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Whether ACA thrives or bombs, the future is likely to bring upheaval that results in cost savings and improved delivery of healthcare services.
Robert MabeeIf the Affordable Care Act collapses, as many think it will, it will create a crisis in healthcare delivery for many Americans. Most Americans seeking ambulatory care services will lack insurance; they will need quality care at affordable prices. It is essential that all American pharmacists prepare for these patients, because they will play a crucial role in helping patients get the care they need.
Routine visits to the emergency room have been and will continue to be cost-prohibitive. In the past, many patients with “good insurance” sought routine care after hours at the ER. For patients without insurance, that is not a viable option.
Pharmacists will need to make sure that they have the comprehensive data on primary care providers in their service areas. Patients with a sore throat and no (or very low) fever can be directed to family-practice physicians, PAs, and nurse clinicians who will be able to assess them and provide care during normal business hours at substantially lower prices.
Expanded pharmacy services
Symptomatic treatment of coughs and colds can be handled by the pharmacist as they always have been. The patient can also treat simple dermatological and minor trauma with advice from the pharmacist.
Pharmacists are already authorized to administer routine vaccinations in a number of states. They also can easily manage simple contact dermatitis, bug bites, and small abrasions or lacerations not requiring stitches.
In most states, pharmacists as providers can be compensated for these services. Many pharmacists already have a provider ID, and a schedule for cash reimbursement for consultations can be developed.
There will be significant resistance from chains, big-box stores, and pharmaceutical manufacturers who have aggressively tried to eliminate pharmacy services from patient-care choices. They have sought to maximize purchase dollars by encouraging the patient to buy a medication supply for three months instead of 30 days, using the incentive of “cost savings” through a reduced number of co-pays.
The corporate practice of pharmacy combined with the corporate practice of medicine has created an anomaly in patient care that holds profit and quantity more important than quality care and patient welfare.
Yet today more than ever cash-paying patients need their pharmacists to assist family-practice physicians and other primary caregivers in meeting their healthcare needs. The community pharmacist as part of the team of primary caregivers will be able to provide affordable care to patients at reasonable prices. This team approach can provide more efficient care, control costs, and reduce drug shortages.
Large corporate retailers have been using pharmacists and their patients to increase their customer count and total sales. Large hospitals need family-practice doctors and other primary care providers to funnel patients into the referral chain to maximize income by providing additional services, even when they are not needed. Cost was no object as long as the funds came from other people, such as third-party payers.
The reemergence of patients as “cash customers” changes the paradigm. It will return the country to a rational approach to healthcare, with healthcare spending cut in half and quality of care substantially improved. High-priced corporate executives, hospital administrators, PBMs, and insurance companies will no longer be able to drain money from the system.
Oddly enough, a collapse of the ACA would actually produce real savings. It would provide the country with a path to affordable care, which is something that the troubled legislation could never do. Patients who identify themselves as consumers and not beneficiaries would become more cost-conscious. Since paying cash for routine care is the only way to actually reduce healthcare spending, the collapse of the ACA would put the country on the road back to affordable care.
The traditional role of the pharmacist, providing just the right amount of the correct medication at the best price, will restore control of healthcare spending to the patients and the providers, where it belongs.
Robert L. Mabee is a pharmacist and attorney practicing in Sioux Falls, S.D. He also holds an MBA. Contact him at firstname.lastname@example.org.