Monday, November 23, 2009

Hey hey's the APhA

Picture Fat Albert saying the title of this post. It might be amusing. It was for me.

But that's not why I wanted to talk today.

I want to address the impact of the largest organization representing pharmacists on the legislation in front of the United States Senate.

The American Pharmacists Association has a nice building located on the Mall in Washington DC, between the Lincoln Memorial and the Department of State. Being located where it is, you would think that the folks at the APhA might be able to have a little influence on the legislative branch of our government.

Based on the text of HR 3590, I would have to give the APhA a failing grade. HR 3590 is 2074 pages of legislation that is supposed to change the way health care is delivered in the United States.

Pharmacists like to think that they are an integral part of the health care system in the United States. We deliver the medications to keep people alive and healthy. We educate the public on the correct use of their medications. After hours and on weekends, we triage people who don't know if their illness/injury is severe enough to warrant a trip to the urgent care center or emergency department.

We are the most accessible health care providers out there. We give our services away for free. Any money that comes our way is tied to a product that we dispense in the terms of a dispensing fee. For the most part, our professional expertise does not generate any revenue.

So when a two-thousand seventy-four page bill is introduced to the Senate and the APhA has a physical presence in the nation's capital, I would expect to see some things in the bill that would advance the professional side of the profession.

Ummm... not in this bill.

I saved the document in .pdf form and searched for the word pharmacist. In a 2074 page bill, the word pharmacist appeared on 14 pages. Seventeen is the total number of times that pharmacist actually appears.

Of those seventeen times that pharmacist appears in the text of HR 3590, nine times it appears in a list of health care professionals. So over half of the time that pharmacist appears in the bill, it is surrounded by other terms like dentist, nutritionist, nurse, etc...

Just for comparison, the seventeenth occurrence of the word physician occurs at the top of page 13 of the table of contents. Wonder whose lobby was more effective for the health care bill?

But back to pharmacist.

Of the remaining eight times that pharmacist occurs in the bill, seven are tied to Medication Therapy Management (MTM). Since the inception of the MTM programs, I have been contacted a whopping two times to conduct an MTM interview by the PDP providers. Hate to tell you this, APhA, but MTM isn't exactly generating a whole lot of business in my corner of the pharmacy universe. I'd rather see the APhA work on something like dispensing fees that are more than $2.50 on a thousand dollar script.

Wouldn't it be great if dispensing fees were tied to the relative danger of the medications. Dispensing the new TNF blocking medication? Get a higher dispensing fee since you will spend a lot more time counseling the patient on the medication. Basically, if the drug has a MedGuide, the pharmacist receives a higher dispensing fee.

But back to HR 3590.

The final occurrence of pharmacist occurs in a section 3502 of the bill that establishes "community health teams to support the patient-centered medical home". In this section we get to provide medication management services, including medication reconciliation. Doesn't sound like any great advances in the practice of pharmacy.

I don't know a whole lot about the lobbying thing in DC, but the APhA doesn't seem to be doing a very good job of it. Or doing anything to help the individual pharmacists out in the real world.

If the APhA wants to truly impact patient care, they need to get higher dispensing fees for those of us practicing in the real world. If we make a decent margin on our scripts, we'll be able to hire more people and provide better pharmaceutical care. But until the pharmacy organizations in DC step up to the plate to push for this, those of us in the retail world are going to continue practicing Burger King pharmacy.

APhA, from what I see in HR 3590, you aren't exactly impressing the folks on Capital Hill. As of right now, I won't be renewing my membership.

If you want to speak to a real pharmacist email or tweet me and maybe you can see what those of us in the real world expect out of the American Pharmacists Association.


ThePharmacyIdealist said...

I totally agree with your assessment of HR 3590, I was beyond disappointed when I took a look and then again when I saw what people the profession were considering victories.

There were no victories in that bill for pharmacy. I wrote a post on it on my blog as well in fact.

1. We get to provide MTM. Wait a minute, we could provide MTM before, that is nothing new, and how many people are are doing it? How many pharmacy managers/administrators are making it a priority?? Yeah, I thought so :).

2. I couldn't see that we were even listed as a practitioner. That would be the most basic win.

3. Absolutely no support for pharmacists in disease management roles.

So I hear you ...


Pharmacynic said...

Eric, my brother, if just pharmacists were of your make and model, there'd be an uprising. I'm a pharmacy student. I've been to numerous APhA-ASP conferences, and all too often, when the issues that really matter are brought up during policy forums, the eyes of my sheltered pharmacy peers glaze over, the messenger of this uncomfortable message flies back home with no new facebook friends. I have been this messenger. The aversion to conflict, and aversion to banding together runs deep in this profession, brother. The fear of "the man" is way too much for pharmacist culture, a culture that heralds "taking what they give" and "giving to those who only take", a culture that hasn't evolved much in like 100 years.

Basically, the APhA is run by these people, the only difference is that they are quite a bit less disgruntled than the average pharmacist and dress truly professionally at work (and probably also take long guaranteed lunches at an actual lunchtime). They are people, just like you and I, who have dreamed of being a "real professional" but still have no concept of professional duty. Maybe they're so afraid of the conflict involved with being rejected if they ask someone in Congress to fight for legislation that will help them? Or, maybe, these issues don't occur to them and they go into meetings everyday agreeing with whatever everyone around them says?

Ergo sum, the problem is not the APhA so much that it is the pharmacist him/herself. As a corollary, there are two of people like us to convince the typical pharmacist to stand up for himself. So what do we do?