Stream: Da+Vinci+PDex+Plan-Net
Topic: Pharmacy count and mix
Scott Robertson (Nov 09 2020 at 22:20):
Per CMS, when we provide a pharmacy list we also need to report the number of pharmacies in the network the the mix of pharmacies. I don't see a place for either. I am missing something (right in front of me)?
I once asked a CMS person about this, they didn't have an answer ... hoping there is an answer now
Saul Kravitz (Nov 09 2020 at 23:14):
Hi @Scott Robertson ,
The number and mix of pharmacies can be computed by a client using the query interface.
There isn't a special operation that returns these values, but the query interface enables a client to determine these values.
Pharmacies are represented by Location instances that are linked via OrganizationAffiliation instances to Networks.
Pharmacy types are represented by specialty codes from the NUCC Provider taxonomy.
So, for example, to count all pharmacies in a network, a query would look like this:
https://davinci-plan-net-ri.logicahealth.org/fhir/OrganizationAffiliation?network=Organization/plannet-network-HPID010000&_include=OrganizationAffiliation:location&location.type=OUTPHARM
And then count the number of Locations returned. The pharmacy specialty is provided in the OrganizationAffiliation instance, so to filter by compounding pharmacy the query would be:
https://davinci-plan-net-ri.logicahealth.org/fhir/OrganizationAffiliation?network=Organization/plannet-network-HPID010000&_include=OrganizationAffiliation:location&location.type=OUTPHARM&specialty=3336C0004X
Regards,
Saul
Scott Robertson (Nov 09 2020 at 23:33):
Yes, I thought about counting the pharmacies - or more specifically using the Bundle.total. And doing the same for each specialties - which requires the requester to request each specialty. Alternatively, request all pharmacies including their specialty(ies) (count=Bundle.total) and then analyzing the returned pharmacies by specialty (to get the mix).
I'm concerned with this approach for reporting the mix. When CMS indicates they want information in a report, they usually do not mean "provide enough data so the receiver can derive the specified information". Is there any info from CMS in this regard?
I submit a question to CMS, but my connection to CMS is indirect and may take some time.
Saul Kravitz (Nov 10 2020 at 14:01):
I'm not sure the bundle total is going to cut it, since the count is based on the number of locations that satisfy some critieria, but the query would probably be against OrganizationAffiliation. So, some minimal processing of the bundle will be required by the client. This question has arisen previously, and CMS is aware of the approach. I'm not sure their awareness has been communicated. I am not a CMS spokesperson.
David Clowers (Nov 10 2020 at 21:55):
I'm also curious about this topic. What specifically is meant by pharmacy "mix?"
Scott Robertson (Nov 10 2020 at 23:19):
how many are retail, compounding, specialty, etc
David Clowers (Nov 11 2020 at 18:17):
@Scott Robertson I'm assuming these are types of pharmacies?
Scott Robertson (Nov 11 2020 at 18:23):
There are NUCC taxonomy codes for pharmacies which are present in OrganizationAffiliation.specialty. I believe those are the concepts CMS wants in the mix report. Although it's not clear, in the final rule the say "...mix (e.g., retail pharmacy)..." Another point to clarify with CMS.
332000000X Military/U.S. Coast Guard Pharmacy
332100000X Department of Veterans Affairs (VA) Pharmacy
332800000X Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharma-cy
332900000X Non-Pharmacy Dispensing Site
333600000X Pharmacy
3336C0002X Clinic Pharmacy
3336C0003X Community/Retail Pharmacy
3336C0004X Compounding Pharmacy
3336H0001X Home Infusion Therapy Pharmacy
3336I0012X Institutional Pharmacy
3336L0003X Long Term Care Pharmacy
3336M0002X Mail Order Pharmacy
3336M0003X Managed Care Organization Pharmacy
3336N0007X Nuclear Pharmacy
3336S0011X Specialty Pharmacy
Saul Kravitz (Nov 18 2020 at 16:21):
These are the only 'types' of pharmacies that the IG can specify.
It would certainly be straightforward to compute the 'mix' of these types using the IG's query interface.
I don't know whether DaVinci has sought/received any guidance on this from CMS.
Last updated: Apr 12 2022 at 19:14 UTC
