The Problem With MTMs

Judging from what we're told at school, MTMs are the second coming of Jesus. It is "an example of the future of the profession" or "identifies the new role of the pharmacist in the health care community."

That is entirely true... to an extent. The problem though is that everyone, and by everyone I mean those in power, realize what MTMs can do for the profession... yet choose to ignore the relevant problems of adopting it to our current business model.

We all know the benefits of a service such as MTMs. Physicians are even conceding to the benefits of MTMs, a fact which is more groundbreaking than most realize.

The problem is the consumer does not know the benefits of MTMs. Hell, they don't even know what MTMs are for the most part.

I covered this fact earlier last year and it is something I have been pushing APhA to look into for the last few months.

Essentially we are telling the various insurance providers that we can offer this service which will, ultimately, save them money but will do so in a novel approach. Herein lies the bigger problem... there's no demand for these services.

Really, there's not. Name one time a patient came up to you asking for something similar to what MTMs do? I bet you cannot name one specific instance can you?

That all comes back to the fact that the public is blissfully unaware of what a pharmacist can do. We have to create the demand if we want to take this next step. Some pharmacists, namely Eric, RPh, are already taking the brave first step into this new world.

If we're so intent on moving in this direction, we have to tackle the business aspects that we have so far been ignoring. Pharmacists, in general, have been the passive members of the health care community and in many ways this has become an ingrained trait. It is time to step out side of this self-induced funk and reassert ourselves.

And if not for ourselves, for the future of our profession.

Would it really be so difficult to devise a system for billing for time spent monitoring a patient? We already have ICD-9 codes and DURs to classify what it is we're doing, would it be so difficult to add one more field classifying some time scale? This wouldn't require a complete rewrite of how we do our every day business, merely a small adjustment.

Honestly, I think that is the biggest hurdle places like WAGs, CVS and the likes have with pushing for these services, successful implementation of billing. Sure there would be some trust involved, but it's there are ways to self, and externally, audit times.

And for the business minded folks, the sheer dollar amount that is available out there is astounding. It's almost as if we're sitting on top a giant field of oil, yet we're too scared to drill some test wells.

Ironically enough, the exact same could be said in terms of benefits for patients.

Really, what on Earth are we waiting for?

Useless Term of the Day: Generic Utilization

Last week at work one of our newer tech's asked me what the phrase "Generic Utilization" meant. He had seen it on a memo from our DM and couldn't quite grasp what it meant.

The more I thought about it and tried to explain it to him, the more I realized how utterly ridiculous the term was.

The memo itself was telling us that we needed to increase our generic utilization. How though? 95% of what receive is filled as a generic (if one exists) right off the bat. The remaining 5% are either on a brand for a specific reason or are anal retentive and refuse to switch.

So how precisely are we to effect that? Why waste time and energy focusing on something of which we have very little control.

Can someone out there with a bigger and more developed brain explain it in any better fashion?

To Speak or Not To Speak

This may not surprise most of you, but I apparently already have a reputation among the other classes at my school.

Shocking, I know.

Through the grapevine I have discovered that I have been referred to as the "guy who doesn't take shit from the professors" or "the guy who brings the real world into class."

Kinda cool, wouldn't you think? Except I've noticed a slightly perplexing side effect to this. It seems, almost, as if I'm being blackballed by certain professors.

That big multi-year research project I had mentioned a few months ago? It's suddenly vanished, along with the regular emails from the related professors. In one of my classes, management class, I am regularly ignored when my hand is raised.

It's frustrating.

Which leads me to this question, should I continue to speak up? Should I continue to push the envelope in our classes in order to ensure my fellow classmates, and future pharmacists, have a truthful view of the pharmacy world?

The me of 2-3 years ago would keep at it. Now that I have a wife, a child and a burgeoning career, I wonder if this is the best course of action. This isn't a small, unknown little school and I certainly do not want to create a negative perception of myself as I enter the pharmacy world as a pharmacist.

And since my plans have changed in the hopes of attaining a particular residency, I really do not want to shoot myself in the foot anymore than I have to.

So do I speak up at every inane situation presented, at every fairy-tale story told, at the incorrect information we're fed? Or do I pick and choose my battles and straddle the line of appeasing both sides.

Truly, I do not know. It's part of the reason why I have been "freakishly silent", as someone told me, the last few weeks.

What good is having a voice if it only spouts negativity?

I suppose that is the ultimate question I have been asking myself. And honestly, I do not have an answer.

Ten Years Ago Today....

Yearly Repost:

That being said today is a special day, although not in a good sense. Nine years ago today my sport lost its leader, its champion and by all rights its greatest driver, Dale Earnhardt. After nine years it still kind of feels as if a family member is gone, which is rather strange. Then again those of you who did not follow the sport prior to that day will never quite understand. But if there is any of you out there who does read this blog and does understand what this day means... well then you'll understand the accompanying video as well.

