tag:blogger.com,1999:blog-51334347521013340712024-03-17T04:17:35.219-04:00Eric, PharmacistThere are a lot of pharmacist-written sites out there that rant about the issues we face as pharmacists. Sites that hate on the patients, insurance companies, etc. This blog is going to be a little different. I'm going to try to address issues that we face as pharmacists, but offer solutions and insights instead of complaining...too much.Eric Durbin, RPhhttp://www.blogger.com/profile/09170995334706647447noreply@blogger.comBlogger184125tag:blogger.com,1999:blog-5133434752101334071.post-21203731572921583632015-06-01T09:35:00.000-04:002015-06-01T09:35:00.244-04:00Update on my MTM experience<!--[if gte mso 9]><xml>
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;">Even though I haven’t posted much on this blog over the last
few years, I still get emails fairly regularly from fellow pharmacists with
questions about medication therapy management, aka MTM. I thought that I should take a little time to
share what has happened over the last few years.</span></span></div>
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;">At one point, I had formed an LLC with the intent of
providing MTM services to local self-insured employers in an attempt to help
them control their health care expenses and to decrease absenteeism due to
preventable complications from chronic illnesses. The idea was to basically conduct
comprehensive medication reviews with high-risk employees and educate them to improve
adherence. I contacted in excess of
two-hundred companies and local governmental bodies. There were phone calls and meetings to
educate the decision-makers on how meeting with a pharmacist regularly could
help the employees and employers. </span></span></div>
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;">Two things always prevented the contract paperwork from
being signed…lack of recognition as providers from the insurance companies and
lack of hard data on the financial impact that pharmacists could make. We’ve been told for years about the successes
of the Ashville and Diabetes Ten City projects, but I have yet to see any hard
numbers on the actual impact that has been made. That lack of data was a sticking point with
the companies.</span></span></div>
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;">So after several years of trying to make a go of contracting
directly with employers, I gave up.
Since there had not been any progress on obtaining provider status
(other than having members of Congress sign on as co-sponsors to a bill that
never gets to the floor for a vote) I didn’t see the point of continually
spinning my wheels only to get nowhere.</span></span></div>
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;">At the same time, I left the retail world to take a director
of pharmacy position at a local critical access hospital. During the interview process several
physicians discussed opening an anticoagulation clinic. That sounded like a neat idea to me. I would be able to actually work directly
with patients to help improve their medication adherence, which was the whole
idea behind MTM when it was initially discussed.</span></span></div>
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;">As you can imagine with hospital politics, it took a while to
get the anticoagulation project moving.
I had spent several months working on the project and was told to put it
on the shelf. To say that I was mad
would be an understatement. I grabbed
all of the work that I had done and almost threw it into the trash can. Instead it found the bottom drawer of a
filing cabinet. </span></span></div>
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;">Shortly after the project was put on hold, it was
resurrected. A few road trips ensued to
see how other facilities were operating their anticoagulation clinics. I presented the clinic for approval and was
given the nod to move forward. This July
we will be celebrating our second anniversary as a clinic.</span></span></div>
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;">Looking at how I would have been practicing MTM if I had
been successful with first venture vs what I am doing now, I would have to say
that I am much more satisfied with what I am currently doing. I am actually managing the patients’
medications through the clinic. Through
the collaborative practice agreements that I have signed with the physicians I
am able to adjust therapy as I see fit instead of faxing a recommendation off
to a practice and hoping the nurse or MA will give it to the physician, who may
or may not agree with me.</span></span></div>
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;">It is my hope that pharmacists are granted provider status
so other pharmacists can enjoy their profession as I have been able to over the
last two years. When you are able to see
how a patient’s quality of life changes due to the impact of your professional
skills, you get the warm fuzzy feelings.
Not to knock comprehensive medication reviews, but you don’t see the
impact when you only see the patient once (maybe twice) a year.</span></span></div>
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;">I encourage all pharmacists and students to contact their
representatives to have them sign-on to the bill that has pushed forward. But don’t stop and be content with having
your Congressperson simply be a co-sponsor.
Contact the APhA and see what can be done to get the bill moved along to
get a vote.</span></span></div>
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Eric Durbin, RPhhttp://www.blogger.com/profile/09170995334706647447noreply@blogger.com2tag:blogger.com,1999:blog-5133434752101334071.post-65656832153109575252015-03-27T14:14:00.000-04:002015-03-27T14:14:23.257-04:00Pharmacists provide care with pharmacist-provided care<span style="font-family: Arial,Helvetica,sans-serif;">Lately I've seen the following header on emails that I have received from the APhA regarding the push for provider status. Maybe you have seen it as well. </span><br />
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<span style="font-family: Arial,Helvetica,sans-serif;">Maybe you've thought to yourself, "I think I've seen that phrase before...Pharmacists Provide Care." </span><br />
<br />
<br />
<span style="font-family: Arial,Helvetica,sans-serif;">That's because you saw it <a href="http://eric-rph.blogspot.com/2013/01/forget-mtm-im-doing-ppc.html" target="_blank">here</a> first...two years ago.</span><br />
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<span style="font-family: Arial,Helvetica,sans-serif;">I'm kicking myself in the rear end for not trademarking or copyrighting the phrase. </span><br />
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<span style="font-family: Arial,Helvetica,sans-serif;">I feel a little bit hurt that the APhA has <strike>stolen</strike> taken my phrase. </span><br />
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<br />
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<span style="font-family: Arial,Helvetica,sans-serif;">Maybe they will want to make amends by floating a free multi-year membership or a free trip to the annual convention my way.</span><br />
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<br />Eric Durbin, RPhhttp://www.blogger.com/profile/09170995334706647447noreply@blogger.com4tag:blogger.com,1999:blog-5133434752101334071.post-38900002675675952012014-08-25T19:48:00.001-04:002014-08-25T19:48:38.163-04:00Any PPC/MTM success stories our there?About a year-and-a-half ago I put up a post on providing pharmacist provided care (PPC) as opposed to medication therapy management (MTM). Since that time I've had dozens of pharmacists contact me with their thoughts and plans for attempting to start a successful PPC/MTM business.<br />
<br />
If you've contacted me and had success, please shoot me an email to let me know how things are going. Let me know what has worked and what hasn't so I can share that information for others. One of the problems that I see is that many of us are attempting to reinvent the same failed wheel. <br />
<br />
For me personally, I have been able to open an outpatient anticoagulation clinic at my hospital. We recently celebrated our first year anniversary. I'll share on that sometime in the (hopefully) near future.<br />
<br />
Until then, it's off to one of the kids' soccer/cross country/swim events and/or practices.Eric Durbin, RPhhttp://www.blogger.com/profile/09170995334706647447noreply@blogger.com0tag:blogger.com,1999:blog-5133434752101334071.post-76945785588489318942013-08-12T14:22:00.000-04:002013-08-12T14:22:25.156-04:00Flash follow-up<!--[if gte mso 9]><xml>
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<br />
<div class="MsoNormal">
<span style="font-family: Verdana,sans-serif;"><span style="font-size: small;">In my last post, I suggested that patients carry a flash
drive that contains their health information.<span>
</span>This drive would contain all medical information, including all
labs/procedures/prescriptions that were ordered.<span> </span>Upon admission to the hospital (or visit to
the physician) the staff could review this information and be able to see if
the patient had been compliant with the prescribed treatment plan.</span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: Verdana,sans-serif;"><span style="font-size: small;">I realize that asking the typical patient to keep track of a
flash drive is an impossibility.<span> </span>But
with the way technology is evolving it wouldn’t surprise me to see data like
this being able to be stored on a chip that is embedded in the patient’s
insurance card.</span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: Verdana,sans-serif;"><span style="font-size: small;">It would be easier to just design a system where all of this
data feeds into a central database, but I can’t see how such a system could be
secured.<span> </span>When our government can’t keep
national security documents safe I really can’t trust that the medical records
of millions of people would be able to be secured.</span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: Verdana,sans-serif;"><span style="font-size: small;">A few days ago I was talking with an acquaintance who works
with health insurance.<span> </span>We discussed
compliance, wellness plans, cost of healthcare.<span>
</span>Pretty much everything that has come up over the past ten years in the world
of health care costs.<span> </span>We came to the
