Thursday, July 29, 2010

Drug Topics wouldn't touch this idea

The following is the article I submitted to Drug Topics. I asked them to give me a response to see if they would consider using it and they haven't responded yet. Rather than sit and wait for weeks or months for a reply, I'm publishing it here. They can put it in Drug Topics as well, but I feel that this article may help pharmacists to view themselves as individual health care providers instead of as employees of some corporation.

So here, enjoy the post that Drug Topics might be afraid to publish.



Recently I had to take my daughter to the local emergency department for a nasty cough. It was on the weekend and in the middle of the night, so her pediatrician was not available and the urgent care centers were closed.

It’s been a few weeks and the insurance EOBs are starting to arrive in the mail. While reviewing these I had what may be an epiphany.

For our hour or so in the ED, we will be receiving bills from the emergency department, the ED physician, the radiology department, and the radiologist. Two bills from the facility and two bills from the health care professionals.

That got me thinking. On-line and in the pharmacy publications I see pharmacists wanting to be reimbursed for their professional services. Some pharmacists are able to generate an income stream through Coumadin clinics and medication therapy management services, but for a lot of community pharmacists the populations we serve can barely afford their medications, let alone these additional services.

Then it hit me. Why aren’t pharmacists billing the insurance companies for our professional services each and every time we fill a prescription?

We’ve allowed the reimbursements for pharmacy services to be lumped into the reimbursement formulas for the drug product. Guess what people? Those contracts are with the pharmaCIES to provide the product. PharmaCIES are businesses or departments where medications are stored and sold. (A July 12 article by David Witmer on the ASHP blog echoes this thought)

PharmaCISTS are medical professionals who review medication orders for accuracy, perform drug utilization reviews on each and every prescription, and educate patients on the proper use of their medications. The pharmaCY can’t do this, only the pharmaCIST. But only the pharmaCY has a contract with the insurer.

I believe that if we, as pharmaCISTS, want to show our value to the health care system, we need to actually try to get reimbursed for each time that we perform a professional function. Physicians do it every time they take a blood pressure; it increases the complexity of the visit. Why not us? Why aren’t we billing for our services each and every time.

We’ve allowed our professional services to be lumped in with the dispensing fee that is tacked on to the MAC or AWP-minus formula that the insurers set. I don’t know about you, but I feel that my professional expertise is worth more than $2.25 per prescription (0.00 on three month Medicare D orders). Well actually less than $2.25 when you factor in costs of vials, labels, technicians, utilities, etc…

As pharmaCISTS, we need to find a way to bill for our professional services each and every time we fill a prescription. The insurers need to contract with the pharmaCISTS, as well as the pharmaCIES, to provide the entire prescription product (medication, consultation, education). They do it for both the hospital and the physician. Why not pharmaCY and pharmaCIST?

I suggest that software be designed to send the NPI of the dispensing pharmacist to the insurers and that the insurers send reimbursement for professional services directly to the pharmacist of record. If we, as pharmaCISTS, truly want to be reimbursed for our professional services, we need to get serious about it and approach it on a wide-scale.



I don't know if this idea has been proposed before. I don't care if it has been or not. It needs to be discussed now. Right now we, as pharmaCISTS, need to get our act together before it's too late. Don't count on the corporations to look out for the well-being of the pharmaCISTS. They are doing everything they can to get tech-check-tech and other legislation passed so they can decrease pharmacist payroll, if not the pharmacist position completely. Don't count on the pharmacist organizations to do anything for you.

It's up to you.....the PHARMACIST.

12 comments:

The Redheaded Pharmacist said...

I agree Eric. It seems like every other healthcare professional has the ability to bill insurance companies directly for their professional services so why not pharmacists? Insurance companies will want to know why we are worth the money but pharmacist MTM services have already been proven to save healthcare dollars. We have the data to back up our claims now. Step one was making it so pharmacists were able to get provider numbers. That was a bigger deal than most pharmacists may realize. Now we simply have to set up some software that allows for us to add a "professional pharmacist" fee or whatever you would want to call it to a claim when billing insurance companies. And the other thing I think is real important is for pharmacists to track patients and show that they are doing better and using less healthcare services by having the pharmacist monitor their care. That way we can take numbers to the insurance industry showing them how much money we save them per patient per year. If we can do that we can justify a generous fee for our efforts and the insurance companies will gladly pay it to save overall expenses per patient going forward. We can justify our fees and show our worth in real dollar amounts! It just takes time and a lot of effort.
On a side note Drug Topics magazine may just be slow in responding to guest columns submitted to them. Hopefully they will realize that this article is worthy of publication and do the right thing. Thanks for posting it here Eric!

