Saturday, January 29, 2011

Back online

Had to take my computer to the shop the other day to get it checked out. Every since our house was struck by lightning in September it had been acting up.

The initial work was to take three days. Ended up being eight. Had to do a restore on the hard drive to get things operating again. Not too happy with the place that worked on it, but they reduced the price of repairs by 33 percent to make up for the inconvenience.

Once the computer returned home, it has taken me several days to reinstall the various programs that were removed during the restore. This process was drawn out over several days due to swim meets and gymnastics practices filling up my evenings, plus a work schedule that hasn't been the most kind recently.

But now I'm back up and running. Posting should get back to normal very soon.

Tuesday, January 25, 2011

Getting paid for MTM services

Getting paid for MTM 42. That was on the cover of the most recent Pharmacy Today. When I saw that, I heard the angels singing.

Finally, an article about getting reimbursed for medication therapy management services. Perhaps some insight in how to sign up as a provider with a medical insurance company. Personally, I've been trying to get contracted with the major insurers in my area for over a year with little success.

This article could be the holy grail for those of us who want to attempt to provide MTM services as a stand-alone business. Finally something from the APhA that tells us how to make some money, rather than just telling us that our services are valuable and save the health care system in the long run.

I sat down to read the article during my lunch hour, legal pad at my side to jot down notes. I had been looking forward to reading this since I received the Pharmacy Today issue in my mailbox a couple days ago.

After reading the article I can tell you this... don't bother reading it.

Not a darn thing.

False advertising.

Monday, January 17, 2011

Medicare Part B

When I started at my current pharmacy, we had a certain physician who didn't want to cooperate and provide valid prescriptions for Medicare B covered items. Well maybe it wasn't the physician...the nurse would not let us speak to the physician to explain what we needed. The nurse would phone-in the orders for testing supplies and leave them on the voice mail.

Which would cause us to call back and say that phone-in orders are not valid for Medicare B diabetes supply claims. We would explain that we needed a hand-written or fax order that had:
  • the patient name
  • the product(s) being ordered
  • the quantity to be dispensed
  • the testing frequency
  • refill information
  • and the ICD coding appropriate for the patient's condition
You would think that we were asking them to fax over the patient's entire medical history in triplicate.

This went on for months. Patients were receiving substandard care because some nurse was having what she believed to be a turf issue. The last thing I want to do is keep a patient from being able to test their blood glucose levels, but I'm not going to circumvent the regulations that are in place.

I think it finally came down to one patient who was able to get the physician's attention on this matter. The patient asked me what I would do if I were in their shoes. I told them that if my physician wasn't willing to provide a valid prescription for my testing supplies, I would assume that they really didn't care about my condition and that I would change physicians. I handed the patient a leaflet that said what was required on the Medicare B prescriptions. The patient was on their way to the physician's office. I don't know the details of the conversation, but whenever we call now, we get what we need from that office.

We could have just fudged the information in the computer. Hope that we wouldn't get audited. Take care of the patient and not really worry about it. Good thing we didn't because...

We've been receiving Medicare B requests for additional information fairly regularly over the last few months. It's not too big of an issue because we follow the rules.

Most of the requests are for copies of the original prescriptions and signatures showing that they were picked up. That takes about five minutes to get together.

But then they want the pharmacy to provide copies of the testing logs and physician progress notes. That's a bit more time-consuming. Especially getting the physician notes. But we do it. And get it back to Medicare by the due date (which isn't too long).

The audit process wastes pharmacist time. Diverts pharmacist attention.

It makes me wonder if my pharmacy is being singled out, or are all Medicare B suppliers getting hit with audit requests. Given that Medicare has been burned by some of the fly-by-night businesses that bill for a couple million dollars of prosthetics, collect payment, then close up shop I can partially see the reason for auditing. But we only bill about 10 claims per week, and we have been doing this for years. It's not like we've suddenly quintupled the number of claims that we are submitting.

It also makes me wonder if Wilford Brimley and the folks over at Liberty Medical are being served with a proportionate amount of audits. Especially since I have had patients come in and tell me that they have over 1200 diabeetus test strips on hand because Liberty won't stop sending them.

Thursday, January 13, 2011


She came in a couple days ago. Mrs. Crow. We knew that she was going to be in, just not when. She had called ahead to make sure that her husband's insulin needles were the correct ones (BD 328411).

So we had braced ourselves.

Well I saw her first, walking across the front of the pharmacy to go to the pick-up window. So I grabbed the phone and started dialing. The local time and temperature line can be a life-saver some days.

And one of my techs saw her as well. She was getting ready to punch-in on the time clock, but decided to wait a few extra minutes to clock-in.

Which meant that my other tech would get to wait on her.

Fortunately we were not real busy at the moment, so Jeff was able to take care of her. Besides her normal routine of opening every bottle, requesting that the medications be bagged separately, etc... she now wants certain medications to be put in certain sized vials. Jeff complied with her requests and was able to get rid of her in about 20 minutes. During that time, I was able to handle about 7 phone calls and 5 fake phone calls.

Overall her visit was uneventful, but it made me appreciate Jeff even more.

Sure, he will get some overtime for efforts, but that's the best money I've spent on payroll in a long time.

Total price of prescriptions... $45.00
OT for Jeff to wait on her... $15.00
Seeing her first and weaseling out... PRICELESS

And even better, our cash register was acting up so we had to send her to a register in the front of the store to check out....... another PRICELESS.

