Monday, January 23, 2012

Something to chew on

I logged on to Facebook the other day and saw a status update from one of the guys from my high school days. He was commenting on the service that he received from a few different pharmacies as he was attempting to find on of the medications that is currently in short-supply.

Would it surprise you to find out that one of the national chains didn't even acknowledge him standing at the drop-off window? Not a "we'll be with you in a moment". Not a nod from a pharmacist or tech to let him know that they spotted him. In fact, two different techs/cashiers walked past him at the drop-off window on their way to the pick-up window to wait on people who entered the pharmacy after he did.

Once he was finally waited on, it took over thirty minutes for the pharmacy staff to inform him that the medication was not available. Needless to say, he was disappointed with the service that he received at the pharmacy. Not one to remain quiet, he addressed the store manager about the "extra care" that he received. Did he receive an "I'm sorry" or any form of compassion from the manager?


The manager pointed to a customer comments phone number that was posted on a sign and was told to call the number.

He went to another pharmacy and was able to obtain the medication. In and out, with pharmacist consultation, in under 15 minutes. He was singing praises about the pharmacy that took care of him. Even to the point of giving the address of the pharmacy in the comments after his post.

In my retail days, I never really thought about how people would comment about the care that they received at my pharmacy on the social media sites. We hear about word-of-mouth advertising, but this was the first time that I have seen it play out in the social media. The volume of comments that his update generated was astounding.

If we, as pharmacists, want to be recognized as individual medical providers then the type of service that the first pharmacy provided is unacceptable. Patients aren't going to want to see providers who ignore their presence for 15 minutes. Sadly, this type of service is common from what I've seen of the first pharmacy chain.

If we want to advance the scope of our practice, we need to provide care that exceeds the patient's expectations. We want the social media to have complements about our profession, not complaints.

Isn't there a saying that says it takes 10 positive comments to cancel the effects of one negative one. Maybe we should set that as our benchmark for how we see pharmacy experiences reported in the social media.

Just something to chew on for a little bit.

AMA vs APhA.... looking out for the interests of their members

Just a quick note on this article that I found on Twitter today.

The AMA pays close attention to the reimbursements that its members receive from third-parties and addresses the issues instantly. Whenever the evening news announces a cut in Medicare reimbursement rates, you can put money down that the AMA will have a statement releases by the start of the next day's news cycle. The AMA understands that without adequate reimbursement, the standard of care will drop and businesses will fail. In the article that I link to, the AMA offers ideas for its members who might be a little cash-strapped.

Let's compare that to the APhA.

The big topics in retail pharmacy over the last couple months has been the Walgreens-Express Scripts drama over reimbursements.

I did a little search on the APhA website to see if there was any commentary on the issue. From the home page I searched for "Express Scripts". Top search result...a 2007 article about drug prices.

So I went over to the APhA CEO blog. With the edit button of my browser I did a "Ctrl+F" (Find on this page) search for "express". Only one match for "express" among the ten blog posts. You probably already know that it didn't match up to Express Scripts.

One of the biggest stories in pharmacy, centering around reimbursement issues, and the APhA has yet to address the issues on its web-site.

Rule #1 for business. You must make money to stay in business. The AMA gets it.

Tuesday, January 10, 2012

Pharmacists as providers?

This past weekend marked the six-month anniversary of my transition from retail to hospital pharmacy. It seems like only yesterday that I was behind the pharmacy counter, while it also seems like forever since I’ve been in a community pharmacy.

One thing that immediately jumps out at me on the difference between the two settings is the manner in which I am treated as a pharmacist. In the retail setting, physicians and nurses (or receptionists or whoever the physician allows to represent them on the phone) didn’t seem to respect the knowledge of the pharmacist. I felt that I was viewed as a nuisance. Not so in the hospital setting. On a daily basis I am asked for my input on decisions relating to the care of my patients. A vast majority of the time my recommendations are accepted and implemented.

It didn’t take long for me to realize that hospital and community pharmacy are worlds apart with regards to the practice of pharmacy. I follow what is happening in the retail sector through blog posts and Twitter updates, but for the most part the issues in retail have no bearing on my practice in the hospital setting. And by the same token the issues that hospital pharmacists face don’t mean a whole lot to the folks out in the retail trenches.

The profession is clearly divided and it’s no surprise that pharmacy isn’t represented that well by the national organizations. There isn’t an issue that all of us can get on board with in order to have a united voice. So you end up having several different organizations (NCPA, ASHP, ASCP, etc…) representing their individual interests, trying to talk over each other and in the end nobody’s voice is heard.

The American Pharmacist Association, in my opinion, should be the organization that should be able to speak for all pharmacists. If you pay attention to the opinions expressed on the social media, pharmacists don’t feel that the APhA is doing much, if anything, to address the issues that pharmacists are facing.

The APhA has totally bought-in to the medication therapy management (MTM) practice model. Over the past 18 to 24 months, various articles have tried to sell MTM as the pharmacist’s component of accountable care organizations, patient-centered medical homes, and collaborative practice arrangements. While I believe that MTM-style services are where pharmacy should be heading, I believe that the so-called leaders of the profession missed a key component of the equation when they decided to go all-in on MTM.


Sure, some Medicare Part D plans are reimbursing pharmacists for MTM services, such as comprehensive medication reviews. But these are limited to the patients who are selected by the insurers. Rather than accept the practice model no-questions-asked, how about taking a step back to get all of our ducks in a row? How about getting us recognized as providers so that MTM services are reimbursable from all insurers and can be offered to all patients instead of the select few Medicare Part D-ers.

The first issue that should have been addressed is recognition of pharmacists as medical providers. If pharmacists receive provider status and are able to bill for services rendered, the entire MTM practice model will take off. There are innovative minds in the pharmacy world that will revolutionize healthcare, but we need to be sure that the bills will be paid at the end of the day. Changing the practice model today with the hopes of reimbursement tomorrow isn’t going to cut it. We need to become recognized providers now. There is a petition floating around out there to try to get pharmacists recognized as providers. If you haven’t done so already, I suggest that you check it out.

Provider status is the issue that covers a majority of the practice settings for pharmacists and could unite the profession into a strong voice. Over a year ago I wrote on how different practice settings could benefit from being recognized as providers*. Community pharmacists could bill professional fees for DURs, OTC consults, and even calls to insurers (nowhere in my state’s pharmacy practice act does it state that pharmacists must call insurance companies). For each service that we provide, we should bill. The days of counting on dispensing fees to cover the costs of these services are long gone. Pharmacists need to be reimbursed for the professional services that are provided.

On the hospital and consultant side, pharmacists could charge for consults and interventions that occur daily. These are documented at many facilities; we just need to develop a charge sheet to be able to submit to the insurers and Medicare. Services such as anticoagulation clinics, diabetes/asthma/COPD-education, and nutrition education would be areas where pharmacists could make a huge difference if the reimbursements were there.

I don’t know what it’s going to take for pharmacists to unite as one voice. It might be the APhA taking the lead and pushing for recognition as providers. It could be retail pharmacists saying enough is enough and forming a union to get issues addressed.

Whatever the practice setting, I think that we all can agree that we need to be paid fairly for what we do as professionals. Recognition as providers is the first step towards achieving that goal.

*Previous posts of mine that address this issue