Note to Pharmacists re: Charging for MTM and Cognitive Services

A pharmacy colleague recently posted a LinkedIn discussion revolving around the topic of  how much to charge for a face-to-face comprehensive medication review with a patient. A few days later I noticed one of my Twitter colleagues, Carrie Wilkerson aka The Barefoot Executive, also posted on her blog a discussion simply titled ‘What Are You Worth?’ and shared the following story:

“A woman in Paris spots Picasso in a cafe. She begs and pleads him to sketch her…he finally relents, whips out his pad and draws a sketch of her.

She’s delighted. “How much do I owe you?” she asks.

“$5,000,” he replies. 

“$5,000!” she exclaims. “But it only took you 2 minutes!”

“No madam,” he replies. “It took me my life”.

This is what your clients are paying you for… not your time, not your ‘effort’ – rather, your WEALTH of experience, knowledge, information and networks which you have built up over YEARS of study, practice, failures, successes and experience.”

For the most part, pharmacists know what their value is with regards to the pharmacy dispensing function. They know what they currently get paid or can check out salary surveys or just ask around to find out what the going hourly rate is for pharmacists in retail or hospital settings.

When it comes to payment for cognitive services it’s a different ballgame. This is a new and unexplored area for most pharmacists who are starting an independent medication therapy management MTM consulting business. First of all, we’re told by others, even those associated with MTM training sessions, that we should not discuss fees for MTM services. This creates a very nebulous picture of what the going rate for MTM services is or what others are charging. But even more important is the fact that most pharmacists undervalue the cognitive services they provide. After all, we’ve been giving it away for free far too long. How patients value our services, if it’s seen only as ‘free advice’ for the most part, will be very misleading, especially if they don’t understand we could be saving them untold cost and misery from adverse drug events, improving their physical health and well being, or possibly even saving their life.

Another problem is pharmacists tend to look at the ‘market place’ and only see what Medicare part D is reimbursing for MTM comprehensive drug reviews. It’s easy to be pulled into the mindset that this sets the true value of MTM services. Why not look at this as a 75% reimbursement level and charge the balance to the patient as a copay?

It’s like the story of a factory manufacturing consultant who charged $10,000 for getting the equipment operating properly. The factory owner complained that all he did was turn one screw to get it working right. The consultant re-writes his bill to the factory owner showing a $1 charge for turning a screw and $9,999 for knowing which screw to turn.

Other health care team members can provide a comprehensive drug review. But pharmacists are the health care team member trained to know ‘what screw to turn’ when there are problems with a patient’s medication therapy. And they should get paid at a rate compensating them for their life spent learning and practicing the art of pharmacy.

So ask yourself this question… What Are You Worth?

Why Can’t Pharmacists Prescribe: Response to @ThePharmerGuy

Twitter’s @ThePharmerGuy recently posted on his blog ‘Another Day Behind the Pharmacy Counter…’ asking the question:  Why Can’t Pharmacists Prescribe?  He details a very good argument as to why pharmacists should have prescription authority.   My thoughts on this topic follow below:

I totally agree it’s past time for pharmacists to be given prescribing authority, at least on a limited basis. There are so many instances where a pharmacist could make the decision to appropriately select and prescribe from a limited formulary of medications for a number of common disease states.

Pharmacists receive more intensive training and are more qualified to make decisions regarding appropriate medication therapy than most nurse practitioners or physicians assistants I know, and probably more qualified than many MDs as well.

Prescribing authority is given to MDs, NPs and PAs, in my opinion, after receiving basic training algorithms to assist them in making prescribing decisions based on their diagnosis. They don’t receive near the training or knowledge base in pharmacology, pharmacokinetics, adverse drug reactions and drug interactions that should be used in the drug prescribing process. They are also somewhat dependent on and easily swayed by the influence of pharmaceutical sales and marketing efforts, something which pharmacists are able to sort through by throwing out the hype and making better clinical decisions based on rational therapeutic approaches.

