Retail pharmacies, DIR Fees, DIR Fees 2024, Pharmacy Growth, Startup Pharmacies

The Bottom Line Pharmacy Podcast Embracing Long-term Care at Home Pharmacy Ownership

The supply of beds at skilled nursing facilities has dropped dramatically which has increased the demand for long-term care at home services.

This has created a lot of opportunities for independent pharmacies to offer a higher level of service to their community and get paid fairly for doing so!

In this episode of The Bottom Line Pharmacy Podcast, we sit down with Lindsay – Dymowski Constantino to discuss embracing long-term care at home pharmacy ownership, why you’re probably already servicing long-term care patients already, The Long-term Care at Home Pharmacy Network, and more!

Join the discussion with us below! 

The Bottom Line Pharmacy Podcast is your regular dose of pharmacy CPA advice to fuel your bottom line, featuring pharmacists, key vendors, and other innovators.

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If you prefer to read this content, the video transcript is below:

Scotty: Welcome everybody to another episode of The Bottom Line Pharmacy Podcast. And today we have Lindsay Dymowski with Long Term Care at Home Pharmacy Network. And as we’ve had on previous guests long-term care is not going anywhere. It’s going to continue to grow. There’s not enough beds in the country for long term care for the boomers and at home, a lot of them choose to go home and want to stay at home. I know I would. And so that presents a lot of opportunities for pharmacy. Lindsay, why don’t you tell us a little bit about yourself and what you do? 

Bonnie: Did he get your name right? Just out of curiosity…   

Lindsay Dymowski – Constantino: Yeah. Lindsay Dymowski. I was laughing because I go by Lindsay Dymowski most of the time, but I added Constantino because my four-year-old got very upset when he saw that I wasn’t Mommy Constantino when he saw one of these things… 

Scotty: That’s a very sophisticated name. That’s like a James Bond. 

Bonnie: That’s a very great name. I’m a little jealous. Mine’s so basic that it’s boring… 

Lindsay Dymowski – Constantino: I wish mine was basic. Like I wish it was like a Smith or something easy you know. So, yeah, I grew up in pharmacy. I, like many people in the community pharmacy and even in the long term care pharmacy world, I worked the pharmacy counter and the cash register for my allowance. And I really got a unique perspective on. The pharmacy business, because my parents always kept us extremely involved. If we wanted to go to wholesaler meetings, or if we wanted to learn about how, or why my parents picked the health care plans they did, and they always wanted us to be as involved as possible so, my younger brother and I, we got a really neat experience into not only pharmacy, but into business. Ended up seeing this packaging machine when I was in college and I thought this is really cool, but it would probably be better in the community than it would be at this facility because all these patients are leaving and they’re coming back in here because they’re not taking their medicine. So, we can get this type of packaging to them in the home instead of once they’re here in the facility. Why don’t we try to do that? So, we ended up putting a packaging machine in the back of one of our community pharmacies. And we just went to the providers that we had really good relationships with and we said, “Hey, we have this idea. We have, something that we think is going to be able to increase adherence for your patient population.” And that was our first goal. Let’s increase medication adherence. And then as we started to work more closely with the providers, we started to get kind of more integrated into the health systems and the social workers and case management who were related to the payers and the plans that are in the area and we realized that pharmacy can make a significant difference in the measured outcomes for what these plans, these providers and these value based health systems were really starting to focus on. So, we started developing more relationships that focused on doing outcome type work and what we realized at the time, well, what we didn’t realize at the time, and we realize now is that we were. Really doing long term care at home. We called it medication management pharmacy. We called it adherence pharmacy. We kind of called it value-based pharmacy for a little bit, but it really was long term care at home pharmacy. We were taking these extremely chronically ill individuals and, supporting them with services that were above and beyond your traditional community pharmacy. So, we decided to jump in two feet. We did a lot of different beta testing and worked with different plans and payers to figure out what made the most sense in regard to reimbursement? What was needed? What kind of…what were the different types of expenses in this? And how did pharmacies need to be reimbursed for this? And we are a full long-term care at home. So, we’re a long term care pharmacy, but we support only community patients. And it’s a really interesting pharmacy model. And I personally believe it’s the future of pharmacy, which is why we started the Long-term Care at Home Pharmacy Network. Because we know that pharmacies are trying to find ways to differentiate themselves. They’re trying to find where the population is, where they can increase their reimbursements and, I truly truly truly feel like long term care at home is the answer.   

