Community Forum : New Practitioner Network
Welcome Guest   
 Subject : Looking toward the Phuture.. 06/29/2017 02:53:56 AM 
Harry M Zollars
Posts: 24
Location: Bethalto, IL
I wanted to bring up something to new practitioners regarding what I'm working with the Board of Directors that truly impacts the future of our practice.

Currently - and don't hesitate to correct me if I'm wrong - we get paid based off the classical form of our practice: dispensing. We get a catch all revenue per prescription with the hope that the profit will cover not only the cost of the medication but also the time it takes to type, check, fill, and verify such a prescription on top of every aspect that surrounds that act of dispensing. We have additional fields where there are alternative revenue sources like with immunization with administration fees as well as through medication therapy management consultations through Medicare Part D. These are all a relation to a fee-for-service payment system that third-party-payers have become so used to following when it comes to Pharmacy as a profession.

However, this will not be sustainable for our futures, especially those looking to practice for 20, 30, 40 years. From what we learned in school, think about how much our profession changed over the last twenty years alone and just imagine how things will continue to change going twenty years into the future. If you work in the independent realm and see reimbursement rates for prescriptions lately, the profits are going down and the focus of the fee-for-service payment is on quantity of prescriptions and less on the quality of the service. Because 500 prescriptions a week could have been sustainable with a decent profit when I first graduated; but now that same volume can lead to barely breaking even.

The focus on healthcare overall is moving away from fee-for-service and move towards outcomes-based payment-for-performance structures. Doctors are already being forced through Medicare to base their payments on their performance for various outcomes measures. Hospitals are dinged on their payments based on rehospitalization rates. And now... Pharmacy is next. Many have probably heard of Medicare STAR ratings and how that is a measure to allow third-party-payers to base their payments on these outcomes ratings to incentivize pharmacies to better their service allowing for the most optimal payments possible. In my opinion, the impact of these STAR ratings has been dragged over the last 3 years because a lot of the payers are finding other ways of dinging pharmacies, but I digress.

What is even more troubling than anything is that the reliance on profit over cost in the act of dispensing has been completely trashed by three simple letters: DIR. Direct/Indirect Remuneration Fees have made it truly impossible to come out ahead in the traditional way of practicing pharmacy. Now more than ever, it is important which contracts your pharmacy participating in. On top of that, these outcomes-based contracts are using these kinds of fees to remove 10-20% of all reimbursement to "reward" high achieving pharmacies by paying only 5-15% of that money back - IF AT ALL. It almost all looks too gloomy looking into the Phuture...

But here's what I'm more excited about that goes beyond STAR ratings and DIR fees: Enhanced Service Networks. We already provide plenty of these enhanced services, such as MTM, Medication Synchronization, Adherence Packaging, Medication Delivery, and many, many more. However, how often do we pharmacies - let alone, pharmacists - get paid for these services? I'd venture that it is not very often. Pharmacists - in spite of what federal perspectives may be - ARE HEALTHCARE PROVIDERS. We provide extensive value not only to patients but to providers and payers alike and these services we provide save costs for everyone. Our cost of dispensing should not be the sole revenue source when we provide more than the simple act of putting medications in vials.

To help rectify this, we as an association are at the beginning stages of creating a network of pharmacies to establish documentable evidence of pharmacy's benefit and value to payers and be recognized as the providers we are. I don't want to ramble too much, but I'll be working with pharmacists across the state to help establish such a network and determine what core services we believe our pharmacies should provide. What this means ultimately is that when we have proof that our efforts alone - not the act of putting tablets into a vial but the synchronization of that vial with the rest of Mrs. Jones' medications as well as the CMR we scheduled to review her medications - we will be unstoppable as a profession. Just like the changing tides that the Asheville project provided to allow for more power in the clinical services pharmacists provide, so too will this network provide for the advancement of the profession.

If you're looking to see what we've done, please catch us at the annual conference in September! We're hoping to launch what we've been working on and hope to get you as enthusiastic about the phuture as I am! Thanks!
Pharmacy Manager
Sullivan's Drugs
Mount Olive, IL
# of Topics per Page