same conclusion after our discussion.</span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: Verdana,sans-serif;"><span style="font-size: small;">People are going to do what they want.<span> </span>You can only incentivize so much, and some
people won’t go for the incentives no matter what.<span> </span></span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: Verdana,sans-serif;"><span style="font-size: small;">With the way the system is currently operating, we are enabling
the patients to be non-compliant.<span> </span>If the
patient doesn’t follow the treatment plan that has been developed by their
physician/health care facility, it’s the physician/facility that is going to
get dinged by not getting reimbursed.<span>
</span>The patient has no skin in the game.</span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: Verdana,sans-serif;"><span style="font-size: small;">By capturing all of the ordered procedures/tests/medications
on a device that the patients must carry with them, compliance with therapy can
quickly be determined.<span> </span>If the patient is
not compliant with therapy, the financial responsibility would get shifted from
the provider to the patient.<span> </span>Patients
who are chronically non-compliant would, as mean as it sounds, receive a lesser
standard of care as providers will be able to see that the patient is not
compliant and adjust the treatment to a level with which the patient would be
able to comply.</span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: Verdana,sans-serif;"><span style="font-size: small;">Before jumping down my throat about not giving the best care
to all patients, remember that the patients who this would apply to are the
patients who have already been given the best care.<span> </span>They have chosen not to continue with the
care plan that has been determined.<span> </span>The
cost for the additional health care expense should not be passed on to the
other members of the health care plan or to the taxpayers if the patient is on
government-funded insurance.</span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: Verdana,sans-serif;"><span style="font-size: small;">A provider/facility can only order so many tests, arrange so
much home health care, and provide so much medication to a patient.<span> </span>But when the patient doesn’t have the tests
run, cancels the home health care, and doesn’t get their prescriptions filled,
is it really the provider/facility’s fault that the patient is readmitted to
the hospital twelve days after discharge for the exact same diagnosis?</span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: Verdana,sans-serif;"><span style="font-size: small;">Maybe a little de-incentivizing is what is needed.<span> </span>When the patient realizes that they are going
to bear a greater portion of their health care expense if they are non-compliant,
perhaps they will follow the treatment plan.<span>
</span>For people who want to be compliant, but financial situations prevent
them from doing so completely, services such as pharmacist-provided care could
help them find alternatives to therapy that help achieve the therapy goals (at
a lesser expense).<span> </span>These services would
be reimbursable to the providers, and would be recorded on the device that the
patient carries with them as proof that they are attempting to comply with the
treatment plan.</span></span></div>
<div class="MsoNormal">
<br /></div>
Eric Durbin, RPhhttp://www.blogger.com/profile/09170995334706647447noreply@blogger.com2tag:blogger.com,1999:blog-5133434752101334071.post-26508981593488423822013-07-10T06:11:00.001-04:002013-07-10T06:11:56.811-04:00Is the answer as simple as a flash drive?<!--[if gte mso 9]><xml>
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<br />
<div class="MsoNormal">
Back in my community pharmacist days, one of my biggest pet
peeves was the lack of coordination of care that occurred when patients were
discharged from the hospital and transitioned back to the care of their primary
care provider.<span style="mso-spacerun: yes;"> </span>Many times when a patient
would follow-up with their primary care provider, they would have medications
ordered that were either duplications in therapy or worse yet, contraindicated
to the medications that were ordered upon discharge.<span style="mso-spacerun: yes;"> </span>It seemed as if nobody at the physician’s
office had reviewed what the discharge orders were.<span style="mso-spacerun: yes;"> </span>Figuring out exactly which medications a
patient was supposed to be taking took up a good portion of many days at the
corner drugstore.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Now I’m on the other side, at the hospital.<span style="mso-spacerun: yes;"> </span>When patients are admitted to our floor it
can take hours to figure out what medications a patient is actually taking.<span style="mso-spacerun: yes;"> </span>At my facility, a large portion of our
patients are poor historians.<span style="mso-spacerun: yes;"> </span>They don’t
know what medications they are on.<span style="mso-spacerun: yes;"> </span>They
don’t carry an updated medication list.<span style="mso-spacerun: yes;">
</span>Many don’t even know who their physicians are.<span style="mso-spacerun: yes;"> </span>It takes hours to figure out what medications
they are taking upon admission, potentially delaying care.<span style="mso-spacerun: yes;"> </span>Heck a couple weeks ago it took 36 hours to
get an accurate medication list from the VA for a veteran that was admitted to
our facility.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
There has to be a better way to reconcile medications to
allow for a better level of care for our patients.<span style="mso-spacerun: yes;"> </span>Is there a role that pharmacists can play in
this process?</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Some pharmacists would jump in and say MTM is the
answer.<span style="mso-spacerun: yes;"> </span>I’m not so sure about that, at
least not with the way that MTM is currently structured.<span style="mso-spacerun: yes;"> </span>With pharmacists not having provider status,
we are not able to bill for our services unless the patient is referred to us
by their Medicare-D plan (at least that’s how it is in my state).<span style="mso-spacerun: yes;"> </span>Second issue with this, not all patients who
are in need of our services are Medicare patients.<span style="mso-spacerun: yes;"> </span>I have had many patients in their 30s and
40s, working full-time jobs who could have benefited from pharmacist-provided
care. </div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
But back to the main point, improving communication between
physicians, facilities, and pharmacists.<span style="mso-spacerun: yes;">
</span>I don’t advocate a central database that contains all of a patient’s
health care information.<span style="mso-spacerun: yes;"> </span>In recent times
we’ve seen far too many sites get hacked and expose sensitive personal
information.<span style="mso-spacerun: yes;"> </span>I know that I don’t want my
information stored in such a manner.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
I would like to see patients carry their information with
them, say on a flash drive or similar device.<span style="mso-spacerun: yes;">
</span>At each encounter at the physician’s office, hospital, pharmacy, etc…
the device could be accessed to update information.<span style="mso-spacerun: yes;"> </span>Providers would be able to see what treatment
was ordered and check to see if the patient actually followed through with the
treatment plan.<span style="mso-spacerun: yes;"> </span>For example, patient is discharged
from hospital with an order for a LABA/steroid inhaler following an admission
for a respiratory problem.<span style="mso-spacerun: yes;"> </span>Five days
later they present to the ER for difficulty breathing.<span style="mso-spacerun: yes;"> </span>The ER staff could access the record and see
that the patient did not have their prescription filled, thus the return to the
hospital.<span style="mso-spacerun: yes;"> </span>The hospital would not get
dinged for a readmission within 30 days since the patient did not follow the
treatment plan.<span style="mso-spacerun: yes;"> </span>Compliance issues could
be identified and referred to the appropriate persons, say a pharmacist who
could educate the patient.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
The flash drive would also enable providers to see changes
in a treatment plan.<span style="mso-spacerun: yes;"> </span>Let’s say that a
primary care provider starts a patient on a medication. <span style="mso-spacerun: yes;"> </span>Two months later a specialist changes the
treatment plan.<span style="mso-spacerun: yes;"> </span>The specialist could
document that the original medication has been discontinued.<span style="mso-spacerun: yes;"> </span>When the patient presents the flash drive at
the pharmacy for updating, the discontinue order would be executed. <span style="mso-spacerun: yes;"> </span>Too many times I have seen a family member try
to help their loved one with medications, only to request refills on a
medication that has been stopped for months.<span style="mso-spacerun: yes;">
</span>A system like this would help prevent such situations.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
I know there are many gaps in my plan that would need to be
addressed, but this could be a start.<span style="mso-spacerun: yes;">
</span>What are you thoughts?</div>
Eric Durbin, RPhhttp://www.blogger.com/profile/09170995334706647447noreply@blogger.com3tag:blogger.com,1999:blog-5133434752101334071.post-50109988838211955642013-05-25T09:53:00.000-04:002013-05-25T09:53:17.287-04:00No words needed<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhgHdnzMS1MGEOAcw-JlMj_f5R3XtDdjirgHXUcXSxNzhCVxeLToLTgCkJ54H5y6s53C7jRHVfRxZAn1ygSxPaO5FLUeGgiiiPngU8OjbrIA-yVE3voqNVYMZPrl4tnyeOQ8UgGDwHVeJXO/s1600/IMG_1740.JPG" imageanchor="1"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhgHdnzMS1MGEOAcw-JlMj_f5R3XtDdjirgHXUcXSxNzhCVxeLToLTgCkJ54H5y6s53C7jRHVfRxZAn1ygSxPaO5FLUeGgiiiPngU8OjbrIA-yVE3voqNVYMZPrl4tnyeOQ8UgGDwHVeJXO/s320/IMG_1740.JPG" /></a>