Scotty: That’s awesome. So, tell me about the reimbursement side. Obviously, you did a trial and error with that. How can we get reimbursed? How can we maximize that? What was that like? And what are you seeing in terms of reimbursements? 

Lindsay Dymowski – Constantino: It was painful at first, right? I’m from the community pharmacy world, so I spent a lot of time just chugging along, hoping that retail reimbursements would change and then we realized that they weren’t going to change, and they just got worse and not only reimbursement, the fees and all that stuff. When we heard that combo shop was an option when it was just becoming, I want to call it mainstream yet, but whispers of this combo shop type of pharmacy we’re happening in the industry. We’re like, we think that we’re a combo shop. We think this is how we should be getting paid. So, it’s really interesting because when you take this population, and you have this chronically illness that these aging in place individuals who are living in their home and they’re qualified properly as long-term care patients, you as a pharmacy are providing that level of support. You’re able to get paid at higher reimbursements for certain payers. It’s not perfect in the industry, so you have some payers are recognizing it, some aren’t, some are recognizing it with skilled nursing rates and long-term care, which your long-term care pharmacies will consider that true long term care reimbursement. Other payers are reimbursing at more of assistant rates. You have some payers who aren’t recognizing it at a higher rate at all but are still allowing it to be seen as a long-term care level of service. It’s very murky right now. There’s a lot of different payers who are doing different things with it, but the most important thing is that every payer is recognizing it in some fashion. They know that it’s here. They know that it’s happening. They know that they have to figure out how to support this population you said it, there are no beds. There’s nowhere for these patients to go. They’re staying home and they want to stay home. So, there has to be solutions and reimbursements aren’t perfect yet, but it makes a significant difference in the bottom line of pharmacies. It really, really does. 

Scotty: So, you’re seeing reimbursements continue to, or you’ve seen the payers recognize it and hopefully over time they continue to reflect that in the reimbursement and so forth. Is that what you’re seeing and hope to see as this evolves? 

Lindsay Dymowski – Constantino: Yeah so, there are several payers who are reimbursing at…so I always say at long-term care, and I know it’s like the wrong terminology because long-term care pharmacies only see skilled nursing at long-term care rates. But from the community pharmacy world, you look at these assistant rates and you’re like, oh my gosh, this is amazing. So, but there are a couple of payers who are paying the skilled rates, there are a couple of payers who are paying more of an assistant rate, and then there are a couple of payers who aren’t paying any higher rates. So, it is mixed, but what’s really interesting is that even at my pharmacy, we have a few thousand patients who are supporting all long-term care at home in the community and, we have all of these mix of pairs and the differences that we’re seeing is, we can see a 28 percent gross margin, some months of 30 percent gross margin, depending on how we’re, ordering inventory and how that month looks and that’s unheard of in the community world and pharmacy and it’s pretty amazing when you can take your pharmacy, you can create a proactive workflow so that it’s not this chaotic environment with a bunch of phone calls and craziness going on at the counter and you can put your white coat on and take care of these patients in a better way and you can support the providers and the home care agencies in a better way and you can get paid for that. It’s pretty incredible. 

Bonnie: I have to go back and ask a completely different question, just take a break for one second. This always interests me. You said that you were born and raised in pharmacy. 

Lindsay Dymowski – Constantino: Yep.   

Bonnie: Did you, as a child, attend all the trade shows? 

[Laugh break] 

Lindsay Dymowski – Constantino: So Interestingly enough my… 

Bonnie: Those kids have a great time at the trade shows. They’re like hitting up all the free stuff. 

Lindsay Dymowski – Constantino: They really do. They have like the kids clubs and stuff like that. I, Yeah, I know. I see that. Sometimes I’m like, I need to bring my kids here. I do so much speaking that I just fly in and out to them now. When I say I grew up in pharmacy, it probably started when I was like 10 or 11. So my dad actually went back to school. My mom ended up leaving her job. She stayed at home with us. My dad went back to school, and we got to see him go through pharmacy school. And then shortly after he graduated from pharmacy school, my parents opened up their first pharmacy. I was probably around 11 or so when the first pharmacy opened, and we really started getting into it. 

Bonnie: So, you missed some of it. Dang. 

Lindsay Dymowski – Constantino: I did…I missed all those fun clubs. 

