the procedure because what can happen if those are not in place is what
7:23
um you kind of have a more stressful environment where errors can be made
7:29
right so maybe the wrong medication is ordered to the wrong dose is ordered or
7:34
it’s prepared incorrectly and puts the patient at risk because we’re trying to
7:40
do that very quickly with items that are unknown that makes sense and then the second
7:46
yeah so um the second item that you know I see many mistakes with is having dedicated
7:52
staff so if there are some surgery centers in the US that do not have a
7:58
consultant pharmacist and so one of the suggestions that you’ll hear me talk
8:03
about throughout this would be to have a consultant pharmacist maybe even if your State Board of Pharmacy rules don’t
8:10
require it or your um your Department of Health doesn’t require it to work out some sort of
8:17
procedure where you have a consultant on board that can help you with these decisions that we’re going to go through
8:23
throughout this podcast um that’s the very minimum having a dedicated nurse so they’re you
8:33
know if so if there’s not someone that volunteers to kind of handle the medication processes in the med room
8:39
trying to get someone assigned to that area the reason why you know I I say
8:45
that as a mistake is what can happen is um folks don’t realize how time
8:51
consuming the medication process can be for surgery centers in other facilities
8:57
and so if there’s no one really a sign no one really takes ownership of that area so you have things that are not
9:05
ordered you don’t have an organized process of where the medications go in
9:11
the med room you don’t have an organized process of documentation and then also
9:16
just follow up let’s say a medication is a multi-dose vial and you can use
9:23
additional doses is somebody making sure those things are getting those vials are
9:28
getting dated and that they’re stored appropriately so that it can be used safely for the other doses
9:36
awesome awesome and then the third yeah the the third item um in that same question of
9:43
the the common mistakes would be having standard protocols um standard protocols and what we call
9:50
order sets and or standard orders this is um been integrated into healthcare
9:56
for many decades now but what I see is sometimes ASCS do not have them in place
10:03
so having structured standard orders or standard protocols where the nursing
10:10
staff can all be educated anesthesia staff can all be educated and know what
10:16
those are so examples would be your pre-operative antibiotic dosing having a
10:23
structured weight-based dosing and the type of antibiotics you use for which
10:30
cases and then if the these cases are a
10:35
long case they will actually have to give additional doses of antibiotic 6 in the case and many times that is not
10:43
written down there’s not a protocol in place and so patients may not get those additional doses for a very long
10:50
surgical cases and now you potentially have put them at risk for not giving
10:56
them additional dose another um yeah so in again this is something
11:02
that I see regularly and can easily be you know addressed ahead of time
11:10
another standard protocol that I haven’t seen in full practice and ASCS is
11:17
multimodal pain management that has been put into place in many of our Hospital
11:22
systems but in your surgery centers I have not seen that routinely in place so
11:28
what I mean by that is having a structured giving patients pain
11:34
medication that’s not just your opioids um you know that that we can give
11:39
multimodal giving them your Tylenols or your NSAIDs which is ibuprofen or maybe
11:47
Celebrex prior to surgical procedures so that we
11:53
can reduce the amount of opioid analgesics that we give patients after
11:59
the surgery or even maybe not having to prescribe those when they’re leaving the
12:05
the surgery center that makes a ton of sense and I I think you nailed kind of a number of things
Vendor Selection
12:12
there that happened directly within a surgery center that with the right protocols and kind of structures around
12:17
the team uh you’re able to manage one of the things that kind of comes to mind is as a part of that is thinking about some
12:23
of the elements of what kind of happens outside of the surgery center in terms of kind of vendor selection what are
12:30
some of the recommendations that you have around kind of vendor selection and like ways that ases can can approach
12:36
that sure yeah that’s a great question and I think that is something even for
12:44
established ASCS that can come up as a point especially if they have not had a
12:49
consultant pharmacist in place but for your newer ASCS um determining a vendor on all vendors
12:56
are not created equal some vendors are focused more on your supply chain so you
13:03
know your needles your syringes IV tubing Etc and then you have vendors
13:09