And, from what I have seen, most prescribers are easily swayed by their patients as well. All of the direct to consumer pharma advertising has created a patient population who go the the doctor with their expectations of what should be prescribed… and sometimes get upset when they don’t get what they want!

Pharmacist prescribing would expedite patient care and lower the cost of care by facilitating or streamlining the process of finding the correct medication and dose to reach and maintain therapeutic goals. This would tie in very well with a medication therapy management type of pharmacy practice that monitors new medications and makes changes or adjustments quickly and efficiently based on patient response to therapy.

All this would help to reduce costs associated with patient medication therapy,improve and streamline the process of reaching therapeutic goals, aid in assisting, educating and counseling patients to ensure compliance and adherence to drug therapy and improve patient outcomes.

The PharmD vs. BSPharmacy status for prescribing authority will need to be addressed in some manner. Pharmacists were making decisions regarding appropriate medication selection and use decades ago. It wasn’t until the prescriber and dispenser functions began to change that pharmacists  began to lose the authority to ‘prescribe’ all but those medications given OTC status. Generally speaking, most RPhs have as much knowledge and decision making skills when it comes to prescribing as those who prescribe the prescription orders they fill and dispense. Same with PharmDs.

Yes, it is time for pharmacists to be given prescribing authority, if even on a limited basis. I would expect that this authority would be expanded after a year or two of monitoring said prescribing authority based on the positive outcomes we would see.

Message to Pharmacists: Be a Survivor

Survival of the Fittest

We’ve all heard the phrase most often used in evolution theory, ‘survival of the fittest’.  And indeed it’s most often true that only those who are ‘fit’ are able to survive in this world. Those who are considered strong, powerful, vigorous, forceful, outgoing or even overbearing are usually considered prime examples of any species that are truly able to survive.   Examples of  survivors in the world of pharmacy might include Walgreens, CVS, Walmart and other familiar big corporate pharmacy names. But are these the characteristics that will be needed to continue to be a pharmacy survivor in the future? Do you and I need to have these characteristics to become pharmacy survivors ourselves?

I recently ran across a quote, or more appropriately a misquote, often attributed to Charles Darwin which gave me a different perspective on the idea of survival of the fittest in the world of pharmacy:

“It is not the strongest of the species that survives, nor the most intelligent, but rather the one most adaptable to change.”  

It was found that this quote is actually attributed to Leon C. Megginson, former Professor of Management and Marketing at Louisiana State University at Baton Rouge, and can be found in his writings,  Lessons from Europe for American Business,  Southwestern Social Science Quarterly (1963) 44(1): 3-13, at p. 4.

Those who are the most adaptable to change will become the survivors of the future in the world of pharmacy as well.

Learning to Adapt;

There is no question in my mind that Professor Megginson was right on target. Today’s pharmacists need to become adaptable to change. The ability to adapt or to acclimate to the changing climate in the world of pharmacy is probably the biggest factor in the success of any pharmacy business today or the future.

Today’s community pharmacists,whether practicing independently in a pharmacy setting or striving to build a medication therapy management MTM consulting business need to learn to adapt to the changes taking place. Today’s pharmacists need to out think, out maneuver and out perform the competition in order to be survivors.  Flexibility and adaptability will be necessary to survive in today’s world of  PBMs, ACOs, CCOs and PCMHs.

Although it will take both business fitness and strength, it will require a more cerebral type of business savvy.  Planning and organizational activities are becoming more crucial for a business to succeed. New ideas and approaches to opportunities and problem solving are needed to survive. The ability to be always be ‘thinking on your feet’ and quick to maneuver through the ins and outs of business will be critical to your success.

Flexibility is now a key component of business marketing strategy.  Finding new ways to market yourself are imperative. Social media marketing, email marketing, guerrilla marketing and other progressive marketing techniques are becoming more prevalent and common.  Finding new ways to fit into the changing landscape of the profession is critical. And finding new resources to assist you in the process is becoming a necessity.