Scotty: Well, we don’t have time, but I know Bonnie would want to know all about the food and what you ate and all that.  

[Laugh break] 

Bonnie: I love trade shows. But seriously. So, back to the actual topic. What can, so we have lots of clients that are looking to get into some kind of this combo shop scenario. What would be the very first step to start to look into that?   

Lindsay Dymowski – Constantino: So, I think the most important thing that pharmacies need to realize is when they look at this and community pharmacies look into going into the combo shop area, they’re going to be really overwhelmed. They’re going to look at this and go “I am not a long-term care pharmacy. I am not doing this. I am not going to be available 24/7. I am not running aspirin to someone at 2 o’clock in the morning.” And that was our feeling as a community pharmacy. What they really need to do is take a look at all the different resources that are available to them. I know at the long-term care at home pharmacy network, we have a ton of resources for people to understand how to start to navigate and give them a road map to becoming a long-term care at home provider. The very first thing is to work on your pharmacy licensing, so you need to make sure that you get that additional NPI, you want a long-term care NPI from there. You want to focus on the contracting. So, you need to get set up with the PSAO, you need to get the long-term care contracts for the entities for the PBMs that you need to self-contract with. And pharmacies are going to look at this and go “wait a minute. I have to recontract, in some circumstances, if I’m in a heat zone, I have to recredential. This is expensive.” And it is when you first, get into this, you are going to put out a few dollars to be able to bill long term care and, you need to be able to access those contracts, but don’t let that scare you and don’t let that deter you from moving forward in this because when you really look at, comparing these patients and how many patients in your specific population, can you qualify to get that R.O.I. you really start to realize that it’s only probably 5, 10, 15 patients that you really have to convert from traditional community pharmacy to that long-term care at home population to be able to cover those expenses. 

Bonnie: Let me interrupt you there. So, for that part of it, because that usually seems to really get people nervous, or they just say “nevermind, if I’ve got to do all that, I just, I don’t have time.” So, is that something that they can do on their own? Or is that something you normally see that they hire help to assistance with getting those regulatory things completed. 

Lindsay Dymowski – Constantino: So, there’s both there’s a lot of pharmacies who will do it on their own. It’s time consuming. I think one of the credentialing contracts, I think you have to do it all within a 90-minute time span. So, you can’t even get up off of your desk it makes you start the whole thing over if you do it out of the time frame. So, that kind of stuff is frustrating, and I mean quite honestly, it’s so unnecessary I don’t know why they make it so difficult. So, it can be time consuming. I think that when pharmacists start to look at this and they go “I’m overwhelmed, I don’t want to spend the time” there are processes in place where they’re able to have this done for them by professionals who can take all the information and get it set up for them. We actually have a solution at the Long-term Care at Home Pharmacy Network, it’s called Simplify Enrollment and essentially the pharmacies can pay for the service, they pay for the contract credentialing fees and all that stuff. And then one of our team members actually does the process for them. 

Bonnie: Nice. 

Scotty: So, what about you’re a pharmacy owner out there and you’re interested, but how do you know whether it makes sense? How do you gauge? Do you like check how many patients you have that may qualify? Like, how do you know whether it makes sense to even go into Combo Shop? 

Lindsay Dymowski – Constantino: Well, I mean you guys are making it really easy for me to plug all these great resources that we have. 

Scotty: Go right ahead. 

Lindsay Dymowski – Constantino: This wasn’t even planned. 

Bonnie: And I promise, we did not talk before and plan any of this right Scotty? 

Scotty: All of our podcasts are off the cuff. We wing all these things, so.  

