Like many of you pharmacists out there I sometimes have to take a break and reassess my direction. I call this my RePhresh period. Any profession, any career needs to pivot at the correct time. We hear the ‘healthcare landscape is ever changing’ and if ‘we don’t have a seat at the table’….blah, blah, blah. I get just as tired of hearing that spill as you do.
During my RePhresh period, I took time to connect with practicing community pharmacists. This is after all my continued hope for collaboration among our profession. I almost felt like I have been shooting a Vice documentary over the past year. Working with individuals across the states and truly tailoring programs to fit their community has been phenomenal. After a long period of working hard with these other practicing pharmacists we have developed true workable, reimbursable models. It has been RePhreshing (I know I can’t stop). We got past the ‘WHY’ we need to practice differently and got into the ‘HOW’ are we going to practice differently.
Outcomes based models are really not as scary as one may think. We are all sitting and waiting for the CMS Enhanced MTM pilot to kick off in January….wait, sitting? There’s our issue again. We collectively choose to sit back time and time again waiting for our marching orders. Eleven states will be included in this Enhanced MTM pilot. I say we all follow a similar pattern and adjust to this style of documentation. If you have been to any conferences recently you have heard about care plans and intervention documentation. We rely on the same leaders in our profession to give us specifics on how to do this. What platform do we use? How often do we meet with our patient? Should we change software vendors? When do we have the time? The questions are so predictable. And I will say I am so thankful for the leaders within community pharmacy to be role models and share their best practices. However, if we truly get to the root of their response the answer is always the same…take good care of your patients.
That is it. Plain and simple. Take good care of your patients. Nothing groundbreaking. Take good care of your patients and document the ‘HOW’. This may include updating your blood pressure machine, purchasing a new scale for the pharmacy or investing in new technology. I am not asking you to completely turn the way you meet patients upside down…I am asking you to build on this piece by piece. Tailor your data collection to your patients. Prove that increased medication adherence rates combined with disease state education show decreased BMIs or blood pressure readings.
You can go back through my past posts and see the desire to tell our story and the WHY we need to stay relevant. We do take good care of our patients. People are listening now. It’s time to put up or shut up! Sorry, I didn’t mean to be so blunt. But there it is. Take good care of your patients and document the HOW. Here’s to kicking off a new round of posts from yours truly, PharmacistJamie!
Innovation in a profession is so much fun. Luckily I am employed by one of the most innovative and creative companies in my profession. We are continually on the edge of new reimbursement models, technology and anything involving high quality pharmacist delivered patient care. The team also works hard to make sure we create something people see the value in. This thought brings me to my topic for today.
Pharmacy has been noted for years as a dinosaur. You know what happened to the dinosaurs? They are EXTINCT! Gone. No more. None left on the planet. What if pharmacists were gone? No more? None left on the planet? I don’t think that sounds like a place I want to be. The reason we are threatened with this possibility over and over is clearly are lack of adaptability. Plain and simple we don’t want to do anything different from what we are doing right now.
Many pharmacists tell me daily they just do not have the time for anything else. Ok. Let’s look at what is taking up your time right now. Are you still inputting prescriptions? Are you spending time restocking shelves? Are you caught up in paperwork? We must adapt. Here are a few options to start.
#1 Workflow Evaluation – We have so many extremely competent pharmacy technicians in the workforce today. Take advantage of this. Empower your technicians with their duties and ask them to make suggestions on increasing productivity. Your technicians should be doing most of the filling process, MTM prep work and inventory control. Period. Look at how much time you are spending on the “counter”.
#2 Technology – Yep. Most of us work with a desktop type computer and will look to nothing else. Everyone else is ahead of the curve. Tablets, laptops, smart devices of any kind can expand your reach … literally. Utilizing an iPad to show a patient a video on how to use their inhaler properly may change their life. I’m not being dramatic. Many patients are visual learners and your counseling time may be wasted if they aren’t comprehending anything you’re telling them.