that do have a pharmaceutical Division and that is one of their major divisions
13:14
of that company so you want to look for those vendors and even if what what I
13:21
commonly see is you have an ASE that’s just opening up and they’re not doing
13:27
any cases at that time because they’re still waiting for either CMS certification or any of their other
13:34
regulatory certifications and they have been able to get by with the vendor that
13:40
they chose but that vendor doesn’t have a strong pharmaceutical division so then
13:46
when they start to do more and more cases they realize that that vendor is not able to keep up with the medication
13:53
Supply so what I always try to choose is a vendor that has a large pharmaceutical
13:59
division is able to keep up with the drug Supply especially with the amount of drug
14:06
shortages that are out there you definitely want them to have a large
14:11
Warehouse or multiple warehouses across the country and just be aware of that
14:16
some other items to think about is in that initial contract what are what is
14:23
going to be the delivery process some vendors will actually restrict you to
14:28
one delivery day a week which can get really tricky is as you get busier right
14:34
so as you add on cases there’s going to be things that come up where you need
14:39
additional medications and if your vendor is only one day a week that’s
14:44
going to put you um you know in a situation where you’re going to have to pay additional fees to
14:50
get an additional delivery so maybe negotiate at the beginning to have a
14:55
multiple day a week delivery schedule to account for the volume that you plan on
15:01
having at your surgery center that that makes a ton of sense there and
Drug Shortages
15:07
you know in terms of just kind of that vendor piece you know you mentioned a couple things there around kind of the supply factors and their ability to meet
15:14
the the supply needs and I know we’ve probably all been hearing a ton in that regard in terms of kind of things that
15:20
have happened during kind of the covet and the pandemic in terms of impact on supply chain um but you know based on just some of
15:26
the things you mentioned there it seems like Supply and kind of managing and preparing ahead
15:31
um for any potential shortages is something that seemed like even past covet or even before covet was a factor
15:37
that that was important you know are there any kind of insights that you or background you can kind of share there
15:43
in terms of just how centers should be thinking about managing for shortages or kind of how those um how those different
15:49
shortages can impact a center sure and so you know just to explain a
15:56
little bit about why drug shortages exist there are multiple factors and I
16:01
think that um it’s worth describing because there are some misconceptions about why drug
16:07
shortages exist so um just with anything right if you’re having a computer made or a car made
16:14
there’s multiple pieces to that production and I think that there are
16:20
misconceptions that that all happens in one place right like one plant in the United States but it doesn’t with drug
16:27
Supply what happens is they will have pharmaceutical companies will have
16:32
plants throughout the world and each of those plants May provide a different
16:38
portion of that production so you may have a plant in India that’s
16:44
making the actual product ingredient or the powder of the drug which we refer to
16:50
as API and if that plant has some issues whether they were shut down or had all
16:58
their staff out for covid or whatever it is you don’t have the actual powder to
17:05
finish the production so maybe your other plants are doing fine but you don’t have these the initial product
17:12
um and then your glass files may be made at a different plant that may all be brought together at one plant and then
17:19
they prepare the final product and so if you know one of those plants goes down
17:25
it can cause a problem or delay some other things that can cause a delay would be if that plant is inspected by
17:33
FDA and the FDA finds some concerns there and that can they can be inspected
17:40
by the FDA in other countries as well I think people don’t realize that but if if a product is being used in the United
17:47
States the FDA or I’m sure they send some a representative to go into another
17:53
country’s plant and do that inspection so if the FDA determines that their
17:59
concerns whether it’s in documentation or their production process or
18:05
contaminants the FDA can actually shut that plant down and so that would cause
18:11
and that’s that’s you know very frequently what you see is you know you have a pharmaceutical company
18:18
who produces let’s give you know we’re going to give lidocaine his example because lidocaine is on shortage right
18:24
now but let’s say that plant um is the only plant that produces
18:29
lidocaine and the FDA comes in and says we we don’t agree with your