Phathead said...

That's just so crazy it might work!

I imagine at SOME POINT this will happen. It's something that can not be ignored forever, but will be put off as long as is humanly possible.

I too have been hitting up Drug Topics with ideas as of late. Haven't heard back much myself, but perhaps they aren't overly interested in a somewhat liberal student lol

Anonymous said...

I clued in Julianne at the magazine to chedck out your essay.

First step is for every RPh to get her/his personal NPI#.

Jay Pee

Anonymous said...

With more and more drugs going out via a FREE and/or $4 promotion list the insurance companies can only sit back and laugh at any request by a pharmacist for more reimbursement for anything we do. I have even heard rumor that flu shots will be undercut by one chain over another this coming season. MTM sounds good til the chain across the street agrees to do reviews for less than you too. And so on. It's a dying profession. I feel sorry for the new grads they are pumping out of all the new Rx schools. No more signing bonuses. And wages have no where to go but down from here.

Anonymous said...

I have to agree with the above poster, I do not see the insurance companies wanting to pay for these services. I see so many of my classmates just wanting their paycheck and then going home, they care nothing for advancing the profession, hell they want the least work possible.

I hope pharmacists can band together and make this happen but I see retail as a volatile area with the tech responsibility growing and the chains looking to cut pharmacists as much as possible.

As a student it is frustrating to see how disconnected pharmacists are from one another.

I have worked with some great retail pharmacists, they really care about their patients but their workloads are just so heavy that they do not want to take on any extra roles.

I am coming from a limited student perspective but I have worked in 3 hospitals and 2 clinics...a small critical care hospital, federal facility, low income clinic, and a medium sized hospital and every single one of those facilities had pharmacy teams actively trying to advance their roles, collaborate with providers, counsel/teach in patient rooms, add protocols, increase abx monitoring, join code teams, take on primary care monitoring roles: lipid, htn, coag, chf, asthma, support groups and so.
I have worked in many retail pharmacies from large to small and I rarely see the pharmacy team meeting on a regular basis discussing how they can advance patient care or advance the profession.
I agree with you Eric, I think your idea has the patient, pharmacist, and health system in mind but it hurts me to say I do not see retail pharmacists rallying together to support this. I hope I am wrong.

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Eric, RPh said...

The $4 and free generic programs are killing the profession. Driving to work yesterday I heard an ad on the radio where a regional grocery chain was giving away certain diabetes medications for free.

Where were the pharmacists when this was discussed? Certainly not in the meeting room.

This is one of the areas that the national pharmacy organizations need to address now, if not sooner.

Anonymous said...

"... I see retail as a volatile area with the tech responsibility growing and the chains looking to cut pharmacists as much as possible."

Could not agree more. If these chains doing the FREE and $4 promos could legally open the gates in the morning without a pharmacist and just man it with technicians they wouldn't have time to think twice. They would do it in a second. The department is run strictly as a loss leader for them.

The ONLY thing that can put an end to all this nonsense in the retail environment unfortunately is a for a major mistake to happen from all the distractions this low ball pricing puts on the pharmacy team. Hopefully it would make national news and the pharmacy boards that close their eyes to all this would have to step in. I just hope it doesn't happen to me.

Anonymous said...

I hope this is workable Eric. Something needs to done to force the profession back into relevancy. It will all depend on whether the real pharmacy leaders (chains and PBMs)can be convinced that their bottom line will be better served with a pharmacist pay per service wage rather than the current flat rate salary. I hope TPA steps in with some very strong legal counsel, or we may be working for next to nothing. I also fear a multi-tiered class of pharmacists will emerge consisting of dispensing pharmacists/technicians, clinical pharmacists, and advanced practice pharmacists. The road ahead will be rocky and the biggest obstacles will be within our own ranks.

Eric, RPh said...

I wouldn't count on the chains or PBMs to lead. And I don't want them to. They don't care about the profession, only the bottom line.

We, the PHARMACISTS, must decide that we are PHARMACY PROFESSIONALS and should be compensated accordingly.

Once you decide that you deserve to be paid as a PHARMACY PROFESSIONAL and not as an employee of XYZ Pharmacy, then you pressure the organizations (such as the APhA and your local state association) to start representing you, the PHARMACY PROFESSIONAL, at the federal and state levels.

The Nail Narc said...

hell yea, Eric!

What's up with DT lately? It sorta sucks. Why they'd pick some lame blogger's article over yours, I'll never know!

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