#3 Continuing Education – Every year we wait until it’s time to renew that license and we hurry up and go online to find the CEs that are free and fast. I get it. You would rather spend time with your family than work on CEs all night on the computer. What about attending just one conference a year that will cover all your CE credits or applying for a certification that covers as well. APhA is constantly offering these style programs locally. You wouldn’t have to travel very far at all. Take some pride in what you do. If you don’t then you are destined to be replaced.
Last thought I leave you with is this. I pass old Blockbuster buildings all the time. I think….wow…when I was growing up I would go to Blockbuster every weekend. We rented movies, ordered concert tickets and honestly hung out with friends. What happens when patients can go to Redbox for their prescriptions, visit online counseling sessions provided directly from insurance companies and start hanging out at McDonalds instead of the corner locally owned pharmacy. Try something new. Do something that makes you feel good. I promise the results will be beneficial for your patients too.
I guess it is only appropriate that American Diabetes Month comes the day after Halloween. I am literally staring at a bowl of sugar on my kitchen counter. As a mom I worry about the boys and their teeth. Constantly reminding them to brush their teeth every morning and every night to get the “sugar bugs” out of there to prevent tooth decay. Then I think about the sugar going in to their bodies and what that is doing. According to the ADA about 86 million Americans are pre diabetic and at the risk of developing Type 2 Diabetes. Ahhh!
So pharmacists I ask you how do we fit in the picture? I think we can provide a great intervention point to many of these patients. I am not always a fan of scare tactics; however, at some point you have to explain what will happen if these patients do not make a change. Wellness and preventative care are highly encouraged by many health insurance plans. It is imperative we find our place in this model. I do think we can all agree the current pay for product model is not sustainable…our “dispensing fees” have decreased. The flip side of this is a new stream of pay for service. This fall my pharmacy has seen the medication administration incentive fee adding to our bottom line. Vaccines are just one answer in preventative care in pharmacy.
Back to the topic at hand, pharmacies can now become accredited to supply Diabetic Self Management Education (DSME) to patients. The process is not even as difficult as you may think. Yes, Medicare does require paperwork. That’s how they measure outcomes…something we are not used to being held accountable for. If we can change our mindset just a little I think we could blast open a new revenue model in pharmacy. Chronic Care Management (CCM) offer the opportunity to document interventions with chronically ill patients. Why can’t we take advantage of that? In most cases these patients see us more than any other healthcare provider.
The last I leave you with in terms of pharmacist provided preventative care is an awesome article in the October 27th edition of Drug Store News. http://www.drugstorenews.com/article/study-pharmacist-intervention-improves-post-surgery-outcomes-diabetics. Please take the time to read…super short I promise :))
“After the second year, patients in the intervention were:
• More than two times as likely to have well-controlled blood sugar the day following surgery;
• 69% less likely to have hypoglycemia (low blood sugar) in the three days following surgery;
• 33% less likely to be readmitted to the hospital in the three months after discharge; and
• 28% less likely to visit the emergency department in the three months after discharge.
Because post-surgical complications and readmissions were reduced, associated costs were also reduced. On average, in the six months following discharge, the patients in the intervention had monthly medical costs that were $284 lower than those of the patients in the control group.”
The proof is there. Another point they mentioned was the program was led by a pharmacists coordinating with the entire hospital team to develop protocols and policies. It does take a team effort. It takes the pharmacist being part of the team. So if the proof is here…we prevent extra costs…we prevent complications…we help patients!…where is the reimbursement model? Will it become proactive MTM claims with private providers or CCM codes with Medicare? Think about it guys! We must continue to evolve.
Bet you didn’t think that’s where the post was going. I like to keep you interested. Now I suppose I should help these children make this Halloween candy disappear. It does only come around once a year. Moderation is key! Hey, no judgment. I think patients appreciate our honesty as well. We are all human. Letting them know they have a true partner in their healthcare is extremely important.