18:34
documentation you’re not taking enough samples or these samples appear to be
18:40
contaminated they will shut that plant down until they see resolution in
18:46
whatever the issue is that the FDA has found well now that company is left
18:53
spinning right because that’s their plant to make lidocaine and they don’t always they’re not always able to Pivot
19:00
very quickly because what these pharmaceutical companies do is they will
19:07
allocate a certain line you can eat kind of all kind of kind of picture a
19:12
manufacturing plant you have you know lines of production in a car factory you’ve got you know several lines making
19:19
different pieces of the car so they’ve dedicated let’s say one one or two lines to making lidocaine
19:27
um and then the rest of the lines are making you know if you pivot cane Republican Etc
19:32
they are not always able to Pivot quickly and say okay we can shut down
19:37
the pupificaine line for three weeks and make lidocaine because of the shortage a
19:45
lot of times they just keep on going and they go they go based on the quota of
19:50
what they’ve produced in the last year in the usage numbers for that year so
19:56
that leads us to another reasons why why shortages happen if let’s say two
20:02
companies in the world make this drug and one of those companies gets shut
20:07
down for whatever reason or the company decides not to make that drug ever again
20:15
like they they can um you know internally determine is this
20:21
something we want to continue making a lot of times it’s a cost versus Revenue
20:26
type scenario and for our generic drugs that many of those we use in our Surgery
20:33
Center so you’re you’re your anesthetics are all generic many of your antibiotics that we use in
20:40
surgery centers are generic um you are also using items for nausea
20:47
that are generic so many of these items are not what we call brand name or first
20:52
to the market items and so those particular products are the first
20:58
where a manufacturer might decide to discontinue it and so if you’re two
21:04
companies making it and one company goes down that other company is now kind of
21:09
trying to address the the whole United States production or even worldwide
21:17
production of that drug and again they may not necessarily be able to Pivot
21:22
that quickly and so that leads to a drug shortage they you know they make it you
21:29
know A month’s notice or a little bit of a notice to say hey this other company has decided they’re no longer going to
21:35
make this but that doesn’t give them enough time to ramp up that production yep
21:43
yeah those are those are the predominant reasons for drug shortages another one
21:49
um is you know kind of self-explanatory but your natural disaster so there was
21:55
hurricane Irma the one that hit Puerto Rico
22:01
um several years ago and that was in 2000 oh no it had been 2014 2015. there
22:09
was a hurricane that hit Puerto Rico and there was one manufacturer in particular that made much of the IV fluids for the
22:17
United States and their plants were there on that island and so that totally destroyed their plants and that
22:25
particular company was left reeling to to now figure out where they were going
22:30
to produce IV fluids at a different plant that doesn’t typically make it for
22:36
that company but that caused a worldwide shortage on your IV fluids at that time
Guiding Tips
22:44
that that makes sense and they’re you know they’re kind of direct relationship there between kind of the supply and demand factors in terms of a lot of
22:51
those shortages being being caused by just a simple lack in supply for a variety of reasons it seems like those
22:58
are things that can directly impact the center um when those things occur and I guess I just would follow that on you
23:03
know in the event of a shortage do you have any kind of guiding tips for surgery centers to kind of um be able to
23:09
leverage to to kind of navigate those situations right so um that’s a great question and
23:17
I think that um folks maybe don’t plan ahead for that so having again
23:24
having a consultant pharmacist on board that can help you with with navigating drug shortages
23:30
um but if if there isn’t um a consultant pharmacist on board keeping an eye out
23:36
on your Pharmacy organization drug shortages Pages because they will post
23:43
expected drug shortages now it goes back to that dedicated staff member that I
23:50
mentioned earlier many times asc’s may not have a dedicated staff member and
23:57
they certainly don’t have a dedicated staff member to be monitoring drug shortages and and addressing those so
24:04
but if they did and somebody was able to kind of anticipate um drug shortages coming up in either
24:12
you know a order additional Supply or B order additional supply of a easy
24:19
alternative and I say easy because there there’s always a plan B and a plan C but
24:26