Lindsay Dymowski – Constantino: Yeah, you’re just setting me up. So, you know, I think a few different things. So, one, a pharmacy really needs to look at their population and go “am I providing compliance packaging? Am I providing delivery services? Am I supporting patients who are chronically ill, who are aging in place? Am I doing more consultations? Am I doing more clinical work?” If your pharmacy is falling into that realm, then you are probably supporting long term care at home patients. So, you have opportunities to be able to do that to bill them differently. That’s very high level. If you really want to get an idea of what your patient population is and your payer mix and what payers do you have who are paying at what rates and what are the opportunities for your patient base based on, what their chronic diseases maybe and medications and so on, we do have a solution at the Long-term Care at Home Pharmacy Network where we can actually do a patient population assessment and say okay, here’s what your revenues are now. Here’s what your revenues would be if you could potentially convert 10 percent of this population, 15%, 40% you can kind of change the numbers and play around with it. And then this is for the payers who are actually paying now and then future state when the payers who aren’t paying higher rates for it. This is what it will look like in future states. So, we do have the availability to work with pharmacies to collect that data and give them deeper insights into exactly what their specific population may be. And then, of course, who is in your neighborhood? When you’re looking at these pharmacies from the retail community aspect and even the long-term care aspect. There’s so much opportunity here to be able to. To support the organizations that are right next door to you. From a community aspect, are there integrated health systems or their home care agencies? Are there case management groups? Those are the organizations who you want to go to a market to and say, hey, I provide a higher level of pharmacy care than what you’re going to be used to. And here’s how I can help you for the long-term care of pharmacies it’s hey, I don’t have to stop supporting these patients once they leave your facility. I can help make sure that these medications are managed once they leave your door so that they don’t end up back in here. And so you have to look at not only that your current population base, but also who is in your market and what patients may be available to you to help support the healthcare system. This is really cool. Let me try to go get more business instead of sitting behind here and being upset at every reimbursement that comes back.   

Scotty: And the patients, you got to think they love it because they’re being serviced. They’re being taken care of. 

Lindsay Dymowski – Constantino: Yep. 

Scotty: They’re at their home. 

Lindsay Dymowski – Constantino: And you know who even loves it more, the patients’ kids. 

Scotty: There you go. 

Lindsay Dymowski – Constantino: Because you have parents who are chronically ill, who are sick and getting sicker and sicker and emotionally, the children are dealing with the fact that their kids, I’m sorry, their parents or their grandparents are getting sick and they don’t want to see that and then all of a sudden, they have the responsibility of health care appointments and getting the doctor’s offices and trying to figure out what is going on with mom and dad’s medicine is just so overwhelming. 

Bonnie: That’s a really good point. We, it might have been on another podcast, or maybe it was an article or something. I read, but it was really talking about that really the target audience for any of this stuff with long term care is not the patient because they…you know, they’re at home. They’re not leaving, they’re homebound. They don’t really care probably who, how the medication gets to them. They just need it. So, it’s really about, like you said a lot of times, the children, the caregivers, it’s those people that this is really that makes it easier for them. So, it’s really about targeting, can’t forget to target those people for sure. 

Scotty: Well, we had on Debbie Marcello. Did I? I may have missed it…Happier at Home, Bonnie.  And she was talking about that and how there’s that opportunity to provide that service in addition to the medical long-term care at home. 

Lindsay Dymowski – Constantino: Yes, she has a really cool concept where these pharmacies can start getting involved in home care and being able to provide home care into their communities. There’s also some really neat things going on and like the at home ecosystem at CPESN. So, at the network, we actually have a special purpose network with CPESN specifically for long-term care, long term care at home. And, there are other things to you have you have a big tree medical where pharmacies can actually get, I believe it’s physician assistance. 

Bonnie: Yep. 

Lindsay Dymowski – Constantino: That kind of have office space in their pharmacy. And then you also have physiatry, where you can send physiatrists out into the home. So, I, the industry knows that home is going to be the next healthcare facility. Home is the healthcare facility. It’s not even going to be. It is the healthcare facility now. So, there’s so many solutions that are out there and I think it’s becoming more and more common for not only pharmacy, but everyone else in the healthcare industry to realize that. We just need answers to support this population. I think it’s neat how much of it can be supported by pharmacy in different ways, because, you can take the whole opportunity and imagine a pharmacy that can support these patients long term care at home and be a long-term care pharmacy, supporting community and getting that level of reimbursement and then also providing home care and physiatry and having the opportunity to have, physician’s assistance and point of care testing and vaccinations. It’s the pharmacy finally becomes the healthcare hub again. And it’s not just this store that people pick up candy and gifts and also happen to get their prescriptions up. 

Bonnie: Right. And that’s really the whole point of, in my opinion, it always has been of independent pharmacy is just, it’s such a difference from the big box. You’re offering just a different level of service to your patients than what you can get somewhere else so. 

Scotty: Well, being that just like you said, the healthcare hub of your community and that is…that’s where it’s at. That is it.  

