Tuesday, May 24, 2011

Cutbacks may jeopardize safety

I would have to complete over 150 med reviews per month to make up for revenues lost due to government cutbacks.

Sue had been taking Cymbalta for fibromyalgia when she became acutely aware of an oft-forgotten ill-effect while visiting Paris. Contemplating the magnificent Eiffel tower as though it were a mere “peanut butter sandwich” (not her favourite), she realized something had gone askew.

“I would rather feel the pain than a lack of feeling,” she told me. “Will you help me wean off this dreadful thing?”

So I did some sleuthing, whilst looking at all of Sue’s meds, and had her come in for a chat thus meeting the requirements of a med review, and billing tax-payers $60. Next, I proceeded to get a new prescription for the half-strength capsules, billing the $70 consultation fee with the aim of eventually stopping the mood-blunting-culprit completely, and I intend to do a follow-up in a month for a $15 fee.

Instead of adding to our work load, would it not be much simpler to just compensate us for what we already do?

It is ironic that I completed my very first med review and consultation—according to the new B.C. government requirements—on the eve of the damning Vancouver Sun article pointing out that Canadians pay top dollars for generics, with B.C. taking the hit.

Yes, UBC researchers say that if the rest of Canada followed Ontario’s model for generic drug pricing, we could save nearly $1.3 billion a year. But the study does not take into account new money some provinces are giving pharmacies to help compensate for services like patient consultations and medication reviews. In fact, it only serves to reinforce in people’s minds the idea that pharmacists work for free.

In all I spent about half an hour—between dispensing—doing some research, phoning up the drug company and printing out interesting reading material for my patient on what to expect upon Cymbalta withdrawal.

Loss of Cymbalta sales aside, my first med review and consultation has been a most rewarding experience, as helping others always is. But from a business perspective, my mind is blown away by the impossible number of med reviews (over 150 per month) that would go to make up for lost yearly revenues due to government cutbacks.

And while I can understand the need to separate our professional allowances from product reimbursements, I am afraid that the need to candy-wrap what most of us have already been doing on a daily basis in order to justify billing, may be leading to inadequate compensation. Ultimately, pharmacists are being asked to do more (in paper-work requirements) for less, and patients are still under the illusion that the most readily accessible professional lives on air alone.

This is perhaps why some pharmacists will be tempted to cheat the system, a maddening phenomenon that I suspected could happen but did not expect to encounter so soon…

A few days after my med review, I was filling a prescription for a new patient when I noticed that her profile included a recent med review allegedly performed at another pharmacy. Curious about how she had found the whole process, and eager to compare this with my own experience, I asked how the med review had been, only to meet with a blank stare.

“What’s that?” the woman asked—no, she is not on Aricept.

“You mean the pharmacist did not sit you down last month to go through all your medications with you …?” I queried in disbelief.

The woman looked at me in alarm afraid she had been billed for something she had not asked for… “ Well no… the pharmacist did nothing different than what she always does…

While not excusing the pharmacist, I can totally understand why someone might be tempted to bill without sitting the patient down for 20 minutes. Yet her unethical demeanor is highly detrimental to the profession and very unfair for those of us who are trying to do things right. Ultimately, abuse of this sort could result in the government pulling back its offer.

But there may be another alternative.

Instead of adding to our work load, would it not be much simpler for the government, private insurers and private payers to just compensate us for what we already do?

Being fully aware that it is not I who will be paid, but the business, I should still be able to bill every time I counsel a patient on a new prescription, every time I phone a doctor to clarify a dosage or to change an order. I should bill, as my doctor does, for every telephone consultation and not just for sit-down med reviews. I should be paid (the business compensated) fairly for every justifiable refusal to fill, and not only when the patient is a Pharmacare subscriber.

True, in B.C. we are currently reimbursed for adaptations and renewals, but adaptation requires lengthy documentation. Also, some physicians are instructing us not to adapt.

And so, until both the government and the public can better appreciate all the hidden work that we do to improve health outcomes, all walk-ins with queries shall be escorted to the Consultation Room. Phone callers will be asked to make appointments.

Yes, patients’ best interests must always come first. But if business is stressed and pharmacists overworked, patient safety will be jeopardized and the interests of no one at all will be served.

Written for the Canadian Healthcare Network under the title "My first paid med review: Professionally satisfying, financially unjustified" on May 24 2011.

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