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjKlohxDtkhOI7B5IKmYMlJzMpzLrGDEJXBBWJmxiI7AW4J7sR87rhB3-9gRLrQxjLTBAGHhr-aORU3VuhEvjPVhIZm-VX-1kXf-79qe3PHve2_MC1-bIGel8ehebhpLynwcAkyqVF6lObq/s1600/IMG_1736.JPG" imageanchor="1"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjKlohxDtkhOI7B5IKmYMlJzMpzLrGDEJXBBWJmxiI7AW4J7sR87rhB3-9gRLrQxjLTBAGHhr-aORU3VuhEvjPVhIZm-VX-1kXf-79qe3PHve2_MC1-bIGel8ehebhpLynwcAkyqVF6lObq/s320/IMG_1736.JPG" /></a><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgG-JbMukvDT-2Lce3UeyptIfIYUBuJC5m3agTdC5d2AHoR9wdkUNhh6hchipd8ldrtXfTmaUYmBKtceMRFqrmug68m6yDl1C5abqbvVey_-isPsBuEvgRyM-HJCTtZ8PZksa4bdafWLXbu/s1600/IMG_1827.JPG" imageanchor="1"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgG-JbMukvDT-2Lce3UeyptIfIYUBuJC5m3agTdC5d2AHoR9wdkUNhh6hchipd8ldrtXfTmaUYmBKtceMRFqrmug68m6yDl1C5abqbvVey_-isPsBuEvgRyM-HJCTtZ8PZksa4bdafWLXbu/s320/IMG_1827.JPG" /></a><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjj5PgPxLawucWU0dJ6ocBYBNAoRpjUtZelaMujHeP1GzI8fXUJ_46hJ6eRHTZa7lSMVMplSrRcyPPnfOlXs17UUM70dVnUj_kpgNncitsG6EMW15joKwQRc6RnyWD_2RERmvZyjxSaY_Uv/s1600/IMG_1845.JPG" imageanchor="1"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjj5PgPxLawucWU0dJ6ocBYBNAoRpjUtZelaMujHeP1GzI8fXUJ_46hJ6eRHTZa7lSMVMplSrRcyPPnfOlXs17UUM70dVnUj_kpgNncitsG6EMW15joKwQRc6RnyWD_2RERmvZyjxSaY_Uv/s320/IMG_1845.JPG" /></a><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiCOAx5frehmgRjPY0oOUNq5vAdff-ZcAfgpSptykue3NcBz2HMjl_8kbv9id0hs0PhARLQjqL9n21QWCz7x7KlohX8SGoTmZERVffy3u68wyCbKa_Mt6rcBuQTrXUPjAihXXT269irRt92/s1600/IMG_1837.JPG" imageanchor="1"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiCOAx5frehmgRjPY0oOUNq5vAdff-ZcAfgpSptykue3NcBz2HMjl_8kbv9id0hs0PhARLQjqL9n21QWCz7x7KlohX8SGoTmZERVffy3u68wyCbKa_Mt6rcBuQTrXUPjAihXXT269irRt92/s320/IMG_1837.JPG" /></a><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjayhpfCo2g1N-DrjDbbPD46z1d9_EOJQQxmxYdCCbIu06cacyEibZM15IWOuyDjd9BJedZ8hfj9dA499_e9oSi2gkOfbzsKtdycETjSiKhJwjgwo-yPUEjVyETbDFTpr570BAQ9jtzpQWP/s1600/IMG_1836.JPG" imageanchor="1"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjayhpfCo2g1N-DrjDbbPD46z1d9_EOJQQxmxYdCCbIu06cacyEibZM15IWOuyDjd9BJedZ8hfj9dA499_e9oSi2gkOfbzsKtdycETjSiKhJwjgwo-yPUEjVyETbDFTpr570BAQ9jtzpQWP/s320/IMG_1836.JPG" /></a><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi93dXsou8Cov6Bf-RfUIoyNIgsDs9CDZJp5D4JeuC_hp-me79b_ogzf79hhd8DnwPE5QES38NmIQIJz7CCTgniHcAnP1XBBf_yMbRobK3BREBGgmJxFV-5cZbkpEaG-cBLRroj0Ku7o2BM/s1600/IMG_1847.JPG" imageanchor="1"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi93dXsou8Cov6Bf-RfUIoyNIgsDs9CDZJp5D4JeuC_hp-me79b_ogzf79hhd8DnwPE5QES38NmIQIJz7CCTgniHcAnP1XBBf_yMbRobK3BREBGgmJxFV-5cZbkpEaG-cBLRroj0Ku7o2BM/s320/IMG_1847.JPG" /></a><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgON_MUOvIyCbXURkffwRWZzMa2gzixF3azgFobirC0aGsNSi6_VDi3865_MsOuJ_n3_cAsQ6s8fzhbbaE_PFFlFUAA3Hyc-IZ9m5DyO5HYPLm2vSW3IHxxV3ECo0hSnte4gFj3oc5UFKKb/s1600/IMG_1867.JPG" imageanchor="1"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgON_MUOvIyCbXURkffwRWZzMa2gzixF3azgFobirC0aGsNSi6_VDi3865_MsOuJ_n3_cAsQ6s8fzhbbaE_PFFlFUAA3Hyc-IZ9m5DyO5HYPLm2vSW3IHxxV3ECo0hSnte4gFj3oc5UFKKb/s320/IMG_1867.JPG" /></a><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiY_GODzODWdpwLjpfLu03SCiS-NRUHHvIEvtD-yYVkaQmoiTFpD6zH9KU9bMYNajz2lZvXJygqkrN4UIzD_JdXsv7fIVEVYEMKCOLx8Ij-SQYbZo0EVGBSU6bj1gxWpOyw4HZsJjuNv_tF/s1600/IMG_1933.JPG" imageanchor="1"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiY_GODzODWdpwLjpfLu03SCiS-NRUHHvIEvtD-yYVkaQmoiTFpD6zH9KU9bMYNajz2lZvXJygqkrN4UIzD_JdXsv7fIVEVYEMKCOLx8Ij-SQYbZo0EVGBSU6bj1gxWpOyw4HZsJjuNv_tF/s320/IMG_1933.JPG" /></a><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEixa4yRJ9hbmU4248lIJU2l92VwSb2orj-iMaY_vVrAzcXc1HhInrwRKfIJNPvFM9LJB2htcYk9uhjsHn_bd1LmaXOz3wCDw2HZO45EAK8qaMHMSYxdZQsmknsAcnhOnsMU-nKkf2i_yb_T/s1600/IMG_1959.JPG" imageanchor="1"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEixa4yRJ9hbmU4248lIJU2l92VwSb2orj-iMaY_vVrAzcXc1HhInrwRKfIJNPvFM9LJB2htcYk9uhjsHn_bd1LmaXOz3wCDw2HZO45EAK8qaMHMSYxdZQsmknsAcnhOnsMU-nKkf2i_yb_T/s320/IMG_1959.JPG" /></a><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgcKPH1FpAxgpG4qdyu6X7hOw3uV6x2DmJkQfhvJqBcYQxusICcyQb40mWXzgCSXo9hgh_x1wsnE9idUBVNNEvtsRA2br1PeF14LxHuj__Yucca5nYtcdBckCgsFkzeN4bSa7l3I8XX69gQ/s1600/IMG_1953.JPG" imageanchor="1"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgcKPH1FpAxgpG4qdyu6X7hOw3uV6x2DmJkQfhvJqBcYQxusICcyQb40mWXzgCSXo9hgh_x1wsnE9idUBVNNEvtsRA2br1PeF14LxHuj__Yucca5nYtcdBckCgsFkzeN4bSa7l3I8XX69gQ/s320/IMG_1953.JPG" /></a><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhFtZV8ULnoWaNPxitkfJD8Pu3J3GEe_sj3oST22rv6tTVFsxYFwfYtsDyvMvW41e3v31P104YM28xGshXZbyoeplrgfsGljs6iqUuFcPrfsBS2J2sj0hhsE2qwqXd8X4mKvOQaBB2RgVZK/s1600/IMG_1985.JPG" imageanchor="1"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhFtZV8ULnoWaNPxitkfJD8Pu3J3GEe_sj3oST22rv6tTVFsxYFwfYtsDyvMvW41e3v31P104YM28xGshXZbyoeplrgfsGljs6iqUuFcPrfsBS2J2sj0hhsE2qwqXd8X4mKvOQaBB2RgVZK/s320/IMG_1985.JPG" /></a><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiWJG3qU5xJU30zSb34-b9YFAWfVhwS_lLL0VwXGP0z77jXZl4-jX9S2tAD-soqWKKInKchvvxnS5rCOCXwGrm2R0GCMaezDNQR9hdXnM4FM66RZhjf6ofP9yFWcwXyZ-2Bf7p1G7cFRDu7/s1600/IMG_1997.JPG" imageanchor="1"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiWJG3qU5xJU30zSb34-b9YFAWfVhwS_lLL0VwXGP0z77jXZl4-jX9S2tAD-soqWKKInKchvvxnS5rCOCXwGrm2R0GCMaezDNQR9hdXnM4FM66RZhjf6ofP9yFWcwXyZ-2Bf7p1G7cFRDu7/s320/IMG_1997.JPG" /></a> /;<img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjmmWISPfenl_Xzaz4lbXLQtsFype0bhF239Zu5h8IQznsbSueRMdGlFqUhW4Zxt5wzCTsEHp8DSvmNl9CwtJeM3bAMxtdc2hBzCohZpeEQCf6egn8JewfgYumewybmr-TKTfGiDahBrcvW/s320/IMG_1835.JPG" />Eric Durbin, RPhhttp://www.blogger.com/profile/09170995334706647447noreply@blogger.com0tag:blogger.com,1999:blog-5133434752101334071.post-54677789749805937382013-01-28T21:54:00.005-05:002013-01-28T21:54:53.889-05:00Forget MTM, I'm doing PPCMedication therapy management.<br />
<br />
MTM.<br />
<br />
That's been the focus of the pharmacist organizations for the past several years. The thought of pharmacists providing direct care to patients in an effort to improve the health of the patient, as well as decrease the health care expenditures for both the patient and the third-party payer.<br />
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In my state, as well as many others, the focus of medication therapy management has been the Medicare patient. Those who have already reached "retirement". When Medicare Part D was introduced, the idea of providing direct care to patients via comprehensive medication reviews made many pharmacists happy. But as the years have passed, we've seen that not all Medicare D patients are eligible for the CMRs. Only the patients who meet insurer-defined criteria have been eligible to receive these services from pharmacists.<br />
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Shortly after providing my first comprehensive medication review for a Medicare D patient, I realized that the focus of pharmacist-provided care shouldn't be on the Medicare D population. These people are already well into their disease processes. Sure, we may be able to help educate these patients and help slow the progression of their health problems. But if we want to show the value of pharmacist-provided care, we need to change our focus.<br />
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We need to educate the younger patient. The 30-somethings who are being started on statins. The twenty-somethings who have been diagnosed with type-II diabetes.<br />
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I was pleased to see that the recent petition to recognize pharmacists as providers received the required amount of signatures. Provider status from Medicare will get the ball rolling for pharmacists as a profession. But we shouldn't wait around for CMS to act.<br />
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We need to take it to the local insurance companies. To the local employers. Sell the idea of pharmacist-provided care to the people in your community. If you generate a local buzz, people will take notice.<br />
<br />
Go to the local self-insured employer. Talk with them about how pharmacists can help decrease their medication expenses. Talk with them about how medication adherence can reduce other health-care expenses. Remind the employer that you can help employee be more productive during their work day. Teaching that diabetic employee about how to better control their blood sugar may increase their productivity by two hours each day. No more early afternoon blahs because the blood sugars are out of whack.<br />
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The profession has created a little bit of buzz about pharmacist care lately. Let's not let the momentum die as we wait for CMS to act or not. <br />
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Personally, I'm not going to use the term "medication therapy management" when I go out and talk about these services. Mostly because my state requires collaborative practice agreements to actually "manage" the patients' medications. I'm going to simply use the term "<i><b>pharmacist-provided care</b></i>". <br />
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MTM keeps the focus on the medication.<br />
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<i><b>PPC</b></i> puts the focus on the<i> <b>pharmacist</b></i>. The <i><b>pharmacist</b></i> as the provider. The <i><b>pharmacist</b></i> as the care-giver. Because folks, it's not all about the medication. It's about the knowledge that the <i><b>pharmacist</b></i> has that will make the difference in the health of our patients. Medications are simply one tool that we may use.<br />
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We can impact the lives of our patients. Let's not wait until they reach retirement age. Let's roll <i><b>PPC</b></i> out to the younger patient and make the difference in their health that we know that we can.Eric Durbin, RPhhttp://www.blogger.com/profile/09170995334706647447noreply@blogger.com4tag:blogger.com,1999:blog-5133434752101334071.post-14133613191613651862012-10-23T03:00:00.000-04:002012-10-23T03:00:17.891-04:00Affordable Care Act...coming to a community pharmacy near you?After sitting through several meetings last week, some of which included discussion of the value-based purchasing and readmission reduction programs that are included in the Affordable Care Act, I wonder how long it will take for the government (through Medicare-D plans) to implement similar programs that impact the world of community pharmacy.<br />
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You see, as pharmacy attempts to move forward and take a more proactive role in patient care we are going to be held accountable for results. Since individual pharmacists have not been granted provider status, the accountability will be passed to the actual pharmacy. This could be a good thing for the professional practice of pharmacy.<br />