Lindsay Dymowski – Constantino: Yeah, yeah. And for a lot of communities out there the pharmacy is really the only accessible provider and we’ve heard that story. We saw it with COVID, and we all know it being in pharmacy. How much the communities, especially these pharmacy desert communities, whether you’re in a rural community, or some of the urban communities that pharmacy is really the only provider and I know, you know, I was just talking about provider status and pharmacy yesterday, actually, and I know pharmacies pharmacists and a lot of states aren’t considered providers, which is crazy, but it’s just such an accessible form of health care and the health care industry as a whole has to better utilize us. And I know we’ve been saying that for years I’m preaching to the choir, but it’s just it’s really amazing what pharmacy can do when we have the ability to do it from the rest of the community, healthcare, integrated health systems, payers, plans when they trust us to be able to do what we do best, we just excel at it. 

Scotty: And hopefully with pharmacies more and more kind of venturing out into these other services and other areas that trend will catch on for being recognized as a provider as a key component of the health care system. 

Bonnie: So, Lindsay, just out of curiosity, I work with a lot of startups. Is this something that you’ve seen people do right out of the gate? Or is it something you wait and sit back a little bit and see what that community looks like and what your makeup is first or? 

Lindsay Dymowski – Constantino: We’re seeing both. So, we’re seeing community pharmacies and long-term care pharmacies that have been around for a while who know that there’s now this population that needs to be supported who are looking to get into long term care at home. We are also seeing just pharmacies, or I should say individuals, who have been in pharmacy historically, who got out of pharmacy and said, “I want nothing to do with this anymore.” And now see the opportunity with long-term care at home and are actually starting up long-term care at home pharmacies, and I think that’s pretty empowering because when you have an owner who may have sold their pharmacy because they were so frustrated with the industry and then they’re looking at this and they go “wait a minute, there’s a different way that we can do this and I can be paid fairly, be paid properly for the level of support I’m providing and then also provide better care for my patients in the community.” I think that it’s pretty empowering for pharmacies and pharmacists and pharmacy owners to be able to look out for. 

Bonnie: Yeah, that speaks volumes that there are people that are doing that. 

Lindsay Dymowski – Constantino: Yep. It’s pretty cool.  

Scotty: Mhm. Sure does. I know I’d do it. 

[Laugh break] 

Bonnie: One day Scotty. One day. 

Scotty: Me and Bonnie’s dream is to own a pharmacy one day. 

Bonnie: We’ve got a spot, and everything picked out. 

Lindsay Dymowski – Constantino: You talk to so many different people, you have to take all of everybody’s ideas and just make it like this big, giant, just fantastic community pharmacy. 

Bonnie: Yeah! Well, I said we could test out all sorts of things and then it would be awesome…We’ve got a spot picked out, but… 

Scotty: …We need a pharmacist. We don’t have a pharmacist. Oh man. 

Bonnie: I even considered going back to pharmacy school 

Lindsay Dymowski – Constantino: There’s, I feel like you can find a pharmacist. There are so many pharmacists out there. 

Bonnie: Yeah. 

Scotty: No, this is great. What else Lindsay, have we left out that’s important to bring up?  

Lindsay Dymowski – Constantino: Oh, goodness. Well, I mean, we were talking earlier about, pharmacies potentially being scared or overwhelmed to jump into this long-term care world, and I was laughing about the aspirin at 2 o’clock in the morning. I think it’s important for pharmacies to also realize that if you are going to get into this model of pharmacy you do need to meet the CMS minimum standards for long term care, which includes things like, IV compounding and 24/7 access, backup pharmacy, but it is a little different in the community world. Even though you are in long term care pharmacy, because you’re working so closely with different providers and caregivers, you’re still seen as a community pharmacy. So, those resources don’t get utilized nearly as much as they do when you’re providing facility-based care. So, I don’t want pharmacies to panic and not jump into that because they go “I’m not a long-term care pharmacy” because they probably are and they just don’t realize that they’re supporting the population.  

Scotty: Yep. So, you might as well get paid for it. 

Lindsay Dymowski – Constantino: Exactly, yeah. 

Scotty: What about qualifying? I know asked this in previous podcasts, but qualifying patients, what’s the best practice to do that? 