the plan a is usually the easiest right you can just order up on Supply looking
24:32
at your usage for 30 days and ordering you know let’s say you know that there’s
24:38
going to be a drug shortage for two months ordering a two-month Supply and that would be again the easiest you’ve
24:44
got additional Supply maybe you spent a little bit more on your drug budget budget but you’re going to prevent any
24:52
um time spent on that drug shortage in the future awesome
24:58
um you’re playing yeah your plan B and C would be determining what is an easy
25:03
alternative and so that would be something you would communicate with your pharmacist uh but if not your
25:10
providers your surgeons your anesthesia team to see what would be a plan B that
25:15
we could use as an alternative and order that instead sometimes Plan B can be
25:21
just ordering different sizes or different preparations of that drug right maybe you’re used to always
25:28
ordering a 30 ml bile and you know what that looks like you know it has a green
25:34
cap and it looks like this but you may have to order a smaller vial or a larger vial drawing that drug shortage
25:42
um and then as I mentioned using Alternatives that are in the same drug class you can get those particular drugs
25:50
and use those so a good timely option right now though that everyone is
25:56
dealing with is your local anesthetics your lidocaine and your bupivacaine can
26:01
be very difficult to find so maybe you transition to ropivicane and you make
26:07
sure with your anesthesia team all we can get right now is repivacaine
26:12
are you all you know okay to use this everyone is familiar with ropivacaine
26:18
and the dosing and then you roll that out during this shortage so that would
26:24
be a plan B a plan C would be where you would have to make a drastic change let’s say
26:31
you um typically give a certain medication pre-op well now you’re saying
26:38
to yourself on every case which patient type really needs this pre-op and if
26:45
they really need it we have it available to them but the rest of the patients maybe don’t get this medication pre-all
26:52
so that would be kind of your plan C that makes a ton of sense and I think that gives our listeners some really
26:58
good options on kind of how to approach that and how to be prepared for those scenarios so you know I want to Pivot us
27:04
a little bit on this because I know there’s some areas that your consultancy really specializes in and I want to give
27:10
us some time to be able to talk through that and one of those topics is around controlled substance diversion
27:16
prevention and that’s an area that I want to make sure our listeners get a chance to kind of understand and also
27:22
understand some of the approaches that you recommend around that so for any of our listeners who aren’t necessarily
27:28
familiar with what that is can you kind of explain that a bit and also maybe talk a little bit about kind of some of
27:33
the processes and steps that that you tend to recommend sure of course so Controlled Substances
27:40
you know most people are familiar but these are the medications that have
27:45
restricted ordering based on their DEA schedule and as well as we need to
27:52
clearly document that inventory usage wastage and destruction so the DEA
28:00
classifies those between a schedule one through five in our surgery centers
28:06
we’re using schedule two which can be you know of the one of the highest
28:11
controlled substance levels that has medical use so you’re scheduled to
28:17
medications for example or your fentanyl your morphine your Hydromorphone and
28:22
those have to be ordered um very specifically with a DEA form or
28:29
through an electronic ordering system which we refer to as csos and then your
28:34
schedule three through fives are still feel of medical use they have some
28:40
addictive potential but they are not as structured in their ordering process as
28:46
those scheduled two medications so yeah so so my recommendations would
28:53
be to have a structured process in place going back to the organization of your
29:01
med room your many of your state boards of Pharmacy have very particular rules on
29:08
where controlled substances can be stored as well as the DEA they want a
29:14
very limited access to where those are stored so simple explanation would be
29:21
having a locked bedroom and that bedroom has a numerical code that’s used or
29:29
maybe a badge code that’s used and that’s very limited to who can get in
29:34
that med room and then you have a locked cabinet again where those controlled
29:40
substances are stored and whether that’s a key code or a badge code again with
29:46
limited access and then having a very structured way of
29:52
one person ordering a different person receiving those medications and then a
29:58
pharmacist or another person coming back and verifying this is what was ordered
30:04
this is what was received and this is what our Perpetual inventory is