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Now I have no knowledge of anything like what I am going to write about being in the works, but after hearing the presentation last week it seems entirely possible. And probably likely in the near future. Actually, I've wondered for quite a while about how long it would be until community pharmacies would be reimbursed based on performance. As the Affordable Care Act develops over the next several years, I can see similar programs being rolled out to the retail pharmacy.<br />
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Some of the measuring sticks for the hospital world under the value-based purchasing aspects of the ACA center on clinical outcomes, patient satisfaction scores, clinical outcomes, and efficiency in delivering medical care. This could very easily be translated to the community pharmacy setting. Can you imagine the change that would occur in the community pharmacy world if reimbursements were tied to things like time spent counseling patients, patient satisfaction scores, medication in-stock rates?<br />
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Imagine walking into a retail pharmacy and actually having a pharmacist be able to counsel a patient without worrying about falling behind by a dozen prescriptions. Imagine working at a pharmacy that has adequate pharmacist-staffing to allow for the patient interaction.<br />
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Of course this would have to be implemented in a manner similar to what is being done to hospitals. A certain percentage of reimbursements from government plans would be withheld, with pharmacies who achieve the goals receiving that money at the end of the year. This type of <i>incentive</i> would make some of the chain pharmacies focus less on the volume of prescriptions and more on the quality of care delivered to our patients.<br />
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Maybe extra reimbursements would be distributed to pharmacies that offer community education programs and show results. The few studies that have focused on the impact of pharmacist care on patient outcomes might actually be able to be implemented on a large scale.<br />
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What would happen if reimbursements were tied to the patient's perception of the care they receive at the pharmacy? If your patients believe that you are providing quality care and surveys back that up, you get an extra 4 or 5-percent on your reimbursements. I think the chains might react if better reimbursements are tied to the satisfaction scores.<br />
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The national pharmacy organizations have been pushing for inclusion of the pharmacist in the different health care models that are being debated. If we are included, we are going to need to show results. Be prepared to make the necessary changes and show your results. <br />
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<br />Eric Durbin, RPhhttp://www.blogger.com/profile/09170995334706647447noreply@blogger.com5tag:blogger.com,1999:blog-5133434752101334071.post-36932549233607505272012-10-08T15:00:00.003-04:002012-10-08T15:00:31.313-04:00Election day is on its wayI've found that as I get older, I have a greater appreciation for what the United States of America is. I have a tremendous amount of respect for the men and women who serve in our armed forces, preserving the freedoms that we have.<br />
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At the present time, I'm honored to have my children attend a school district where our veterans are honored. Our district has one of the top football programs in the state. The fans get jacked for our home games.<br />
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But at each home game, the crowd falls silent, rises to their feet, and honors our servicemen as an honor guard marches with the flag from one goal-line to the other. he crowd noise doesn't go down in volume a little bit. It is silent. You can hear a baby crying on the other side of the stadium. The amount of respect that is shown to our military by the crowd at the games is amazing. As soon as the honor guard comes to a halt, the band takes the field and the crowd gets back to its' pre-game craziness.<br />
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You don't see that in too many places anymore.<br />
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As we head into the election season, I encourage you to deliberate on what the United States of America is, and to vote for the candidates that represent the ideals of the United States.<br />
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One a side note... a local radio host has been playing this version of the Star-Spangled Banner over the airways quite a bit recently. After visiting the Smithsonian's American History museum a couple times over the last year or so and seeing the actual flag that the Star-Spangled Banner is written about, I have a greater appreciation for the words of the Star-Spangled Banner. Watch this video, reflect on the lyrics, and remember what the United States of America represents. <br />
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<iframe allowfullscreen="allowfullscreen" frameborder="0" height="315" src="http://www.youtube.com/embed/c8C7i9kdEf8" width="560"></iframe>
Eric Durbin, RPhhttp://www.blogger.com/profile/09170995334706647447noreply@blogger.com3tag:blogger.com,1999:blog-5133434752101334071.post-8057877992661455922012-08-22T07:25:00.000-04:002012-08-22T09:20:45.849-04:00Free preventive careLast night I received an email from the American Pharmacists Association that had a link to an article on the APhA website that caught my eye. This morning when I woke up, there were a few links to the same story on my Twitter timeline.<br />
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The story... <a href="http://www.pharmacist.com/pharmacies-team-hhs-promote-free-preventive-care">Pharmacies team with HHS to promote free preventive care</a>.<br />
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When I initially read the article on my smart phone, I read it as pharmacists providing care for free. That had my blood boiling and I wanted to jump all over the thought of free care. But I slept on it and re-read the article this morning.<br />
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The article states that there is growing recognition by HHS of the role that pharmacists play in a patient's health care. Personally I'm don't entirely agree with that, but I'll give that comment a pass.<br />
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HHS has, in what is called a pharmacist-friendly move, has partnered with pharmacists to.....<br />
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Drum roll<br />
...<br />
...<br />
...<br />
...<br />...<br />
... <br />
<br />
"...inform Medicare patients about free preventive services and the closing
of the Part D coverage gap under the health care reform law."<br />
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<br />
<applause></applause><br />
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Pharmacists get to put up posters and pass out fliers on free preventive services for the Medicare population.<br />
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WOOHOO!!!<br />
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I was hoping to see pharmacists get the opportunity to provide services to the patients (and get reimbursed for said services). But this announcement is underwhelming to say the least.<br />
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C'mon APhA. Pharmacists need to be the providers. If we wanted to be the advertising department for HHS, we would have majored in advertising.Eric Durbin, RPhhttp://www.blogger.com/profile/09170995334706647447noreply@blogger.com4tag:blogger.com,1999:blog-5133434752101334071.post-79687687866024497652012-08-14T22:19:00.000-04:002012-08-14T22:19:00.252-04:00Should I become a pharmacist?One of my oldest son's friends is entering her senior year of high school this year. Her plans after graduation...attend pharmacy school in order to become the clinical pharmacist in a children's hospital. An admirable career choice.<br />
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But, in my opinion, she's about ten years late on entering the pharmacy profession. I've told my son that I need to have a conversation with her before she totally commits to the profession.<br />
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Do I believe that she can make it through the academics? Absolutely. She has been taking advanced courses at the local college instead of regular high school classes since the start of her junior year. <br />
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The problem lies in the fact that about eighty-seven kajillion pharmacy programs have opened up in the last decade. Remember the days when pharmacists were in demand? Those days have long passed us. We are now facing a flooded jobs market.<br />
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With a typical course of study running eight years and debt loads pushing the quarter-million dollar mark, is it advisable to enter a profession where there are no guaranteed jobs? For basically the same amount of schooling you can become a physician. When I look at the news stories and see that there is going to be a shortage of physicians, I am inclined to believe that medicine is a better career path. Heck, I still toy with the idea of leaving pharmacy to go back to medical school.<br />
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Now pharmacy is still an excellent career, especially if your employer treats you with the respect that should be afforded to somebody with an advanced degree. But too many of our colleagues are still being treated as merely a name on a license that can easily be replaced if they so much as voice concerns about the working conditions. <br />
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In my previous position, due to sales and script volume not reaching budgeted amounts, I was shipped out to neighboring pharmacies in my chain to work a few shifts each month. After a shift where I personally checked over 475 scripts in a 10 hour shift, I decided that it was time to leave that particular company. I was fortunate enough to have a physician friend tell me about an open director of pharmacy position at a local critical access hospital. A couple interviews later I was on my way out of retail pharmacy. I was lucky.<br />