But most importantly is the need to believe in who and what you are. You need to be the pharmacist, a trusted member of the healthcare team. You need to be the healthcare provider that patients (not customers) expect you to be. Customers just want to buy something from you. Patients want the beneficial concern and care you offer them that gives value to the products or services you provide.

This is where the big players have dropped the ball… they have distanced the patient from the pharmacists they employ. The counseling, care and concern that used to be in the pharmacist/patient relationship is, for the most part, no longer there, turning patients into mere customers at best.

This is where you can take the advantage in the world of pharmacy.  Be the pharmacist and healthcare provider your patients expect you to be.  Be flexible in your thinking and maneuvering through your daily business activities.  And most important… Be a Survivor.

Message to Pharmacists: Be the Healthcare Provider

Do pharmacists need to be recognized as medical providers? Or is it time to move forward without waiting for this to happen?

I’ve seen a lot of discussion about the need for pharmacists to be recognized as medical providers. Is this something that needs to happen before MTM can move forward? Eric (@EricRPh on Twitter) writes on his blog Eric, Pharmacist on this topic:

“If pharmacists receive provider status and are able to bill for services rendered, the entire medication therapy management MTM practice model will take off. There are innovative minds in the pharmacy world that will revolutionize healthcare, 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 isn’t going to cut it. We need to become recognized providers now. There is a petition floating around out there to try to get pharmacists recognized as providers. If you haven’t done so already, I suggest that you check it out.” – read Eric,Pharmacist’s blog @ http://ht.ly/8p8nv )

I appreciate and agree with Eric’s comments. But I also would say pharmacists need to “BE the healthcare provider now… the rest will fall into place” to all pharmacists, whether in retail, hospital, drug chains or pharmacists interested in MTM consulting.

Pharmacists have been using the ‘waiting for reimbursement’ argument for providing MTM or consulting services for years. We could continue to wait like the profession has in the past. OR we can step up and BE THE HEALTHCARE PROVIDER now and show that we can provide valuable services to patients, physician practices, medical home providers, and any other applicable areas of healthcare.

According to my trusted advisers at Wikipedia, “a health care provider is an individual or an institution that provides preventive, curative, promotional or rehabilitative health care services in a systematic way to individuals, families or communities”.  Pharmacists have been doing all the above for years.

“An individual health care provider (also known as a health worker) may be a health care professional, an allied health professional, a community health worker, or another person trained and knowledgeable in medicine, nursing or other allied health professions, or public/community health”.  Pharmacists fall within this definition of a health care provider already.

So I ask the question again:

Do pharmacists need to be recognized as medical providers?

I was pleased to read Medscape/Pharmacists recent interview with Vincent J. Willey, PharmD, who comments on the pharmacists role in the medical home model (see attached link http://ht.ly/8p9qx ).   He illustrates how and where a pharmacist can provide input and interact within the system and the healthcare team to provide services and promote better overall patient care.  This is the picture of what I think of as a pharmacist ‘being a healthcare provider’.  He, and many other pharmacists like him, are already recognized as medical or healthcare providers based on the value of the services they add to patient care and other healthcare providers.

Believe in yourself, your profession, and the services you provide as a pharmacist.  In whatever area of pharmacy you practice you should ‘BE THE HEALTHCARE PROVIDER’ at all times. Whether in retail, hospital, long term care or other area of pharmacy practice, you should ‘step up and show your stuff’. Providing valuable information to patients, physicians, nurses, etc., will show them your true capabilities and further define your place on the healthcare team. Continue to do so and they will become dependent on your input. You will get the respect, cooperation and reimbursement you deserve in direct proportion to the value you provide to them.

Maybe, more importantly, you will have the personal satisfaction of knowing you’ve done your best in your efforts to apply your pharmacy knowledge to improve patient care and promote positive outcomes.