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A Prescription for Stress

When you made the decision to become a pharmacist, you knew you were entering a profession that was honorable, respected and would bring you great rewards when helping people in your community. But most jobs with high-reward payouts tend to bring a level of stress also. As more demands are placed on pharmacists, and the pharmacy staff, work hours tend to be nonstop. It’s rare to take a break to catch your breath and ensure you are not only filling prescriptions correctly but also keeping up with the many regulatory demands that cannot be overlooked.

QS/1 - Built for Pharmacy by Pharmacists

QS/1 understands the growing demands and increased stress factors that pharmacists face. Kristy Leonard and Ed Vess are registered pharmacists who work at QS/1. It’s that edge that gives QS/1 true insight into what pharmacists want and need to do their jobs well. Vess, who is QS/1’s senior manager of Market Analysts, was recently elected president of the South Carolina Pharmacy Association (SCPhA). He has worked in long-term care pharmacy as a consultant and manager as well as in community pharmacy. He has been with QS/1 for three years. Leonard is QS/1’s senior manager of Pharmacy Operations. She has been at QS/1 for more than a decade and still works behind the pharmacy counter on occasion filling prescriptions and counseling patients. Recently, Vess and Leonard took an hour to discuss the stressful challenges pharmacies face, in no particular order, and offer advice on how to alleviate the pressure.

Stretching Yourself Thin

There’s only so much of you to go around. Parents can appreciate the fact that their child wants to take part in after-school activities. One activity is manageable. Two can become a juggling act. Add a third and it’s enough to make parents want to pull their hair out. The same can be said for pharmacists. Taking care of patients is not a problem. Factor in the call from a mother with a sick child who needs your advice, and after you hang up from that call, the phone rings again and it’s a doctor who has dosing questions for a specific medication. When the mother with the sick child comes in, she has several questions about the prescription you’ve just filled for her child. There are also other customers awaiting counsel. There just isn’t enough of you to go around.

“You never know who is going to walk through the door next or who is going to be on the phone when you answer,” Leonard said, when talking about the chaotic days in the lives of pharmacists. “If you don’t have a plan, it can all get away from you quickly.” Proper planning is an ideal way to avoid stress. Streamlining tasks can help you avoid being bombarded.

“Encourage patients to take advantage of a synchronization program,” Vess interjected. “If you know in advance the prescriptions you’ll need to fill, you can get them done, have them completed before they are due and, more importantly, before you find yourself without adequate time to do it.”

If your pharmacy hasn’t implemented a medication synchronization program, you are missing a great opportunity. Synchronization has been the buzz in pharmacy for several years. It allows you to fill all of a patient’s prescriptions on the same day, rather than spreading them out throughout the month. This is a win-win for the pharmacy and patient. It enables patients to make one trip to the pharmacy each month. It also helps improve patient medication compliance, which relieves another stress factor.

Another resource at your disposal is QS/1’s Workflow module, which is available in SharpRx®, NRx® and PrimeCare®. Workflow gives you the tools to segment the prescription process. Whether it is a new prescription entering the queue, or a refill request from a patient or doctor, the prescription advances from queue to queue until it’s complete and ready for pickup. You can assign specific staff members to specific queues. Workflow truly streamlines the process. QS/1’s Pharmacy at a Glance provides a quick snapshot of what’s happening within the queues. By setting up thresholds, you can color code the information as a visual alert when there is a slowdown in any of the queues. Workflow and Pharmacy at a Glance are features included in your QS/1 software at no additional cost.

Pharmacists are always on the go. Planning ahead is one way to avoid headaches during and at the end of the day.

Pharmacist – Owner

As if not already spread thin, sometimes the pharmacist is also the business owner. That can add an entirely different set of challenges. Not only is that person working with patients and doctors, they’re also responsible for business operations. If you don’t make a profit, it’s nearly impossible to keep the business going. The owner has to consider more than the well-being of patients; that person also has to have consideration for their employees.

The staff is looking to you to help provide for their families. Without profit, you might be forced to make difficult decisions. For example, laying off employees or closing the pharmacy, which could be detrimental to employees and patients.

Turning a profit can be stressful, even for busy pharmacies. With drug prices on the rise and insurance companies cutting the amount they will reimburse your pharmacy, you have to wonder if the customer’s co-pay will be enough to cover the difference. “Insurance rates are dwindling at a faster pace than the pricing of drugs are,” Vess said.

Getting involved can help. Both Vess and Leonard agree that joining pharmacy associations is beneficial. These groups can help lobby on your behalf to the people who make decisions.

“Pharmacy associations are always working to get legislation passed to make insurance companies more transparent with their pricing structures,” Vess added. “If you’re a member of one or more of these associations, you can benefit from having strength in numbers.”

If your budget allows, consider joining a pharmacy services administration organization (PSAO). The PSAO is active in negotiating contracts for pharmacies. Make sure you research the PSAO before joining. Once you’re a member, you will be subject to the price rates that are negotiated. You need to make sure the money you spend to join the PSAO benefits your bottom line.

Medicare Part D Open Enrollment

We’re quickly approaching that time of year when patients often ask pharmacists about which Medicare Part D plan is right for them.

“This is where it can get tricky,” Leonard said. “Insurance companies can recommend a pharmacy, but the pharmacy isn’t allowed to recommend a specific insurance plan.”

