Thursday, September 9, 2010

Out of the Box

There's a nice discussion going on over at the MTM e-community portion of the APhA website about pharmacists being recognized as providers by medical insurance companies in order to be reimbursed for providing MTM services.

I read the first few comments on the thread and decided that I had to share my two cents. Since that section of the site is members-only, I thought that I would share the comments that I left. I believe that my comments should be considered for every new venture that pharmacists pursue.

My comments were the following:

We, as pharmacists, have grown accustomed to being contracted with insurance companies as a result of the dispensing function. We are comfortable having that contract with the insurers. It gives us security.

Over the years, the insurers have chipped away at the reimbursements to pharmacies. So pharmacists have looked for alternative methods to generate income. MTM is one method where we can utilize our professional expertise and see the impact that it has while getting reimbursed at a decent rate.

So why are we in a rush to get contracted with an insurer?

The insurance companies have people whose sole job responsibility is to reduce costs for the insurer. Don't you think that they will reduce payments to MTM providers? They are doing it to physicians. Do you think pharmacists will get treated any better?

Maybe we need to take a step back and talk to physicians about how the insurance companies have treated them over the past 10 years. Maybe we don't want to jump into bed with the insurance companies right away. Just looking at the EOBs that I receive from my medical insurance company shows me how much the providers discount their professional services. I'm not sure that I want to do the same. I'm not willing to bill an insurer my U&C only to see them discount it 40 percent.

Maybe we should take a look at how dentists have set up their contracts. They seem to be sitting pretty on the reimbursements.

I just think that if we are going to pioneer a new practice in the field of pharmacy, we need to be careful to not give away the farm in order to say that we are a provider for XYZ Insurance Company. I like what Don has said that he does...bill the patient directly and take payment, then provide the patient the form to submit to their insurer. We protect our fees this way. As insurers see more people seeking reimbursement for our services, they may approach us about being providers. We can control the reimbursements better this way. I don't like the idea of submitting claims and hoping to be reimbursed. Collect from the patient and let them worry.

* * * * *

I started pharmacy school twenty years ago. I didn't have an internship until late in my schooling, so I only have about sixteen years behind the counter. In those sixteen years, I really haven't seen too many new ideas for pharmacy. Immunizations and MTM are the only new things.

The sad thing about this lack of change is that most pharmacists that I talk to really don't care to see the profession evolve. They are there to collect a paycheck and go home. Get up tomorrow and repeat. They are literally trapped inside the box.

Pharmacists need to get out of the box. One of the other comments on the thread was the following: Many times our biggest obstacles are other resistant pharmacists who can only think of why we shouldn't expand our cognitive services and recognition for those services or colleagues who cannot visualize us as anything other than what we have traditionally been in the past professionally (i.e. the "in-the-box" thinkers).

As a pharmacist (or student), you need to step back and do a little self-evaluation. Are you an in-the-box pharmacist? Are you okay with allowing your professional practice to be dictated to you by others, many times non-pharmacists?

Or are you going to step out of your comfort zone and start to think outside of the box? There are limitless opportunities to expand your practice if you take a look outside of the box. Are you going to be the pioneer to lead pharmacists into a whole new world of pharmacy?

I fear that 99 percent of the people who read this will think it sure would be nice to see the profession evolve, but then do absolutely nothing about. I encourage the other one percent to voice their thoughts and ideas, preferably as a comment (so everybody can benefit) rather than as an email to me.

We, as pharmacists, need to set the agenda for the pharmacist organizations. Rather than follow along with (or gripe about) whatever the organizations are proposing, we need to get our own ideas out and discussed. If we get enough chatter going, it might, just might, get heard by the organizations and get acted on.

Even if the organizations don't listen, that doesn't mean that we can't share our ideas about the profession of pharmacy and how we can expand the roles of pharmacists.

Personally, I'm aiming big. I want to build a self-sustaining medication therapy management business that is not affiliated with a dispensing pharmacy. I want to be recognized for the medical services that I provide, not the product that I put in a bottle. It's going to take some time, but I believe that the effort is going to pay off.

I hope to see other pharmacists join me in taking the profession to another level. I'm tired of dealing with third-parties and junkies and ungrateful people. That's the stuff I've seen from inside the box for the past sixteen years.

Come join me outside of the box, it's going to be fun.


Anonymous said...

I wanted to get into hospital pharmacy umpteen years ago because I didn't know how to handle being my own boss and pharmacist advocate. Since then, I've seen that boxing myself in with a 9-5 (or other specific shift) means that advancement is limited to the dictates of a boss, whose personality may or may not be compatible with my expectations. So, I quit my hospital after 15 years, went back for the advanced degree and sought agency work to see different pharmacist 'work' options. Since the schooling and different exposures, I decided to work part-time in various settings which legitimizes my assessment of the situation somewhat. (I don't fill in for Walgreens or other chains that have their own relief pharmacy positions.)

What I see is that as individuals we gain respect by our impact and positive efforts in settings outside of work and in how we do our job. Some employers 'force' licensed pharmacists to portray themselves in non-professional activities by limiting input into daily pharmacy work-flow and working conditions, kowtowing to pushy patients, and requiring genuflection to disinterested health insurers, technicians, and ancillary personnel. And, if the credentialing, licensing, and pharmacy profession decision-makers are not doing anything to ensure pharmacists have a voice in how the profession is practiced, then it's probably past time to 'step out of the box'.

I find that working part-time somewhat limits my input into specific management decisions, but it also liberates me in telling other groups of pharmacists that their present working conditions do not have to be accepted, that there are other choices in how to do things, and in fact some of the practices I've observed might be considered unprofessional or illegal. Some of the chain jobs where I work, though, my only interaction is with the techs or with letters to the manager about why I would never work there again.

Guzzo said...

Some pharmacists would consider pharmacy to be evolving while other pharmacists would consider the profession to be de-evolving.

If one went to pharmacy school with the idea of practicing the traditional concept of community pharmacy, then one may not be happy with the changes being presented as thinking "outside-the-box".

However, if potential pharmacy students are being presented with the "evolving" practice of pharmacy by the universities, where they are expected to provide services traditionally associated with doctors, nurses, or PAs, then they should be happy upon graduation when competing with the established healthcare providers. It was expected.

Personally, I signed up to be a traditional pharmacist. If I wanted to practice "evolving" community pharmacy, I would have went to medical or nursing school.

Scott said...

Hey, I'm a relatively new technician who will be applying to pharmacy school shortly. I don't have a lot of experience behind the counter yet, but I am trying to change that. Because of this, what I say is just my opinion, and I cannot stress that enough.

From what I've seen working at a big chain pharmacy, everything is really de-evolving. There really aren't a whole lot of independents left in my city, most of the chains have taken over. At least my state still requires that a pharmacist owns a majority of the pharmacy, even if it is in a corporation.

The pharmacists that I work with are basically glorified associates. During my shifts, I hardly ever, if even at all, see them give counseling to new patients on medication. This is something they are required to do, but the store doesn't care as long as the volume of scripts stays high. The patients just don't care until it inconveniences them, like when they don't read secondary labels and do something stupid, etc. This bothers me quite a bit, and it just enforces the stereotype that most people have of a pharmacist

We recently got a pharmacist trained to give immunizations, so at least that's a step, but I'd like to see pharmacists be able to apply the knowledge gained through those 4-5 years of school in some way other than calling insurance companies.

I'm hoping the situation is different for independents, otherwise I'm really losing hope in the profession. The pharmacists either just fill prescriptions like us or verify ours, mostly. The salary will be nice, and it would allow me to do a lot of good things, but is that all pharmacists are anymore, just a stamp?