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Physician Medication Dispensing - A Healthy Choice For Primary Care Practices And Patients Alike
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Working on the front lines of modern health care, the primary care physician is arguably the most important physician any patient comes in contact with throughout life. Yet, more than half of primary care physicians feel they aren't getting credit where credit is due. According to a 2007 survey done by Merritt Hawkins & Associates, 53 percent of primary care physicians said they felt like second-class citizens in the medical hierarchy. Why? Too much work and not enough pay. The same survey showed while 83.1 percent of primary care physicians considered their practices to be very busy or even too busy, 58.6 percent of those surveyed were disappointed in their income. Many struggled with the cost of overhead, and 22 percent worried they could not sustain that overhead in the next five years. How can primary care physicians generate more income and manage overhead more efficiently without shortchanging the patients who rely on them? The solution is physician medication dispensing. Out with the new, in with the old Abandoning the pharmacy concept may seem new. However, historically physicians dispensed the medications while pharmacists manufactured them. In the early to mid 20th century, things changed. Pharmaceutical companies began manufacturing and distributing medications, pharmacists began dispensing medications, and physicians prescribed medications. Most primary care physicians currently dispense medications in the form of samples, infusions and injections. In-office dispensing allows physicians to dispense all the medications they prescribe while increasing their practice revenue. Increased revenue The most obvious pro for primary care practices is the opening of a new revenue stream. Physicians usually fail to realize how much time is spent each day dealing with pharmacy issues. Each pharmacy callback costs the physician on average $5-$7 per call. A typical practice can spend $30,000 a year handling these pharmacy-related issues, all for no revenue. These issues consume 6-12 percent of physicians' time. In-office dispensing can also improve the cost and management of overhead. There is, of course, an initial learning curve and time investment. The process of training staff and implementing physician dispensing can be difficult, but the training process is essential for success. Successful training and implementation + time + physician leadership = increased revenue for a practice. Space requirements for dispensing vary according to practice or clinic size. Medications must be kept in locked cabinets; typically, a five- or six-foot locked tool cabinet is sufficient for a solo practice. Medications should be kept out of patient-accessible areas. Larger practices may find it more efficient to dedicate a room entirely to dispensing. These start-up costs are nominal. With successful training, implementation and continued use, those costs can be recouped within a few months. Improved patient care A simple reason for physician dispensing of medications is improved patient care. Two more compelling reasons are: 1) writing and dispensing errors are nearly eliminated and, 2) compliance rates (patients getting their prescriptions filled and taking all the medication as directed) are increased by more than 60 percent. An increased compliance rate means lower overall health care costs. According to the Institute of Safe Medicine Practices, more than 3 million of the adverse drug events that occur each year in ambulatory care are preventable. These adverse drug events (i.e., illegible writing of prescriptions, unclear telephone/verbal orders, unclear abbreviations, unclear or inappropriate dosages, etc.) cost
primary care practices thousands of dollars in overhead. The pharmacy has to call the physician to clarify, and the physician must take the time to call the pharmacy back. More importantly, these errors cause a decrease in patients' overall health, and a decrease in the confidence they have in their provider. Convenience is another benefit of physician dispensing. A typical pharmacy wait time can be upwards of one hour, not including the time it takes for the patient to drive to the pharmacy after their physician visit. The pharmacy visit time is due in large part by design. The pharmacy is oriented more for sales rather than health care Extra time in their store means more dollars and profits from the patient. Physician dispensing allows the patient to receive their medications at the point-of-care and eliminate this additional pharmacy wait time. All patients, including the elderly, disabled, and parents with sick children, are appreciative of this convenience. Physicians who dispense are also more aware of the costs of medications. With physician dispensing, they can make the lower-cost generic and therapeutic substitutions on the spot. Traditionally, a pharmacist has to call the physician's office to get the change made, then wait for the physician to call back to approve the change. This additional wait time (often the patient must leave and return) means the patient is not getting the medication they need when they need it. Therefore, their medication treatment is postponed. Legal and ethical implications Physician dispensing is fully legal in 44 of the 50 states. The states of Texas, New York, and New Jersey have placed restrictions on physician dispensing. Only three states have prohibited physician dispensing: Massachusetts, Montana, and Utah. These restrictive laws when dissected serve only one purpose: isolate the profit to the pharmacy. These laws and regulations would probably be held an illegal restraint of trade if challenged under federal law. Each state is different in their dispensing guidelines. Some states also require an additional dispensing license, which can be obtained for a nominal fee. A qualified and reputable physician dispensing provider can assist you in these areas. Some physicians are also concerned physician dispensing is a conflict of interest. This could be a conflict of interest, but so is a physician scheduling an office visit, ordering X-rays, lab tests, a hospital stay for a patient and surgery. The American Medical Association (AMA) endorses the concept of physician dispensing, provided the physicians follow state and federal guidelines, and still allow their patients a choice of where to get their medications. The overall goal of X-rays, lab tests, surgery and physician dispensing is improved patient health. Physician dispensing is clearly a necessary tool for better patient health. A choice for your practice Physician dispensing improves patients' health. It increases a physician's practice revenue. It creates higher compliance rates, which in turn lowers overall health care costs for patients and payers. It is completely safe, legal, and endorsed by the AMA. All of these benefits rally on the side of the physician. Medication dispensing is a service that should be in your practice. About the Author
Warren Moseley is president of Physicians Total Care, a Tulsa-based business whose software, the PTC9000, has helped numerous clinics and practices start physician dispensing. Visit them online at http://www.physicianstotalcare.com to get a free analysis of how physician dispensing could work at your practice.
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