30:10
that will identify simple things such as just counts were incorrect but
30:18
potentially any diversion that’s happening if you have the same person
30:23
doing every step there’s definitely an opportunity where diversion could occur
30:28
right if that person you know had a situation where they were addicted or
30:35
they were selling those medications they could order they could receive they
30:40
could modify the inventory if there are not multiple people involved in that
30:47
process so that that would be kind of the easiest recommendation is to Define what that process is Define who is going
30:55
to do each set of those processes and that somebody’s coming back and just verifying yes this is what we ordered
31:02
this is what we received and this is what was put onto the inventory some other processes to have in place
31:09
would be to really limit the areas that you have your Controlled Substances
31:15
stored in and go throughout your surgery center what I will see if I walk into a surgery
31:22
center that I’m adopting from someone else is that you’ll have medications
31:27
stored in multiple areas of the center and some of them are not secured some of
31:34
them are not maintained so trying to limit the areas where those medications
31:39
are stored and especially those Controlled Substances four surgery centers many of those do
31:47
not have automation so in our Hospital Systems we have automation where we
31:52
store those medications in what we call dispensing cabinets and there’s a process for pharmacy to load them
32:00
nursing to pull them and it’s all recorded electronically
32:05
but in surgery centers typically that’s all done manually so you do want to have
32:12
a process in place where medications are put into what we call Anesthesia kits those kits are
32:19
um standardized we know what we’re going to put in a teach kit the the kit is
32:26
numbered the kit is sealed we know if we give that kit to an anesthesia Personnel
32:32
for the day that it’s also returned that day so having a process in place that
32:39
you know who’s going to fill the kit who checks the kit and who is making sure
32:45
that they all the kids get back into that bedroom at the end of the day and someone you may maybe didn’t walk out of
32:51
the center with it or that any of the medications not missing from the kids
32:56
so those are pretty easy I mean they sound pretty easy but I do see that that
33:02
those processes are not in place in some surgery centers those are all really good insights and
33:08
it seems like there’s a lot of easy and kind of straightforward steps but I can see how you know when it comes to change
33:13
management and and kind of making new processes on any team a surgery center or otherwise it can be tough for people
33:19
to kind of adopt some of those changes but considering the risk factors there it seems like you know taking those
33:25
steps would be a slam dunk for any surgery centers so that that’s super helpful I know we’re we’re kind of
33:30
pushing up against our normal kind of time here but there is something that we do every single episode with every
33:36
single one of our guests and we always ask our guests what is one thing our listeners at their surgery centers can
33:43
do this week to improve their Surgery Center yeah I think that’s a great topic to
33:50
have you know for every speaker that’s coming on so I love that um one thing from a medication
33:55
management perspective is having a consultant pharmacist and whether you have a consultant pharmacist at the very
34:02
minimum having a dedicated staff member that can help you with your medication management that will lead to standard of
34:10
care best practice preventing drug errors uh having you know a safe
34:17
effective way to give medications in your surgery center and you know
34:22
allocating the staff to that so if the consultant is coming in and helping with those processes or the dedicated staff
34:30
member is is given time to work on those I think that’s the simplest you know
34:36
answer to walk away with and and for people whether that is the owners of the
34:42
surgery centers or the providers knowing how important and how time consuming the
34:48
medication process can be that that’s super helpful and I I feel like this episode’s got a ton of really
34:54
good nuggets in it you know we try and make some Great Clips coming out of every episode so we can kind of share some of them in addition to the whole
35:01
episode and it’s going to be tough for us to choose which which parts to use as Clips but Amy it has been fantastic
35:06
having you on I know our listeners are going to really enjoy this one thank you so much for your for your time and for
35:12
your insights thank you so much for having me and I wish every ASC the best awesome
ASCs in Virginia
35:19
good night [Music] as always it has been a busy week in
35:25
healthcare so let’s Jump Right In in our first story today Virginia ASCS are to