Monday, January 10, 2011

I don't (heart) the Weather Channel

Tomorrow's forecast is for snow, snow, and more snow. Lots of it. All day long. Yep, that's what the Weather Channel says.

Of course the last four times that the Weather Channel has predicted this, all we have received is 40 degree temperatures and a light mist, if any precipitation.

But that doesn't stop the onslaught at the pharmacy. Everybody needs to have everything refilled now because, as we all know, a little ice and snow on the road means the end of the freakin' world.

So today, in anticipation of the storm to end all storms, we'll get hammered. Then tomorrow it will barely do anything and I can resume my hatred for all the folks at the Weather Channel for scaring my patients and causing me to work way too hard for a storm that only exists to get you ratings.

Friday, January 7, 2011

Happiness is a 16 dram bottle away

During the next to last week of the NFL season, Pennsylvania governor Ed Rendell was quoted as saying "I think we've become wussies" with regards to the Eagles-Vikings game being rescheduled due to the winter weather that hit the Philadelphia-New York-Boston area.

I thought about his words. He's right. We are a bunch of wussies.

But I'm not thinking in the same terms that he was. I'm looking at it from the pharmacy counter.

I worked the first three weekdays of the new year. Looking at the scripts that have crossed in front of me, Americans really need to suck it up. Somehow the American public has turned from being able to suck it up when faced with adversity to running to a little amber bottle any time adversity shows its face.

I'm not going to touch on narcotics with this post. We all know how narco-happy the United States is.

But based on the volume of other medications that I have checked this week, we've got a serious pill problem going on here. Rather than addressing the issues causing their problems, Americans are running to us to supply them with the means to solve their problems.

Drinking too much alcohol or caffeine? Don't cut back, just take a proton-pump inhibitor or H2-receptor antagonist to fix your problems.

Feeling a little bit nervous or anxious? Take a benzo. You'll feel better. A lot better. Go ahead and mix it with some alcohol and a stomach pill.

Is your life so hectic that you can't wind down in the evening? Don't even think about looking for ways to de-clutter your schedule. Just start taking this pill before bed for a month, oh what the heck let's give you five refills and let's see how you are doing in six months.

And while we're at it, don't worry about trying to lose weight. Let's just try some muscle relaxers to settle down those back muscles that are strained from carrying around an extra eight pounds.

Better living through chemistry....the American way.

Sunday, January 2, 2011

Lobbying and communication

As I was watching my favorite collegiate football team go down in defeat during their bowl game on New Year's Day, a commercial came on that caught my eye. It basically told the story of a father and daughter as they went through life. The spot was titled "You Can Let Go" and (to me) showed the daughter letting her father know that he didn't need to fight against death any longer. He had raised her and she was letting him know that she was grown up now and that she would be fine if he passed away.

It was a touching commercial. Both my 5 year-old daughter and 6 year-old niece commented on how sad it was.

But my inner conspiracy-theory detector started going off. You see, several days ago I heard some commentary on the radio concerning the Affordable Care Act. When the bill was signed into law, a provision that called for end of life counseling every five years was not included. Some argued that the section that included this lead to "death panels".

Well now the end of life counseling sessions are back in the bill. This time through the rule-making process. And on an annual basis. The new rule says Medicare will cover “voluntary advance care planning” to discuss end-of-life treatment, as part of the annual visit.

My brain started playing a little game of Coincidence or Conspiracy. I thought it was funny how, shortly after the rule was made, commercials saying that it was alright to die started airing. Especially during an event (college bowl game) where there would be a large viewing audience.

I did a little checking, and from what I found it turns out to be coincidence.

Then I started thinking... this is just another example of the influence of the lobbying efforts of the different physician groups. Somehow they were able to get the advanced care planning changed from every 5 years to every year. They can bill for this service each and every year that their patient stays alive.

I thought a little more. Pharmacy has a lobby in Washington DC. But we seldom hear what is happening with the pharmacy lobby. We hear plenty about the lobbying efforts of Big Pharma, but not pharmacy.

I think it comes down to a communications issue.

You see, I like to gripe about things such as not being able to contract for my pharmaceutical care/ medication therapy management services with insurance companies. It turns out that there are a lot of barriers to this for pharmacists. Recently some changes were made to rules and regulations that will help pharmacists get contracted.

But I had no clue about this. I actually stumbled upon it as I was linking around on the APhA website. And I haven't been able to find the story since then.

As much as we like to rag on the APhA for being out of contact with the average pharmacist, I think that they might have our best interests at heart. But they need to communicate everything that they are doing on our behalf in a better manner.

I would love to see several tweets every day on issues that affect the profession of pharmacy. I'm not talking about clinical trials and new drug approvals. I'd love to know what is happening in DC and how the APhA is working for us. Perhaps if this information were to be pushed to us via the social media (as opposed to being buried in the APhA website or in a weekly email), more pharmacists would become more active in and less critical of the APhA. The AMA blasts emails and tweets on issues affecting their members several times each day, why not our organization?

Like I said, it's a communications thing. If the practicing pharmacist knows how the APhA is working for them, the pharmacist would be more inclined to support the organization.

As always, I'd love to hear your thoughts on this. Comments and emails are always appreciated. Comments get seen by everybody, emails only get seen by me.