Logistics aside, pharmacists are allowed to show patients the various options and then let the patient decide which plan they want. This open enrollment period is when pharmacies will see an increase in traffic, either in person or, most likely, on the phone. This time you spend with patients can cause your prescription process to stall and cause a delay in filling medications. If your pharmacy has a high volume of senior patients, there is an option that could be cost effective to help ease some of the stress – iMedicare. This is an online service that pharmacies can subscribe to and offer to customers. Patients can use iMedicare to enter their personal information, including age and health, and then see a comparison of the best plans suited for their specific healthcare needs.

“One of the nice features of iMedicare is the reports,” Leonard added. “One of the reports will identify a list of patients in a specific geographical area who will become Medicare eligible within the year. You can target those individuals and send them marketing literature from your pharmacy advertising the various services you offer. This can help you grow your customer base to increase sales and profit.”

Reaching for the Stars

The Five-Star Quality Rating System has put pressure on many pharmacies and long-term care facilities. That added pressure can bring added stress. Implemented in 2008, the Centers for Medicare & Medicaid Services (CMS) uses the Five-Star Quality Rating System to rate the quality of care provided by those who assist Medicare Part D patients. CMS rates provider plans and not individual pharmacies, but pharmacies do have a stake in the ratings. To help boost Five-Star Quality Ratings, NRx and PrimeCare have included resources since Service Pack 19.1.15.

“Medication Therapy Management (MTM) is also a key part to improving ratings,” Leonard said. “Spending time talking to patients and explaining how they should properly take their medications and why it’s important goes a long way in helping improve compliance. There are even times when pharmacists can be reimbursed for their time by Medicare.”

In addition to MTM, Medication Possession Ratio (MPR) is a tool that allows you to measure patients’ medication adherence. The software can calculate how compliant patients are based on when they refill prescriptions compared to when they should be complete. If a patient is refilling weeks after the original fill should have run out, you know that patient isn’t taking the medications as prescribed. MPR is an automatic process that can track and score the patient in that area. If the pharmacy staff notices the patient has a low MPR score, they can spend a few extra minutes asking questions and helping the patient better understand the necessity of taking prescriptions as prescribed. If the patient is having an issue with the medication, the pharmacist can sometimes work with the prescriber to find a resolution.

Recent studies confirm what many already know: pharmacists play a key role in healthcare. Often, pharmacists catch medication issues and prove to be champions for both patients and prescribers.

Keeping up with Regulations

As with any business, it is important to know what trends are impacting the industry and whether those trends are important enough to add to your business model. Those are options you can implement as a business owner. What are not optional are government regulations. In a sea of bureaucracy, this can be challenging. If keeping up with customers and doctors seems daunting, government regulations can appear outright overwhelming at times. While regulations are not always unwelcomed, it would be nice if they came from one entity. In addition to federal regulations, pharmacies must also stay abreast of regulations that come from the state and, in some instances, the municipal level.

“It’s always a tad frustrating to see areas where a drug may be classified one way on the federal level and another way by the state,” Leonard added. “And if you want to complicate things even more, think about pharmacies that operate near a state border.”

QS/1’s team of market analysts keeps track of those regulations that can impact your operation. Not only do they alert pharmacies to impending changes through Insight magazine, The Edge, The Edge LTC and various other QS/1 communication platforms, they also work with QS/1 programmers to ensure your pharmacy management systems do everything possible to keep you compliant with those regulations.

Bridging the Gap

Over the last few decades, the role of the pharmacist has come full circle. More patients are going to the pharmacist for their opinion before going to see their doctors. This increased workload can add to the stress.

“We are slowly going back to doing things the way they used to be done,” Vess said, with a slight grin.

“When I graduated, the pharmacist’s job was to count pills, give them to the patient and ask if they had any questions,” Leonard said. Vess quickly added, “The pendulum has swung back to the way I was taught. Before the 1980s, most patients went to the pharmacist first, then went to see their doctor. The pharmacist was really the patient’s first line of defense.”

Pharmacists may be back in the starting lineup in that line of defense. No matter which side of the bridge a pharmacist is on, it can be tough to adjust and cross. After Leonard graduated, pharmacists switched from a five-year bachelor’s degree to a six-year doctorate program. The United States went two years with no pharmacists graduating and moving into the workforce. That caused a decrease in available pharmacists. The shortage forced pharmacists to streamline workflow. After a two-year lag time, the next class of graduating pharmacists flooded the market. With more pharmacists back behind the counter, the ability to spend more time with patients and help them one-on-one has opened up.

Finding Balance

One of the key elements of dealing with any stressful situation is to find balance. It’s easy to find yourself overwhelmed by things that afterward might seem trivial. Many factors come into play, including how much sleep you’re getting, what is happening in your personal life and how much support staff you have to relieve some of the tasks. Pharmacists make many decisions throughout the day, some of which can have a life-or-death consequence. There is no room for error. That thought alone is a weight to carry. Ten-plus hour workdays are not uncommon. So, use all the resources available to help make your workday more productive and efficient. In addition to the tools you find in QS/1’s Pharmacy Management Systems, reach out to your fellow pharmacists and have conversations about how they handle challenges. Few will understand like your peers. Just as you can offer advice and suggestions to help them along the way, take time to listen to theirs.

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