The typical pharmacist gets to spend just 10% of their working day with patients, but they want to spend exponentially more time with them; up to 74% of their time for chain pharmacists and 60% for health system and specialty pharmacists.
That is the key take away from the first-ever Pharmacy Check-Up survey sponsored by AmerisourceBergen. This nationwide survey across practice settings found that all pharmacists expect to spend significantly more time on patient-focused activities in the next five years.
Patients visit a pharmacy an average 35 times per year compared to just four visits to see medical providers. The potential is there to expand pharmacists’ role in providing direct patient care, but turning that potential into practice will take major changes in healthcare delivery systems.
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“We are at a pivotal place in our profession,” says Matthew Wolf, PharmD, Group Vice President, Consulting Practice, at AmerisourceBergen’s Pharmacy Healthcare Solutions. “We have got to get better at getting a seat at the table in the C suite so leaders understand the importance of who we are and what we do. We have to help other players in healthcare understand the importance of who we are and what we can do. Pharmacy is shifting away from being a cost center, especially in the health system and specialty worlds, to becoming a revenue center. The closer we get to the patient, the more time we can spend with patients, the more we can affect their health outcomes. That is particularly important as we move away from fee for service to fee for value.”
The move toward pay for performance is an important opportunity for pharmacists, Wolf says. While he focuses on the evolving role of pharmacists and pharmacy services in health systems, the same need to demonstrate value and improved outcomes is also playing out in chain and independent pharmacy.
The barriers to expanding patient contact time depend on the practice setting. Chain pharmacists must deal with staffing limitations and insurance reimbursement issues. They need more time to deliver the level of care they have been trained to provide and want to provide.
“The metrics imposed by many retail corporations are not conducive to quality patient care,” one chain pharmacist said in the survey. “Too much focus is being placed on number and patient care is suffering. Staffing is being decreased while the workload is increasing.
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Independent pharmacists must deal with reimbursement issues as well as with payer and manufacturer contracting complications.
“As reimbursement declines and cost continues to increase, the only thing we can do to stay afloat is reduce labor. And when you reduce labor, it affects patient care,” said one independent pharmacist.
On the health system side, pharmacy has long been viewed as a cost center. That began to change a decade ago as changes in reimbursement across different care settings encouraged hospitals to focus on ambulatory clinics and ambulatory pharmacy. More recently, the focus has shifted to specialty pharmacy. What hasn’t changed is the potential impact pharmacists can have on metrics such as readmissions as well as on the bottom line.
Take discharge planning and counseling: In an era when more than half of hospital readmissions are linked to some sort of adverse drug event, the need for pharmacist involvement in discharge planning is greater than ever. Where the financial rewards of healthcare were once focused on dealing with acute events through physician visits, hospital admissions, and urgent prescriptions, financial rewards going forward are focused on preventing acute events: fewer admissions, fewer readmissions, fewer acute scripts, more preventative care, more chronic medications.
“We need, as a profession, to stop looking at ourselves as inpatient pharmacists or outpatient pharmacists,” Wolf said. “We are pharmacists. As care is shifting from the inpatient hospital to ambulatory, we are all shifting to more of a quality-driven perspective, keeping the patient out of the hospital by keeping them well. That changes the paradigm for pharmacists. We have to care for the whole patient continuum rather than just ‘I’m a pharmacist who supports a patient while they are in the hospital’ or ‘I support patients in the ambulatory setting.’ Our new paradigm is ‘I support the patient, period.’ ”