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Not everybody has connections that can lead to the better jobs, especially new graduates in a flooded market. Even a resume with a residency doesn't guarantee a position. <br />
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I put the blame for the flooded market on both academia and the big chains. The prospects of four years of extra tuition has the financial folks at the universities going gaga over the thoughts of opening up their own programs. Especially when they can quote a six-figure salary upon completion of the program. To any person checking out a pharmacy school, be sure to find out what percentage of their graduates have jobs upon graduation and three months after graduation. I'm fairly certain it won't be in the high 90s like it was when I graduated in the mid 1990s.<br />
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Then there's the influence of the chains. They will tell you that they wanted more pharmacists due to the shortage that we saw in the mid-to-late 90s. I can buy that to some extent, but my conspiracy-driven brain thinks that they were actually looking at the staffing issues from a supply-and-demand aspect. If they could get the supply of pharmacists to exceed the demand, then they could start to drive down salaries and benefits, and thus increase their bottom line. Don't believe me? Check out some of the proposed concessions that Dave Stanley wrote about in a recent Drug Topics article. A major employer was wanting to shift the costs of benefits over to the pharmacists, while cutting the hours that the pharmacists were able to work each week.<br />
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If I'm entering the job market right now (or actually four to eight years from now), that's not what I would want to be facing. I'm hopeful that the job market will correct itself, but if I were to offer advice right now I'd tell you to look at another option in the medical professions.Eric Durbin, RPhhttp://www.blogger.com/profile/09170995334706647447noreply@blogger.com4tag:blogger.com,1999:blog-5133434752101334071.post-8939850686623896582012-07-10T07:30:00.000-04:002012-07-10T07:30:04.703-04:00Pharmacist prescribingIt hardy seems like it, but Monday was the one year anniversary of my switch from retail/community pharmacy to the hospital setting. After 16 years behind the counter I have spent the last twelve months behind a desk and have loved every minute of it.<br />
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Over this past year, I've been able to see the successes in the health care industry. I've also seen some of the failures of the system. Some of my more memorable moments have come when I have been able to work with our interdisciplinary team and contribute to positive patient outcomes. I feel that I have earned the respect of the hospitalists and the nursing staff on our main patient floor.<br />
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One of the key things that I've found that has helped me earn their respect is to ask how the pharmacy service can help make their lives easier. There have been instances where I have made their lives more difficult as well. When that has happened, it didn't take long for somebody to explain the situation to me and I made the adjustments to correct the situation. The key to this has been open communication and open minds.<br />
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Open communication.....<br />
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Hmmmmm.......<br />
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Over the past year I haven't seen a whole lot of news in the pharmacy world. The only three "big" stories that I can think of are the Express Scripts-Medco merger, the move for more OTC/behind-the-counter medications, and pharmacists gaining prescriptive authority.<br />
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When I read articles/blogs/tweets on the prescribing issue, I keep seeing the same things. <i> Pharmacists are the medication experts, so why shouldn't we be able to prescribe.</i> I have my personal opinion on the issue, but I would like to ask a question that I haven't seen addressed anywhere.<br />
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Have we asked if the other members of the health care team want us to have have prescriptive authority? Do the physicians want us to have that authority? Has anybody in pharmacy actually <i>communicated</i> with the AMA and asked them for their thoughts on how the pharmacy profession can help the doctors?<br />
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It seems to me that pharmacist prescribing may be another idea dreamed up in academia that might not be able to fly in the real world. I've seen links to several stories lately that shows that the medical doctors really don't want us to prescribe.<br />
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Does anybody know if this has been addressed with our medical colleagues? If so, please share.<br />
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<br />Eric Durbin, RPhhttp://www.blogger.com/profile/09170995334706647447noreply@blogger.com8tag:blogger.com,1999:blog-5133434752101334071.post-63168519788295469902012-03-21T16:25:00.000-04:002012-03-21T16:25:00.052-04:00Who benefits from more OTC medications?Thursday and Friday (March 22 & 23) the FDA is holding its <a href="http://www.regulations.gov/#%21documentDetail;D=FDA-2012-N-0171-0001">public hearings</a> on "using innovative technologies and other conditions of safe use to expand drug products considered nonprescription". You know, moving more drug categories to OTC status.<br /><br />The initial response that I had, and that has been voiced through several outlets, is that this may be the step that is needed to enable pharmacists to be recognized as providers. My thoughts were that this should not move forward unless the OTC move was restricted to pharmacies-only with a built-in means for reimbursement to the pharmacists providing the consultation. This would keep the consultation separate from the drug product. This could be very good for the profession.<br /><br />But now I've had a few days to mull this around in my head. Something just doesn't sit well with me on this.<br /><br />I've never known our government or any of its agencies to move quickly on issues, especially when it comes to our profession. But for this issue, the notification for the hearing was filed on February 27, published in the Federal Register on February 28, with a deadline to present oral comments & presentations of March 9. That's less than two weeks. With the hearing being held less than two weeks after the deadline.<br /><br />3-1/2 weeks from the notice of hearing in the Federal Register until the hearings begin seems to be moving rather quick to me. Which makes me skeptical. <br /><br />Who are the entities that are pushing for this? <br /><br />Who has been working behind the scenes with the FDA to get this agenda advanced? How much have they prepared for the hearings prior to the announcement?<br /><br />It will be interesting to see who actually makes oral presentations and comments at the hearings. With such short notice, I doubt that there will be very many, if any, practicing pharmacists at the hearings. <br /><br />My concern is that the entities who stand to profit the most from this will dominate the hearings and the voice of the practicing pharmacists will not be heard. And we all know who stands to profit the most.<br /><br /><br />Manufacturers.<br /><br />Insurers.<br /><br />Chains.<br /><br /><br />Manufacturers know that moving the items from prescription status to non-prescription status will decrease the competition for their product. Not too many manufacturers are competing for the generic OTC market, so the brand-name manufacturers can keep a better market share by going OTC. When you consider the rebates that they must give on Medicare/Medicaid scripts, they potentially will make more profit with the switch.<br /><br />Then there are the insurers. No-brainer for them. <span style="font-style: italic;">Our plan does not cover over-the-counter medications</span>. They can eliminate several medications that are standard on formularies. For them, OTC = $$$.<br /><br />Then there are the chain pharmacies. We all know that the chains are looking to decrease labor costs, especially pharmacist labor. Sure the move of certain medications to OTC status will decrease script counts, but that gives them a reason to decrease pharmacist payroll. Nevermind that the pharmacist will get pulled aside every seven minutes to consult a patient about these new OTC meds. Chain pharmacy staffing follows a simple equation... X scripts/hr/pharmacist. If you are not hitting the numbers, you lose the payroll. The profit on an OTC medication is better than the standard dispensing fee from insurers, so why wouldn't the chains be on-board?<br /><br />I hope my gut is wrong on this one. But less than four weeks from the time of announcement until the FDA hearing just makes me think that something funny is going on... and not for the betterment of our profession.<br /><br />What do you think?Eric Durbin, RPhhttp://www.blogger.com/profile/09170995334706647447noreply@blogger.com2tag:blogger.com,1999:blog-5133434752101334071.post-47495600642305338932012-03-15T19:34:00.002-04:002012-03-15T19:41:57.689-04:00But you didn't.......Today starts the beginning of the NCAA Basketball tournament. St.Patrick's Day and all of its merriment is a couple days away.<br /><br />I came upon this a couple days ago on one of the apps that I waste time on. I don't know if it was written by somebody who actually suffered a loss, but this struck a chord with me.<br /><br />As we go about celebrating springtime here in the United States let us remember those who aren't safe at home, but are allowing us to be safe at home.