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Political Action

For as long as I can remember (and that’s a long time), the battle cry in pharmacy has been “Get into politics or get out of Pharmacy.”  That cry is no less important now than it was forty years ago.  While legislative challenges abound, there are friends of pharmacy and patient champions in Congress.  If you don’t believe it, take a look at the You Tube video of Georgia U.S. Representative Doug Collins defending pharmacy in a House committee meeting.  Whether you agree or disagree with his political views, Representative Collins “gets it” where pharmacy is concerned.  He understands what it means to patients and to healthcare to have healthy and financially secure community pharmacies available to patients…….and he’s willing to stand up for us. 

Rep. Collins, and others know as our healthcare system moves from fee for service to a patient centric, value based payment model that the professional role of the pharmacist will be taking on a more meaningful position in providing patient care.

The value of pharmacy services is undeniable.  Multiple studies over many years have shown pharmacist involvement to improve care and reduce the cost of care.  Improving medication adherence in a diabetic yields a seven dollar healthcare savings for each dollar spent on pharmacy.  Pharmacy involvement in hospital discharge transitions of care has been shown to reduce costly early readmissions.  The case could be made (and I have made it at multiple forums) that the success of value based healthcare, in many instances, pivots on pharmacy involvement.  Simply put, if pharmacists are not involved in patient care, it will create a void into which one could not pour enough money to fill.

Many stakeholders are realizing the value of pharmacy services and moving to include them in comprehensive payment plans.  While this is a good sign and a positive direction, we must not lose sight of the fact that these stakeholders actions are often being promulgated by individuals working outside the C-suites.  While executives within organizations might have the data to see the value of pharmacy to their organization, many times the people actually doing the work are not privy to the whole picture.  In order for healthcare to become affordable, those making the rules need to have panoramic views of the entire field and not look at healthcare spending through a microscope.

MedHere Today is working diligently with other national organizations to bring pharmacy’s message to the forefront.  We have presented our case to Congress, CMS, commercial payers and the like.  We will continue to do so.  Those of us bringing this message to the rule-makers and rule-enforcers need help.  Every pharmacist needs to be an advocate of the profession.  We each need to let the public know what we do goes beyond putting pills in a vial and how our actions reduce healthcare spend.  Without a concerted effort, our clinical services will not be included in the value based purchasing conversation.  That will create a black hole that will need to have money poured into it for generations.

Political action is vital.  Beyond that, a concerted, sustained information agenda directed toward those who carry out legislative directives is no less imperative.

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I like baseball.  I follow team standings across multiple divisions and enjoy catching a game now and again.  My wife, on the other hand, is a baseball FAN.  More specifically she is a St. Louis Cardinal fan.  Every game night she and a group of her rabid Cardinal fan girlfriends open up their social media hotlines and sit in front of the TV watching every Cardinal play and texting/Facebooking madly back and forth about every move every player makes.  They enjoy talking baseball, watching baseball, obsessing over baseball, and are familiar with the statistics of their favorite players.  It’s easy for them to become involved in the ratings and statistics of their favorite players because baseball is a game of numbers.  From the time a player becomes a prospect and throughout their career someone is tracking every professional move they make.  From the number of at-bats, to strikeouts and hits versus right handed and left handed pitchers to the number of catches, baseball tracks and records every conceivable move a player makes and uses those numbers to benefit the team when analyzing player performance.  A player with high percentages in the appropriate categories can command a higher salary when negotiation times come around.  Lower rated players, not so much.  Every player strives to do their best and put up good numbers.  It’s a baseball thing.

The ladies’ baseball ritual occupies them for several hours most summer nights. Those are precious hours for me.  I am allowed free range of the house.  If I wish to turn in early, who’s to know?  If I wish to have a root beer float and eat pork rinds, no one will be the wiser and I won’t face that look every husband fears.  I probably have too much time if truth be told.  During my baseball “vacation time” the other day I took the opportunity to read some online news.  I came across an article talking about a site called “Roast Me.”  Evidently, this site invites people to post snapshots of themselves and invites anyone on the internet to post rude comments about the picture.  Unfortunately, there was a link to the website.  My recommendation to you is to NOT click the link.  I offer that recommendation from experience.  The website is full of perfectly ordinary looking people, mostly young, who have taken “selfies” and posted them to the site with a hand-written note that says “roast me.”  The comments are mostly awful.  They’re insulting.  They’re based on a single snapshot of a person who willingly subjects themselves to ridicule.  I cannot imagine anyone doing that to themselves!

Oh wait………..pharmacies do that to themselves daily.  We allow a third party to base an opinion on our practices using only a snapshot.  This snapshot is in the form of claims data.  Third parties use submitted and scrubbed claims data not only to evaluate your pharmacy but also base payments on this snapshot.  Many times this evaluation of a pharmacy is based on a minimal number of claims.  Which means an entire practice, for the purposes of payment, is evaluated on claims for perhaps no more than 1 or 2 percent of patients served.  It’s much like throwing our pharmacy selfie on the net and saying roast my pharmacy.  Base it on a single snapshot.  Base it on a few claims for even fewer patients and then lower my pay rate based on this snapshot.

It is impossible to holistically evaluate the value of a pharmacy’s service based on a few paid claims.  I’ve heard pharmacists say, “I’m a 4 Star Pharmacy.”  Nope.  Not 5 Star. Not 4, 3, 2, or 1 Star. Your pharmacy does not have a rating.  Your pharmacy may have a few patients who appear as 4 Star to a particular payer, but that’s a few patients and one plan.  Each plan looks only at that plans patients and can have a totally different view of your pharmacy.

Rating a pharmacy, and there are discussions going on now about rating pharmacies, must be done more like rating a baseball player than rating a Roast Me snapshot.  We need to look at the pharmacy practice and its impact on the health of patients served.  Look at the patients a pharmacy serves.  Is the population a difficult, unhealthy population?  Is the population health literate? What are the pharmacy demographics and how has the pharmacy responded to those demographics to improve patient care? No one in pharmacy opposes rating a practice if payment is higher for pharmacies that are doing more for their patients and lowering healthcare costs.  It can be a showcase of pharmacy practice.  But Rate a pharmacy, don’t Roast it!

 

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