|Member Profile - Jonathan Shaatal|
Practicing in a Long-Term Care Rehabilitation Center
This is one in an occasional series of member profiles. All pharmacists were asked to provide answers to several questions. This was originally published in the June, 2014 issue of The Consultant Pharmacist.
Jonathan Shaatal, MS, RPh, is director of pharmacy at the Four Seasons Nursing & Rehabilitation Center located in Brooklyn, New York, and president of PharmQuestR, a pharmacy consulting company.
Tell us about yourself and your business/ practice.
My concentration in pharmacy has always been in long-term care. While still an undergraduate, I worked part-time in a nursing facility as a pharmacy technician, but I was drawn to a career in long-term care after visiting my grandmother in a nursing facility. I noticed a pharmacist in a room filled with medications and textbooks. What was interesting to me was that this staff member was being asked questions about medications and dosages by various members of the health care team. It was obvious that the pharmacist was seen as a valuable resource. When things quieted down, I asked him about his job. After a brief conversation I was convinced that this was a profession that was well respected and that it was something that I would be happy doing.
I have been a director of pharmacy in various longterm care facilities, and I am presently the director of pharmacy at the Four Seasons Nursing & Rehabilitation Center in Brooklyn, New York, which provides shortterm rehabilitation, long-term care, hospice, dialysis, ventilator, and adult day care services.
What are the challenges of working in a long-term care facility?
One of the greatest challenges is helping our patients to transition from the community to an institutionalized setting. For many, this is their final home, and we try to provide them with the respect, privacy, and dignity they deserve. As pharmacists we recognize that our population receives multiple medications for multiple comorbidities and that our job is to strive to ensure that the patient receives the most appropriate medications. Often, we are asked about dosages, frequencies, and other clinical issues as they relate to medications, so we always keep ourselves up to date with information on new medications that arrive with our patients from the hospital and the community setting.
How difficult was it to start your own consulting practice?
In 1988, I started a pharmacy consulting practice called PharmQuestR. We now service 25 long-term care and health-related facilities, performing medication regimen reviews, inservice education programs, and consulting services related to establishing institutional pharmacies.
The most difficult aspect of starting a consulting practice is understanding your given setting—in this case long-term care—and acquiring the knowledge base before you can begin to market yourself as a consultant; this takes patience and time. We began to market ourselves as consultants after seven years of exposure in the long-term care setting. We have never advertised our services, and have acquired every account through word of mouth and peer recommendations.
What have the highlights and challenges been over the years?
One of the biggest highlights of my career has been establishing an in-house pharmacy in a long-term care setting back in 2006 after the advent of Medicare Part D. The Four Seasons facility made the unprecedented decision to cut its ties with a long-term care vendor pharmacy and establish its own in-house pharmacy. We introduced high-speed automation with a seven-day dispensing feature, commingling medications according to the time of administration. We also were the first long-term care facility in the New York City area to transition to a complete electronic health record in 2007. This allowed us to more effectively manage the facility’s formulary, correct and update medication orders, and perform medication regimen reviews in a much more efficient manner.
One of the many challenges facing consultant pharmacists today is the shrinking profit margins we experience on a day-to-day basis. Profit margins appear to erode every year, with reduced maximum acquisition costs and reimbursements that at times are less than our costs. Unlike chain pharmacies that can survive easily in such an environment because of their tremendous over-the-counter sales, long-term care pharmacies (both in-house and vendor pharmacies) rely on fair and adequate reimbursement from payers such as Medicare Part D and Medicaid to fund their software systems, automation, staffing, and other operating costs.
What are your hopes for the future of your business/practice?
In my opinion, the future for pharmacy is in the area of immunization. I would encourage all pharmacists to become “immunizers” and be a part of this exciting new opportunity. Many states allow pharmacists to provide and bill for immunizations against influenza, pneumonia, and shingles. I believe that this is just the first rung of the ladder, and in time pharmacists will provide many more approved vaccines to both children and adults. This is particularly appealing because pharmacists can bill the medical part of the patient’s insurance, which provides reimbursement on the vaccine, supplies, and administration.
What advice can you offer other consultant and senior care pharmacists?
The number one advice I would offer to a new graduate or a pharmacist interested in long-term care is to take advantage of resources available through ASCP. It provides up-to-date drug information as it relates to the older adults, continuing education, and the opportunity to interact with colleagues and experienced members at the annual and local chapter meetings. ASCP also provides extremely valuable information on federal rules and regulations pertaining to long-term-care. As a pharmacist and member of ASCP, I believe it is important to mentor students in local colleges of pharmacy and to become involved and advocate on behalf of the profession.