Lindsay Dymowski – Constantino: Your typical long-term care at home patient is going to be qualified through a waiver program. So, they either are receiving long term care services in the community through some type of waiver or Medicare program that would auto qualify them. I don’t like to say auto qualify, but, essentially, it guarantees a long-term care home patient and then additionally, you can qualify patients based on what we’re saying their health detriments. So, a patient who is, goodness gracious, this is all I talk about every day, and I always feel like I’ve got to forget something when I start getting down into the nitty gritty of this, it’s a patient who is 2 or more ADLs or activities of daily living or instrumental activities of daily living. Those are usually qualifiers of what would. Qualify someone for skilled or assisted living care. So, it’s important to make sure that person has an ADL, or 2 ADLs or IADLs and then they also need to have 3 or more chronic conditions beyond multiple medications for those chronic conditions, so they can’t have diabetes and heart failure and C.O.P.D. and then not be on any Medicaid, many medications for them or not be filling any medications for those patients or I’m sorry for those chronic diseases. 

Bonnie: So, the medications have to qualify their condition?   

Lindsay Dymowski – Constantino: Yep. 

Bonnie: Gotcha. 

Lindsay Dymowski – Constantino: And then they also Need to be home bound to the extent where they cannot leave the home independently. So, they may be able to leave the home to go to doctor’s offices or doctor’s appointments or dialysis or something like that, but they typically are going to need a caregiver or transport company or someone, something like that to be able to take them to a facility. They shouldn’t be able to get in a car and drive themselves. 

Bonnie: Hm. And who qualifies all that? Who goes through and says check the box for all these things they qualify? Like who makes that call? 

Lindsay Dymowski – Constantino: Different pharmacies first and foremost, the pharmacy needs to remember that you have to keep the documentation on file. So, when you’re qualifying a patient, you want to make sure that you’re documenting that this patient is a long-term care at home patient and that attestation is done at the pharmacy level. So, what we typically see is either the pharmacy is utilizing an outside source, like a home care agency or even a provider’s office to qualify the patients, and then they’re coming over verifying the qualification and then attesting to it being correct or the attestation is done on the pharmacy level and the pharmacist will actually go through and when there’s a patient who they think is a long-term care at home patient or maybe they’re working with an organization and the organization is sending them a patient file and asking them about it, the pharmacy will go through, and we typically see that it’s either pharmacists or specifically trained support staff will go through and qualify the patient. Are you in a waiver program? Do you have three or more chronic conditions? Do you have ADLs? Are you homebound? Are you on multiple medications? And if they check all the boxes, then they would qualify. And then that pharmacist does that final attestation of, yes, this is verified. This patient is a true long-term care at home patient. And we typically recommend at the network that pharmacies do that qualification every 6 months so that they’re continually making sure that their patients are long term care at home patients and that their disease state status hasn’t changed in any way. 

Scotty: Do you have a number of patients that is ideal to get in here? I’ve seen, we’ve got some pharmacies I know got 100, 150 patients and the numbers are pretty daggone good. Do you have a benchmark for getting how many patients to get going on it or? 

Lindsay Dymowski – Constantino: I mean, I always tell every pharmacy if you have one patient, you’re doing better than you are today. So, if you can qualify one patient, you’re guaranteed to do better than what you’re getting today. But realistically, when you start looking at the money that you’re going to put out to get credentialed, get on these contracts, join the long-term care at home pharmacy network get your PSAO set up, I think that probably somewhere, depending on the payers that you have in your ecosystem between 30 and 50 patients would be the benchmark of okay, this is, covering everything and I’m still making profit if. And I would even say that you probably include an additional technician that would just be focused on that type of patient. 

Bonnie: This is what I was going to ask you, do you normally see where the pharmacy dedicates a staff member to just working on this particular thing? 

Lindsay Dymowski – Constantino: I think that you can, I think once you get to once you start moving into a 50 to 100 patients, I think it’s probably necessary because you do need someone who’s taking ownership of this in the pharmacy and making sure that everything that needs to get done for these patients. 

Bonnie: Is doing a good job. 

Lindsay Dymowski – Constantino: Yeah, exactly. So, even if you have a pharmacist who’s working the bench, maybe at the beginning of the day, and then is moving over to do the med recs and more of the clinical work that long term care at home takes you still have a technician who’s organizing that, preparing everything, making sure that the compliance packaging is filled and focusing solely on those patients. But again, I think, as if you have a community pharmacy, that is just getting into this that you can do multitasking with your staff as long as you definitely have your staff dedicate time. And then I think you do need to migrate at least a technician to begin with over to fully focusing on those at home patients. 