Goblins and ghouls. Witches and monsters. Headless horsemen and jack o lanterns. That’s what most people think about around this time of year. It’s Halloween! My house is a bit of a construction zone for the entire week. My husband takes this opportunity to create something for children to experience. A few find fear in the front creepy castle or the long walk across the haunted bridge around back. This year we fear the rain may get the best of us. We will be working diligently night and day to get ready for the big day.
So there’s some of the fear surrounding the week and weekend. Let me tell you about what I fear. It may not be what you are thinking. I genuinely fear for our profession. It is a true fear that has awaken me from sleep a few nights recently.
We all plan for the future. We invest money in our retirement funds, save up vacation days, put away for children’s college, the list goes on and on. Most of us are fortunate in the fact we make a nice salary to assist in all these areas. What if that nice salary isn’t available anymore? So many of my colleagues are quick to complain about the new reimbursement models and low dispensing fees in today’s retail pharmacy space. It is hard. As I have said before we have more work and less time to complete all of our tasks. However, automation could completely take over those tasks as of right now! If you do not think a corporation could come in with robots to replace us you are sadly mistaken. We have to give value…we have to prove outcomes…we have to show we CARE!
My fear is that so many practicing pharmacists will just give up. They will take whatever is handed to them and lose sight of the end goal. And they should be scared of the robots. With some great opportunities on the horizon many of us sit back and wait for instructions on the next step. We must find some hope and avoid the doom and gloom. It scares me that I do not know what the next practice model will look like…but I will not let that fear take me down. I will instead harness the anxiety and do something productive.
For example, we talk so much about provider status. Ok so we gain provider status… what’s next? How are we billing? What services are we providing? We must have sustainability and the only way to get there is to keep pushing and innovating. Look at the current medication administration rates for vaccinating patients. That is an extreme increase in your pharmacy’s bottom line. What if you were reimbursed for patient education? Oh wait…you can be! What if you were reimbursed for cessation counseling? Not there yet, but by golly we can be.
I read a fantastic article on Chronic Care Management Codes. So many physicians are shying away from the process. They are worried about audits and amount of work for payment. One practitioner did speak on the success of his program. He stated many of the requirements were things they were already doing with patients. The documentation is the difference. Yes, you must show data. He hired another LPN to assist with the paperwork. Sound familiar? Pharmacists, I know you are short on time. Hire another technician…or office manager.
I feel like we are scratching the surface on some great things. I am just not sure scratching is going to get us there. You may remember the “how many licks does it take to get to the center of the Tootsie Pop?” We have got to dive in! Start doing something in your pharmacy. Whether you support provider status or not…get over it. You ARE a healthcare provider. Period. We have to take some responsibility. Begin a chronic care documentation process. We can show payers. If we make enough noise and bite really hard…only kidding…we can get someone to notice. You will live in fear if you do not stand up for yourself.
Bet you didn’t see that one coming after the Halloween intro? I am making a commitment to this profession. I will never give up. I will not be replaced by a robot.
It is September 22. Fall is my favorite time of year. I love the weather, watching football games and holidays are just around the corner. The last thing on anyone’s mind is probably “spring cleaning”. Well, what I do may not be considered cleaning…we do some cleaning out.
This weekend we spent quite some time organizing the boys’ rooms. We made piles of toys and clothes to give to other children. We reorganized drawers and closets. Even separating super heros and legos into designated buckets. There were many groans and grimaces. I spent my time overseeing the activity as well as actually putting things where they go. As Sunday evening approached my 10 year old literally put his hands on his hips, looked at his room and said “You know…sometimes it feels good to get things in order.”
Now remember I live in a home with 4 males. My husband, two children and our newest addition, Ghost, the mini Australia Shepard. The boys spent their time upstairs cleaning out their rooms. My husband begrudgingly attempted to begin cleaning out the office closet. He pulled out electronics from decades ago. I had to laugh. He almost had a tear in his eye when he showed me his 6 disc CD changer. He asked what we should do with it. I tried to understand the sentimental value, but quite honestly could not understand keeping this piece of equipment hanging around. The more he dug, the more energized he became. Seriously. He could not believe the space we were creating. By Sunday evening he had moved all of our Christmas decorations in the office, bagged up things for GoodWill, made a trash run and finally found a place for my filing cabinet…yes I have a file cabinet. No judging. I love my Mac but sometimes you just have to have a place to put paper! The football game was on in the living room…he walked in…looked at me and said “You know…that’s not what I wanted to get into this weekend…but man am I glad I did.”