35:30
be included in the implementation of the state’s Hospital price transparency laws this story comes from asca’s government
35:37
Affairs update so major shout out to Stephen abrush of ASCA for summarizing this so clearly for us
35:44
on April 11th Virginia governor Glenn youngkin signed into law House Bill 481
35:50
the measure requires hospitals to make publicly available on their websites a machine readable file containing a list
35:57
of all standard charges for all items and services provided by the hospital now a lot of that language really isn’t
36:04
new but on September 7th a committee got together to discuss recommendations for
36:11
implementing the law now it’s important to note that in Virginia ASCS are actually referred to as Outpatient
36:18
Surgical Hospitals so if you look through the minutes just a heads up that that’s what you’ll be looking for not
36:23
Ambulatory Surgery centers by the end of the meeting though the committee unanimously recommended that
36:29
ASC should be subject to the state’s Hospital price transparency requirements as well
36:35
and according to the house bill the deadline to comply is July 1st 2023
36:40
which we all know will come up sooner rather than later so first for all the
36:46
ASCS in Virginia please make sure you check out the episode notes for all of the links so you can learn more and
36:52
start preparing for this and then for the rest of the states it’s important that we take what’s happening in Virginia as just another wake-up call
36:59
that more and more transparency requirements are coming your way
37:04
according to an article written by Becker’s ASC declining pay is pushing
37:09
more and more Physicians to ASCS CMS proposed a physician fika a 4.42
37:16
percent in 2023 and if that takes effect it will continue to sweeten the deal for
37:22
Physicians who may currently be on the fence about whether they should transition their cases to a surgery
37:27
center or not we already understand the value of working in an ASC over a hospital
37:34
higher efficiency safety better outcomes better work-life balance but declining
37:40
pay in a hospital setting will impact Physicians pockets and we all know that there is no bigger driver than that for
37:47
most of them so don’t hesitate to start networking and doing some marketing to your local Physicians and letting them
37:54
know the benefits of Performing cases at your surgery center especially if that
37:59
physician fee cut does does take place our third story comes from PR newswire
38:06
last week National medical billing services announced that they have officially acquired med tech Medtech was
38:12
founded in 2001 and offers medical transcription coding billing and other software products to ASCS and National
38:19
medical is one of the industry’s leading providers of revenue cycle Management Solutions so you can imagine the Synergy
38:26
here both companies have a goal of being able to one provide ASCS with a complete
38:32
end-to-end revenue cycle solution and two help ASCS get paid more and of course get paid faster so by acquiring
38:39
Medtech National medical will be able to move more quickly on both fronts and expand their product offerings we’ll be
38:46
keeping a close eye on how this develops and what it means for the industry but for now congrats to both companies and
38:53
excited to see where you go from here and to end our new segment on a positive
38:59
note while the story isn’t directly related to ASCS it’s a win for health for lowering health care costs which I
39:06
think everybody can get behind uh President Biden issued an executive order requiring the FDA to allow hearing
39:13
aids to be sold over the counter to anyone 18 or older in the next four months now this was something that was
39:20
actually signed into law four years ago but no action has been taken so
39:26
um President Biden issued that executive order to kind of get things moving and consumers with mild to moderate
39:33
hearing impairments can actually purchase these hearing aids without the need for a medical exam prescription or
39:39
a fitting and the FDA estimates that this could lower average costs by as
39:45
much as three thousand dollars per pair and you can get them at Walgreens CVS Walmart Sam’s Club and Best Buy and from
39:53
what I can tell the costs range from 199 to 9.99 and while conversations happen all the
40:00
time around lowering costs it’s really great to see something actually happening and for those of you who have
40:06
hearing impairments or know someone who does I’m excited that you now have this option available to you
40:13
and that news story officially wraps up this week’s podcast to thank you as always for spending a few minutes of
40:20
your week with us make sure to subscribe or leave a review on whichever platform you’re listening from I hope you have a
40:26
great day and we’ll see you again next week [Music]
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