<br /><br /><br /><br /><br /><br /><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiwaOOs6rEfZTxtO0z60ftI7w2CPptM7whByfOIbgZU-6wQQSu1lhzjc6nRHTd1RcMFsHK2yGCPdtqsPeKSzdnhaZviIO3VlrZ2hSrjXH4sAY3A4dmboXJM55cLvAZ_dL4lXzTyBurippnc/s1600/9695.jpg"><img style="display:block; margin:0px auto 10px; text-align:center;cursor:pointer; cursor:hand;width: 296px; height: 400px;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiwaOOs6rEfZTxtO0z60ftI7w2CPptM7whByfOIbgZU-6wQQSu1lhzjc6nRHTd1RcMFsHK2yGCPdtqsPeKSzdnhaZviIO3VlrZ2hSrjXH4sAY3A4dmboXJM55cLvAZ_dL4lXzTyBurippnc/s400/9695.jpg" alt="" id="BLOGGER_PHOTO_ID_5720272100875766338" border="0" /></a>Eric Durbin, RPhhttp://www.blogger.com/profile/09170995334706647447noreply@blogger.com0tag:blogger.com,1999:blog-5133434752101334071.post-44541445674771949562012-03-12T20:56:00.003-04:002012-03-12T21:30:56.954-04:00Medications available under "safe use"Recently I came upon a <a href="http://blog.pharmacist.com/tmenighan/index.php/2012/02/28/fda-proposes-new-paradigm-for-drug-categories/">blog post</a> by <span class="blsp-spelling-error" id="SPELLING_ERROR_0">APhA</span> CEO Tom <span class="blsp-spelling-error" id="SPELLING_ERROR_1">Menighan</span> where he brings up the <span class="blsp-spelling-error" id="SPELLING_ERROR_2">FDA's</span> idea of making certain prescription medications available without a prescription, provided that the medications are provided under conditions of safe use.<br /><br />This proposal combines a couple of the ideas that have been floating around for several years...a pharmacist-only class of medications as well as limited pharmacist prescribing. Under one safe use provisions, the sale of these agents <span style="font-style: italic;">might </span>be limited to certain health care settings, such as a pharmacy. I emphasize the word <span style="font-style: italic;">might</span>, as <a href="http://www.regulations.gov/#%21documentDetail;D=FDA-2012-N-0171-0001">Docket No. FDA-2012-N-0171</a> use the word <span style="font-style: italic;">might</span> rather than <span style="font-style: italic;">would</span> when it discusses whether or not the sales would be restricted to pharmacies.<br /><br />I believe that this proposal is a step in the right direction for pharmacy. Opening up access to pharmacists as providers with limited prescriptive authority could ease the burden on primary care practitioners and help advance our profession. My concern is that pharmacy will provide this service without ensuring a reimbursement structure for the pharmacists who are providing the service.<br /><br />We can't continue to give away our services without getting paid because face it, at the end of the day pharmacy is still a business and if your business isn't generating cash-flow it won't be a business very long. This may be the chance that our profession can capitalize on and be granted the provider status that we have been petitioning for over the last several years.<br /><br />We need to make sure that the regulations contain language that <span style="font-style: italic;">requires</span> pharmacist intervention, not suggests or recommends t. We also need to make sure that provisions are included that allow for reimbursement for services. We can't rely on building the professional fee into the price of the product because people will not see our services as being professional. They will simply look for the pharmacy that has the lowest price and go there. The consultation with the pharmacist must be removed from the product if we truly hope to advance the professional scope of our practice.<br /><br /><br /><br /><br />Sorry for getting this out so late. The notice came out in the Federal Register on Feb 28 and the deadline for being able to present oral presentations and comments has already passed. However, electronic and written comments will be accepted until May 7, 2012. I encourage you to chime in on this topic.Eric Durbin, RPhhttp://www.blogger.com/profile/09170995334706647447noreply@blogger.com2tag:blogger.com,1999:blog-5133434752101334071.post-85537054712192765712012-01-23T23:59:00.001-05:002012-01-23T23:59:00.721-05:00Something to chew onI 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.<br /><br />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.<br /><br />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?<br /><br />Nope.<br /><br />The manager pointed to a customer comments phone number that was posted on a sign and was told to call the number.<br /><br />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.<br /><br />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.<br /><br />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. <br /><br />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.<br /><br />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.<br /><br />Just something to chew on for a little bit.Eric Durbin, RPhhttp://www.blogger.com/profile/09170995334706647447noreply@blogger.com4tag:blogger.com,1999:blog-5133434752101334071.post-63001596989110571842012-01-23T16:11:00.000-05:002012-01-23T16:11:00.073-05:00AMA vs APhA.... looking out for the interests of their membersJust a quick note on <a href="http://www.ama-assn.org/amednews/2011/05/16/bisa0516.htm">this article</a> that I found on Twitter today.<br /><br />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.<br /><br />Let's compare that to the <span class="blsp-spelling-error" id="SPELLING_ERROR_0">APhA</span>.<br /><br />The big topics in retail pharmacy over the last couple months has been the <span class="blsp-spelling-error" id="SPELLING_ERROR_1">Walgreens</span>-Express Scripts drama over reimbursements.<br /><br />I did a little search on the <span class="blsp-spelling-error" id="SPELLING_ERROR_2">APhA</span> 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. <br /><br />So I went over to the <span class="blsp-spelling-error" id="SPELLING_ERROR_3">APhA</span> CEO blog. With the edit button of my browser I did a "<span class="blsp-spelling-error" id="SPELLING_ERROR_4">Ctrl</span>+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.<br /><br />One of the biggest stories in pharmacy, centering around reimbursement issues, and the <span class="blsp-spelling-error" id="SPELLING_ERROR_5">APhA</span> has yet to address the issues on its web-site.<br /><br />Rule #1 for business. You must make money to stay in business. The AMA gets it.Eric Durbin, RPhhttp://www.blogger.com/profile/09170995334706647447noreply@blogger.com2tag:blogger.com,1999:blog-5133434752101334071.post-28423764109288697072012-01-10T00:05:00.001-05:002012-01-10T05:59:38.318-05:00Pharmacists as providers?<span style="font-family:georgia;">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’<span class="blsp-spelling-error" id="SPELLING_ERROR_0">ve</span> been in a community pharmacy.</span><br style="font-family:georgia;"><br style="font-family:georgia;"><span style="font-family:georgia;">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) <span class="blsp-spelling-error" id="SPELLING_ERROR_1">didn</span>’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.</span><br style="font-family:georgia;"><br style="font-family:georgia;"><span style="font-family:georgia;">It <span class="blsp-spelling-error" id="SPELLING_ERROR_2">didn</span>’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.</span><br style="font-family:georgia;"><br style="font-family:georgia;"><span style="font-family:georgia;">The profession is clearly divided and it’s no surprise that pharmacy <span class="blsp-spelling-error" id="SPELLING_ERROR_3">isn</span>’t represented that well by the national organizations. There <span class="blsp-spelling-error" id="SPELLING_ERROR_4">isn</span>’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 (<span class="blsp-spelling-error" id="SPELLING_ERROR_5">NCPA</span>, <span class="blsp-spelling-error" id="SPELLING_ERROR_6">ASHP</span>, <span class="blsp-spelling-error" id="SPELLING_ERROR_7">ASCP</span>, etc…) representing their individual interests, trying to talk over each other and in the end nobody’s voice is heard.</span><br style="font-family:georgia;"><br style="font-family:georgia;"><span style="font-family:georgia;">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 <span class="blsp-spelling-error" id="SPELLING_ERROR_8">APhA</span> is doing much, if anything, to address the issues that pharmacists are facing.</span><br style="font-family:georgia;"><br style="font-family:georgia;"><span style="font-family:georgia;">The <span class="blsp-spelling-error" id="SPELLING_ERROR_9">APhA</span> has totally bought-in to the medication therapy management (<span class="blsp-spelling-error" id="SPELLING_ERROR_10">MTM</span>) practice model. Over the past 18 to 24 months, various articles have tried to sell <span class="blsp-spelling-error" id="SPELLING_ERROR_11">MTM</span> as the pharmacist’s component of accountable care organizations, patient-centered medical homes, and collaborative practice arrangements. While I believe that <span class="blsp-spelling-error" id="SPELLING_ERROR_12">MTM</span>-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 <span class="blsp-spelling-error" id="SPELLING_ERROR_13">MTM</span>.</span><br style="font-family:georgia;"><br style="font-family:georgia;"><span style="font-family:georgia;">Reimbursement.</span><br style="font-family:georgia;"><br style="font-family:georgia;"><span style="font-family:georgia;">Sure, some Medicare Part D plans are reimbursing pharmacists for <span class="blsp-spelling-error" id="SPELLING_ERROR_14">MTM</span> 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 <span class="blsp-spelling-error" id="SPELLING_ERROR_15">MTM</span> services are reimbursable from all insurers and can be offered to all patients instead of the select few Medicare Part D-<span class="blsp-spelling-error" id="SPELLING_ERROR_16">ers</span>.</span><br style="font-family:georgia;"><br style="font-family:georgia;"><span style="font-family:georgia;">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 <span class="blsp-spelling-error" id="SPELLING_ERROR_17">MTM</span> practice model will take off. There are innovative minds in the pharmacy world that will revolutionize <span class="blsp-spelling-error" id="SPELLING_ERROR_18">healthcare</span>, 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 <span class="blsp-spelling-error" id="SPELLING_ERROR_19">isn</span>’t going to cut it. We need to become recognized providers now. There is a<a href="http://www.change.org/petitions/the-president-of-the-united-states-recognize-pharmacists-as-health-care-providers"> petition floating around</a> out there to try to get pharmacists recognized as providers. If you haven’t done so already, I suggest that you check it out.</span><br style="font-family:georgia;"><br style="font-family:georgia;"><span style="font-family:georgia;">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 <span class="blsp-spelling-error" id="SPELLING_ERROR_20">DURs</span>, 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.