Bonnie: That makes sense. Yeah. You want to do a good job with it, I would think. If it were me, I mean, I’d want to, you know, knock it out of the park. And so, taking the someone to really… 

Scotty: I’ve been to some pharmacies where they have a separate kind of room for their long-term care and separate staff.   

Lindsay Dymowski – Constantino: Yeah, that’s how we started it. We had a pharmacy in Philly that quite literally just met the pharmacy spacing requirements. It was a tiny little shop, and we had our packaging machine in there and we had the pharmacist to work the bench who was seeing customers come in and then we had 1 technician and eventually we ended up getting another pharmacist, but it was 1 technician who was in like this back kind of sectioned off area that was kind of doing all of the processing and getting med list from doctors and making sure that we had every the pharmacist had everything that they need it so that, they could just go down the patient files towards the end of the day, or at the beginning of the day, the next day, however it was organized at that time and just focus on those patients at that point. And then our technician would go back into his little area and fill the machine and make sure the compliance packaging was done and then pharmacists would go check it. Then eventually we were like, okay, we have enough patients here we should probably focus on this. 

Scotty: Well good stuff. Bonnie, do you wanna?   

Bonnie: So, every episode we do the bottom line, just a quick…And Scotty told me last time we recorded that my bottom line was too long. But I have a really good one today. 

Scotty: That was like three podcasts ago by the way and you keep bringing it up. 

Bonnie: I think it was the last one. Anyway, I actually have two bottom lines, but they’re both really quick. One has nothing to do with this podcast. I love your wallpaper. It is amazing. 

Lindsay Dymowski – Constantino: Thank you so much. It’s not mine. So, my husband and I, we just moved and we’re… 

Scotty: About to tear it out and get rid of it.   

Lindsay Dymowski – Constantino: Yeah, well, no no. So, our house isn’t actually ready yet. We actually move in next week and I’m at my in-laws house.  

Bonnie: Ok so, it’s temporary.  

Lindsay Dymowski – Constantino: So, this is my in-laws beautiful wallpaper in their office that I have moved over.  

Bonnie: It’s awesome! I can’t quite, we built a house a couple years ago, and I couldn’t quite, because to me, wallpaper, the thought of wallpaper was, like, the 70s and the 80s. My parents had it everywhere. And then, when wallpaper went away, I can just remember them tearing it down. It was a nightmare. Having to it was bad. I couldn’t quite do it anywhere, but I do love it. It’s great. Sorry, just had to say that number 2, the actual bottom line. So, we may have a lot of listeners that say “my pharmacy is not a long-term care pharmacy” but Lindsay has explained that you probably already are, you just don’t know it. How do you like that?  

Scotty: That’s the bottom line. That is the bottom line.   

Lindsay Dymowski – Constantino: That is, I need to take that and post that everywhere, because that is the truth.  

Scotty: That’s the mic drop. I guess my bottom line would be the same thing. I’m going to copy that. Lindsay, what are your last thoughts here for the audience here?  

Lindsay Dymowski – Constantino: Goodness. This is a lot of pressure. Do not be scared to call yourself a long-term care pharmacy. If you are supporting your patients in this way. And if you have this population, then you should be fairly reimbursed for the level of support you’re providing this population and do not be afraid to take ownership of that.  

Scotty: Great. That’s well said. Well, Lindsay, you’ve been great. Great information.  

Bonnie: Yeah, good information.  

Scotty: Fantastic conversation here today. So, thank you so much for jumping on with us and maybe we’ll see you out on a trade show here in the near future. You and Bonnie can go get some food and eat because I know Bonnie loves to eat at trade shows. 

Lindsay Dymowski – Constantino: Yeah, we can sneak into the kid’s club.  

Bonnie: What does that…? Yeah, the kids club. Listen, we were at one of the trade shows, I think it was this summer, I can’t even remember where it was, they were having a party across the hall from the trade show, and it was all the kids. We were like, we thought it was another trade show, huge group or whatever. Went over there. It was the kids’ club. It was literally like a nightclub in there. They were having a good time.  

Lindsay Dymowski – Constantino: Yeah. It’s always a good time there. Yeah, well I can’t thank you enough. This was a lot of fun and yeah, there’s a big conference circuit this year, so if you see me find me now and we will definitely hang out. 

Scotty: All right. Thanks everybody for listening. 

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