A Cavet of Knowing the Inner Details of the Profession

I have an exam later tonight on pharmacy systems. When we first started these classes I was ecstatic because, as some of you may have gathered, between my business background and my experience, I know how and why pharmacies work and function quite well.

I've studied CQI, the various ISOs and I've seen every flavor of community pharmacy (the main focus of the course) that there is. It should be a cinch right?

Nope. Not at all.

You see, I know too much. How can that be? I shall explain.

The first exam we had in this type of course way back in September was about the economics of pharmacy. I had taken many Econ classes during my undergrad and feel like I have a rather good understanding of the topic. On the exam though... that was another story.

I lost numerous points because either my thought process went beyond the scope of the problem, even though it was completely correct and that they did not define the scope, or that I understood the topic better than the TA who did not understand what I was saying.

It was immensely frustrating, and alas that has been the theme for the rest of the course.

Tonight's though could be far worse. You see, the material we have been given is, at best, five years out of date. Our text talks about the 'new' use of PDAs in health care, or how eRxs are going to take off.

One of our readings is an analysis of the functions of the pharmacy... only it states that one of the problems they recognized is that pharmacists do 95% of data entry and 50% of filling. The article is twenty years old.

For the most part, this isn't the fault of the course or the professor. It is such a fluid topic, that it is hard to devise a textbook or lecture set that is current. I completely and totally understand that.

But I will be going into a test today with the knowledge that I need to dumb down my answers. I can't sit down and study a lot of this information because I know it's wrong. It's a very unusual position to be in, and a very frustrating position to be in.

To state a quote that my wife hates, it is what it is... isn't it?

Improving the Pharmacy Profession… One Wal-Beer At a Time

Walgreen’s bills itself as “The Pharmacy America Trusts.” With that trust comes the responsibility of an honest and ethical management of their patient’s health care. If America trusts them as they suggest, and honestly it’s probably hard to argue otherwise, due to their size they are the public face of pharmacy.

It’s not preferable that one, generic entity represents the varied world of pharmacy, but alas that is what we have to live with.

Imagine the shock pharmacists across the nation had when a little nugget of news appeared, even as it was clearly attempted to be brushed under the rug. That nugget? The creation of Wal-Beer.

We live in a massively evolving health care system in which pharmacists are fighting to rightfully assert themselves as a respected and educated member in modern collaborative practice. For too long we have been either dismissed or ignored, but in the last two decades have seen the profession begin to shred itself of those shackles and become an integral part in the management of a patient’s health.

And it is something to be applauded.

The bigger issue, something which I have touched on in the past, is that while those within the medical profession now readily acknowledge our presence, the public has a complete lack of understanding of our abilities. It is a fact that, at some point, will need to be addressed if we are to reach our full potential.

Now, the public will have Wal-Beer.

How morally and ethically responsible is it for the largest pharmacy chain in this country to create a beer label, with a low-ball price point, in the midst of this change? Pharmacy’s across the nation are refusing to sell cigarettes and alcohol in their pharmacy, yet Walgreen’s has decided to not only ignore this but to instead take it a step farther.

And don’t tell me that it’s okay to sell cigarettes in a pharmacy as the pharmacist can consul a patient on the negative aspects of smoking. The day that truly happens is the day the cigarettes are kept behind the pharmacy counter.

Fat chance of that.

Instead, “The Pharmacy America Trusts” is undermining everything we have fought for these past decades. In class we are preached “Patient Care, Patient Care, Patient Care,” and that our generation of pharmacists will be focused on this for our entire career in new and novel ways.

So how does Wal-Beer fit into that? How is what Walgreen’s doing an attempt to not only further the profession but increase the health of their patient population?

I realize that chain pharmacies are more profit driven than others, but this is a deplorable step even by those standards. Every day we deal with shrinking reimbursements and the lack of an ability to bill for basic services. This is what Walgreen’s should be focusing on and standing up against, not creating its own line of cheap beer.

The better question is, what will organizations like APhA say about it? Will they ignore it? Or will they stand up and denounce the creation Wal-Beer and what it means for the profession? A dare not to be overly dramatic and overstate the importance of doing so… but I’m not sure that would be overly dramatic.

Surely Walgreen’s isn’t the first pharmacy to attempt something of this nature, but as the face of the profession they should be held to a higher standard. If not by the public, then by their employees and the profession itself.

There are bigger fights on the horizon and many will dismiss this as something trivial. It is far, far from trivial however, and represents a dangerous tipping point for the profession. If we wish pharmacy to be properly understood and respected among not only our peers, but the public, we cannot condone this.

Until then, Walgreen’s shouldn’t be the pharmacy America trusts. Hell, they shouldn’t be the pharmacy pharmacists trust. Should they?