</span><br style="font-family:georgia;"><br style="font-family:georgia;"><span style="font-family:georgia;">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 <span class="blsp-spelling-error" id="SPELLING_ERROR_21">anticoagulation</span> clinics, diabetes/asthma/<span class="blsp-spelling-error" id="SPELLING_ERROR_22">COPD</span>-education, and nutrition education would be areas where pharmacists could make a huge difference if the reimbursements were there.</span><br style="font-family:georgia;"><br style="font-family:georgia;"><span style="font-family:georgia;">I don’t know what it’s going to take for pharmacists to unite as one voice. It might be the <span class="blsp-spelling-error" id="SPELLING_ERROR_23">APhA</span> 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.</span><br style="font-family:georgia;"><br style="font-family:georgia;"><span style="font-family:georgia;">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.</span><br /><br /><br /><br /><br /><br /><br /><br /><br /><br /><br /><br /><br /><br />*Previous posts of mine that address this issue<br /><ul><li style="font-weight: bold;"><span style="font-size:85%;"><a href="http://eric-rph.blogspot.com/2010/09/state-of-professionunity.html">State of the Profession.....Unity</a></span></li><li><h3 class="post-title entry-title"> <span style="font-size:85%;"><a href="http://eric-rph.blogspot.com/2010/09/state-of-profession-part.html">State of the Profession, Part Two...Organization</a></span></h3></li><li><h3 class="post-title entry-title"> <span style="font-size:85%;"><a href="http://eric-rph.blogspot.com/2010/09/state-of-profession-reimbursement-part.html">State of the Profession.... Reimbursement Part I</a></span></h3></li><li><h3 class="post-title entry-title"> <span style="font-size:85%;"><a href="http://eric-rph.blogspot.com/2010/10/state-of-professionreimbursements-part.html">State of the profession.....Reimbursements Part II</a></span></h3></li><li><h3 class="post-title entry-title"> <span style="font-size:85%;"><a href="http://eric-rph.blogspot.com/2010/11/change-in-thinking.html">A change in thinking</a></span></h3></li><li><h3 class="post-title entry-title"> <span style="font-size:85%;"><a href="http://eric-rph.blogspot.com/2010/11/ctp-codes-how-about-cps-codes.html"><span class="blsp-spelling-error" id="SPELLING_ERROR_24">CTP</span> codes. How about CPS codes?</a></span></h3></li><li><h3 class="post-title entry-title"> <span style="font-size:85%;"><a href="http://eric-rph.blogspot.com/2010/12/pharmacist-reimbursement-for.html">Pharmacist reimbursement for professional aspects of dispensing</a></span></h3></li><li><h3 class="post-title entry-title"> <span style="font-size:85%;"><a href="http://eric-rph.blogspot.com/2010/12/reimbursement-for-otc-consults.html">Reimbursement for OTC consults</a></span></h3></li></ul><p><br /></p><br style="font-family: georgia;">Eric Durbin, RPhhttp://www.blogger.com/profile/09170995334706647447noreply@blogger.com7tag:blogger.com,1999:blog-5133434752101334071.post-34037328535977447262011-12-23T13:20:00.002-05:002011-12-23T13:26:49.663-05:00Twelve Days of (Pharmacy) ChristmasStolen from a Twitter feed from <a href="http://twitter.com/#%21/_RxLauren">@_<span class="blsp-spelling-error" id="SPELLING_ERROR_0">RxLauren</span></a><br /><br /><ul><li>Twelve hours standing</li><li>Eleven early refills</li><li>Ten screaming customers</li><li>Nine <span class="blsp-spelling-error" id="SPELLING_ERROR_1">benzo</span> scripts</li><li>Eight a$$hole doctors</li><li>Seven drive <span class="blsp-spelling-error" id="SPELLING_ERROR_2">throughs</span> beeping</li><li>Six Plan B pick-ups</li><li>Five prior <span class="blsp-spelling-error" id="SPELLING_ERROR_3">auths</span></li><li>Four cash narcotics</li><li>Three fake prescriptions</li><li>Two tripping junkies</li><li>And a pharmacist who hates her job.</li></ul><p><br /></p><p><br /></p><p><br /></p><p><br /></p><p>Merry Christmas!<br /></p>Eric Durbin, RPhhttp://www.blogger.com/profile/09170995334706647447noreply@blogger.com2tag:blogger.com,1999:blog-5133434752101334071.post-35485806860442245792011-12-06T23:09:00.001-05:002011-12-06T23:09:00.153-05:00Frogger, RPhHave you ever tried to boil a live frog? Just throw the frog into a pot of boiling water. It doesn't work because the frog's survival instincts kit in a it will try to escape. If the water isn't too deep, it will be able to leap out and survive.<br /><br />But if you put the frog in the same amount of lukewarm water and gradually increase the temperature to a boil, the frog is not able to detect the temperature changes and will be boiled alive.<br /><br />I've heard this several times over the years without thinking much about it. This past week, the president of our facility shared it during a meeting of our management staff and a thought immediately jumped into my head.<br /><br />This is the world of retail pharmacy. Pharmacists are the frogs.<br /><br />If you think about how the world of retail pharmacy has evolved over the past 20 years, I think it's easy to see how the pharmacist is getting slowly boiled. Many factors have come into play that are cranking up the heat on our professionals in the retail trenches.<br /><br />Let's take a look at some of them. While in and of themselves they aren't necessarily bad (in fact some are good), the combined effects of all of these have turned up the heat on community pharmacists.<br /><br /><ul><li>Third-party insurers. These initially helped level the playing field for pharmacists since patients would pay the same price wherever they chose to fill their prescriptions. However the ever-decreasing rates of reimbursement have driven many pharmacies out of business. And those that remain must fill more scripts to bring in the same dollars.</li><li><span class="blsp-spelling-error" id="SPELLING_ERROR_0">OBRA</span> 90. Mandatory counseling, <span class="blsp-spelling-error" id="SPELLING_ERROR_1">DURs</span>, etc for certain patients. While these are good, there was no increase in reimbursements to hire additional staff to safely fill the prescriptions. Rather than ensuring that every prescription would receive its due attention, I think that it can be argued that the pharmacist has been legislatively forced to have interruptions in their work flow in order to offer the required counseling. And what passes as counseling falls far short of the intent of the law.</li><li>Drive-<span class="blsp-spelling-error" id="SPELLING_ERROR_2">thru</span> pharmacy. One more drop-off and pick-up area. Usually without additional staff (or reduced staff after the first three months).</li><li>Gift cards for transferred prescriptions. More phone calls to distract the pharmacists from their primary duties. And one more place where an error in communication can occur.</li><li>Pharmacy-initiated refill requests to <span class="blsp-spelling-error" id="SPELLING_ERROR_3">prescribers</span>. While this may help with compliance for some patients, it adds another uncompensated task for the pharmacist to oversee. I'm sorry, but responsibility for refills should fall upon the patient. It's no surprise that our patients don't take ownership of their health because they aren't asked to do anything other than fork over their copay.</li><li>Immunizations are good. The interruption to <span class="blsp-spelling-error" id="SPELLING_ERROR_4">workflow</span> is bad. Quotas on immunizations (which I have heard rumors of) are unsafe.</li><li>Auto-refills (aka predictive refills). Similar to the refill requests. Good intent, but patients need to be responsible for their own health. In my experience, about half of the prescriptions that my retail pharmacies filled through these programs were returned after 7 to 10 days. The process of returning the prescriptions is just as, if not more, labor intensive as the original fill. More uncompensated work for the pharmacists.</li><li>$4 generics. Affordable medications can increase compliance, but the amount of staffing hasn't grown to offset the increased workload. More scripts, less help. Not good.</li><li>15 minute guarantees. Only to be outdone by 10 minute guarantees. Sure. Why not? While we're at it, let's have corporate call to find out why it's taking so long to get the scripts out the door. One of my friends recently had a corporate person call to inform her that corporate was looking at the video cameras and the pharmacy pick-up lines were too long and wanted to know how she was going to rectify the situation.</li></ul><p><br /></p><p>The pastor at my church often asks us if we are being a thermometer or thermostat in our community. The thermometer simply is a reflection of the environment. The thermostat sets the environment.</p><p>In order to effect any change in the retail environment, we need more pharmacists to be thermostats. Speak up when necessary. Promote positive change for the profession.</p><p>Because if we continue to just be thermometers, we're a bunch of boiled frogs.<br /></p>Eric Durbin, RPhhttp://www.blogger.com/profile/09170995334706647447noreply@blogger.com6tag:blogger.com,1999:blog-5133434752101334071.post-20592889291783368012011-11-01T00:01:00.000-04:002011-11-01T00:01:03.830-04:00David Snow U<div><br />Unless you've been under a rock recently, you would know that Medco's David Snow caused quite a ruckus lately with his comments about retail pharmacists. I haven't looked into his comments, and I'm not going to. I think that the reaction that has already taken place gives me a good idea of what he said.<br /><br />One question comes to mind...if retail pharmacists are so inaccurate, why does Medco have their name on the yet-to-be-accredited college of pharmacy at Farleigh Dickinson University? Do they somehow have the ability to train human to be 23-times more accurate than we currently are?Those are the figures that he quoted when he spoke at the Cleveland Clinic.<br /><br />The Accreditation Council for Pharmacy Education hasn't accredited the college...yet. Corporate money will help the ACPE turn a blind eye to this slap-in-the-face to pharmacists.<br /><br />But then again, Farleigh Dickinson could make a stand against Medco as well. Isn't a bit hypocritical for a pharmacy college to accept funding from a company that is trying to decrease the number of pharmacists out there in the retail setting? We know that won't happen either. What college is going to turn away people willing to pay $40,000+ per year for 4 to 6 years to enter a career field that is already saturated?<br /><br />But then the answer came to me. I know what student the pharmacy college at Farleigh Dickinson is trying to attract. I don't want to stereotype the student who would attend this school, but I will share a picture of what the initial students graduating from this school may look like.