I am not claiming to be the neatest person. My desk can sometimes start looking like a library, gym or daycare center. I do believe in organization. I think in order to get to where you are going you must have your duckies in a row. How do you know what you have to work with if you can’t see it? As always, this could tie back to your pharmacy. Do you have some closets you need to clean out?
How many of you look around and wonder why you have notes taped up behind your computer or piles of manufacturer coupons? Clean it out. Make your space what you want it to be. Your workspace can be different. What do your patients see when they enter your pharmacy? Do they see a health or wellness center or do they see paper stacked all over the place and a poster from 1997 on the wall? We will talk about deep cleaning some other time. I challenge you to spend this upcoming weekend or next few days getting your pharmacy in order. I know you have a million things to finish…filing, you have that audit coming up, getting ready for flu season. However, think about what that patient sees when they come in for a flu vaccine. Let’s get the closets cleaned out first! I bet you will feel accomplished and reenergized. Sometimes it takes getting rid of something old to prepare for something new.
On a island in the sun…we will be playing and having fun
I think the kooky 90s band, Weezer, has nicely summed up my feeling for this summer! I have so many ideas and so many things coming through my mind. It is hard sometimes to organize all of them and get down on paper. Honestly having my two boys at home this summer wanting to play in the pool, throw frisbee and paint with me (a new venture ) has been, well shall we say, a happy distraction (but distraction nonetheless). I am not ashamed though. We wear so many hats. The pharmacist hat is not always the most important. Take the time this summer to reconnect with your loved ones, make a plan for your pharmacy, do some team building with your co-workers. This summer may be the perfect chance for you to explore your way to #ReThinkPharmacy.
Transitions can be difficult and will definitely not always be perfect. Like most of you, I am a product of my profession. When something does not go according to plan I see a complete atomic meltdown in the future. I’ve often thought that the ancient eruption on Santorini (another island in the sun) was a direct result of an ancient Greek pharmacist not being able to get Zofran to go through their Minoan health care plan. In our pharmacy when the computer system would go down ….AHHHH. You are then explaining to patients that you are not sure how long will be before you can check their profile, you see the baskets stacking up, you hear the phones ringing constantly because the IVR is now down as well. Do I need to go on? The day is RUINED! You will never catch up. Just soon hang it up, lock the doors and go home before…BOOM!!! Read more
Leaving Las Vegas…well kind of. I am on an airplane leaving Reno! Yesterday morning I had the pleasure of addressing new pharmacy owners at the NCPA Ownership Workshop. It was great! These guys and gals were so eager and so ready to get home and get to work.
After giving a keynote or CE class I always critique myself. I think about all the information I delivered and usually think of at least three more key tips or hints or advice I wish I would have offered. So here are my final thoughts from the workshop.
First of all the group I spoke with Sunday morning in Reno I believe were having a bit of information overload hangover…or maybe it was a genuine hangover. Remember I mentioned we were in Reno truth be told. As I spoke on the topic of Star Ratings and how they effect your pharmacy the pharmacists were feverishly taking notes. I tried to pause and make directed statements on big points. Finally a few minutes in heads started to lift. The pharmacists started to make eye contact with me. Then I realized they are scared. These pharmacists are taking a huge leap of faith! They are going to own a pharmacy. Of course they want to take notes and soak in everything NCPA is offering them. My hat goes offto you! Better yet my prayers. Community pharmacy can be so rewarding and making the decision to open your own place is amazing! I can see the apprehension and wish I would have acknowledged their efforts in the setting of Ballroom B or the Ponderosa room (wherever we were on the fifth floor). Read more
Check out my new article in the Winter 2015 issue of Compounding Matters Quarterly.
(Image links to article)