<br /><br />The ideal FDU Medco College of Pharmacy graduate looks like this....<br /><br /><br /><br /><br /><br /><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEivoKHAeHufVeDzghu4kxlijlGAOmDlHuw6xQhUn-wQETIvbSRShTUXzAJyaX9cE6p4mcLauMaXFOzQoGtf-uiq5E2ZlpEqQMLMA3QxTNksrns3Jm72o-PeMMphui8j7g7Bwf60EPoeDKw7/s1600/RoboRPh.JPG"><img style="margin: 0px auto 10px; width: 300px; height: 364px; text-align: center; display: block; cursor: pointer;" id="BLOGGER_PHOTO_ID_5669831536627401170" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEivoKHAeHufVeDzghu4kxlijlGAOmDlHuw6xQhUn-wQETIvbSRShTUXzAJyaX9cE6p4mcLauMaXFOzQoGtf-uiq5E2ZlpEqQMLMA3QxTNksrns3Jm72o-PeMMphui8j7g7Bwf60EPoeDKw7/s400/RoboRPh.JPG" border="0" /></a><br /></div>Eric Durbin, RPhhttp://www.blogger.com/profile/09170995334706647447noreply@blogger.com1tag:blogger.com,1999:blog-5133434752101334071.post-17365085690960829952011-10-25T00:01:00.000-04:002011-10-25T00:01:00.765-04:00Even if the truth hurts<div>Several days ago I stopped by a local pharmacy on my way home from the hospital to pick up an item for my wife. While waiting in the checkout line, I overheard the conversation of two senior women who were ahead of me. One of the women was telling the other about her husband, who was hospitalized due to a diabetic foot ulcer. She said that he had known about the sore on his foot for quite a while, but he had chosen to ignore it. Upon admission, the ulcer had reached through all of his tissue and the bone of his heal was exposed.<br /><br />Upon hearing this, most people would think “poor guy, hope it heals”.<br /><br />But that wasn’t my thought.<br /><br />Maybe my years in community pharmacy have jaded me. Maybe seeing patients admitted repeatedly for the same diagnosis has hardened me since my move to the hospital setting a few months ago. Whatever the reason, my sympathetic side took a backburner to my practical side. My thought was a simple one.<br /><br />This admission was totally preventable.<br /><br />Seriously. It is 2011 and we are living in the United States. There is no reason that anybody should be admitted for a diabetic foot ulcer.<br /><br />We have the best medications to control blood glucose levels. We have at-home testing machines that can tell you what your blood sugar (and hemoglobin A1c) levels are. We even have little mirrors on the ends of poles to help diabetics inspect the bottoms of their feet.<br /><br />We have home health care companies that go to patient’s homes three, four, even five times a day to help people take their medications. There are social services that come into people’s homes to help with meal preparation and housekeeping.<br /><br />We have a vast amount of information available to us over the internet. With a few keystrokes we can find out about our medical conditions and how to stay healthy. If your physician is tech-savvy, you can have access to him or her with a few keystrokes on your cellular phone.<br /><br />With all of the advances in technology and medicine, there really isn’t a good reason that I can think of as to why somebody should be admitted for a diabetic foot ulcer that has reached the bone.<br /><br />Other than patient apathy.<br /><br />The hospital administrator side of me started thinking about how, in the near future, hospitals aren’t going to get paid by Medicare for patients who are readmitted within 30 days for certain conditions. Even if the hospital does everything correctly, a patient who doesn’t care about his/her health is going to receive thousands of dollars of care for which the hospital will not be reimbursed. Diabetics who bounce back into the hospital because they can’t manage their disease are going to drain my facility of resources that could be used to treat patients who genuinely desire to get well. It makes me kind of angry.<br /><br />Then there’s another side of me that wonders why nobody said or did anything. Why did this guy’s wife let the foot go untreated? Has this guy ever been educated about his disease? When was the last time this guy saw his physician? Is he taking his medications correctly? Has he ever talked with his pharmacist about his medications? Can he afford his medications?<br /><br />These thoughts are running through my mind and I remember a comment that somebody recently left on one of my older blog posts. The jist of the comment centered around a thought that I had shared when a patient asked why they needed to be on a medication. My thought was “because you are fat, lazy, and need to exercise”. The commenter thought it was unprofessional of me to think like that, and who was I to judge.<br /><br />Maybe I was wrong to think like that (even though I saw the grocery items that were in the cart). But then again, maybe I should have said what I was thinking. So much of our effort in pharmacy is dedicated to keeping the person as a customer rather than speaking to them as a patient. Are we doing our patients a disservice by sugarcoating our message? Sometimes being blunt is what is required to get the point made.<br /><br />Would this woman’s husband have been better served if somebody had actually said “keep your blood sugar under control or you are going to get a nasty infection on your foot that may require amputation” Most people are afraid of losing body parts so that may have resonated more than “Jim, are you taking your pills right? No? Well you better. That’ll be $4.00.” When I worked for one of the chains offering $4 prescriptions, I didn’t have the opportunity to even have that discussion.<br /><br />I did have a position at a regional grocery chain (where we filled 120-180 scripts/day) where I was able to talk to my patients. I got to know my patients and their families. And when warranted, I would be blunt with them. They understood that it was coming from somebody who cared for them and wanted to see them healthy. It has been three years since I left that position and I still get stopped at football games and swim meets by my former patients who thank me for how I helped them with their medical conditions.<br /><br />I didn’t become a pharmacist to sugarcoat the truth to make people think that they are being healthy. If pharmacists want to impact the health of our patients, we need to be truthful.<br /><br />Even if the truth hurts.<br /></div>Eric Durbin, RPhhttp://www.blogger.com/profile/09170995334706647447noreply@blogger.com3tag:blogger.com,1999:blog-5133434752101334071.post-39008545191461878232011-09-29T00:01:00.000-04:002011-09-29T00:01:00.525-04:00MTM WorkshopIn an effort to achieve my <span class="blsp-spelling-error" id="SPELLING_ERROR_0">blog's</span> goal of advancing the profession of pharmacy, I decided to post a link to a workshop that is being provided at the <span class="blsp-spelling-error" id="SPELLING_ERROR_1">ASCP's</span> annual meeting this November in Phoenix.<br /><br />I was made aware of the meeting by one of the members of the <span class="blsp-spelling-error" id="SPELLING_ERROR_2">ASCP</span> Foundation following a recent post about the future of <span class="blsp-spelling-error" id="SPELLING_ERROR_3">MTM</span>. If you are like me, a mid-November meeting is really kinda last-minute. But if you have flexibility, it may be helpful.<br /><br />To me, it looks like a "how-to do <span class="blsp-spelling-error" id="SPELLING_ERROR_4">MTM</span>" session. It does look like it has a little bit of info on developing a business plan. Personally, I'd rather attend a "how-to get your services paid for by an insurance company" session. I live in an area where people don't exactly have a spare hundred bucks of their income to spend on an <span class="blsp-spelling-error" id="SPELLING_ERROR_5">MTM</span> session with a pharmacist, so I'd like to hear from individual pharmacists who have successfully enrolled as a provider with an insurer.<br /><br />For those of you who are interested, <a href="http://www.ascpannual.com/program/workshops/private-practice-boot-camp">here's the link</a> to the <span class="blsp-spelling-error" id="SPELLING_ERROR_6">ASCP's</span> page for the session.Eric Durbin, RPhhttp://www.blogger.com/profile/09170995334706647447noreply@blogger.com0tag:blogger.com,1999:blog-5133434752101334071.post-88509622257077958532011-09-28T19:17:00.003-04:002011-09-28T19:21:18.738-04:00The ASCP wants you.....To help them out. Click <a href="http://www.checkpointsurveys.com/adg004.html">here</a> to link to a survey for long-term care pharmacies and consultant pharmacists. The results are sent to a third-party, who will in turn submit a report to the <a href="https://www.ascp.com/">ASCP</a>.<br /><br /><br /><br /><br /><br /><br /><br /><br /><br /><span style="font-style: italic;font-size:78%;" ><br />Wonder if they will give me a year's membership in exchange for the promotion of their survey and web-site?</span>Eric Durbin, RPhhttp://www.blogger.com/profile/09170995334706647447noreply@blogger.com0tag:blogger.com,1999:blog-5133434752101334071.post-42769221260796027962011-09-22T19:20:00.002-04:002011-09-22T19:31:48.847-04:00Thank goodness for United Healthcare<iframe src="http://www.youtube.com/embed/8O1i0InZ8bM" allowfullscreen="" frameborder="0" height="315" width="560"></iframe><br /><br /><br />I've been hearing this commercial over the radio for the last several days. Each time that I hear it, I get a little bit more pissed off.<br /><br />Pharmacists are being depicted, at least by United Healthcare, as idiots who can only catch a drug-drug interaction if the almighty insurance company alerts them. <br /><br />Rather than promote themselves as the ever-present protective force in the prescription drug arena, how about running an advertisement to encourage your subscribers to pick one pharmacy and stick with it? You know, so your records are in one location instead of being scattered between Walgreen's, CVS, and Target?<br /><br />Oh yeah, because you force your subscribers to use the mail-order service where they never even get to meet the pharmacist who fills their prescriptions. You promote the very practice by which you claim to be protecting your subscribers from.<br /><br />Don't insult us, United Healthcare.*<br /><br /><br /><br /><br /><br /><br /><br /><br /><br /><br /><br /><span style="font-size:78%;"><br /><span style="font-style: italic;font-size:85%;" ><br />*-this post doesn't apply only to United Healthcare, but to all insurers and pharmacy benefits managers who place profits first and patient safety second. </span></span>Eric Durbin, RPhhttp://www.blogger.com/profile/09170995334706647447noreply@blogger.com4