Optimizing Prescription Medications for Your Patients and Practice

According to a study published in the Journal of the American Board of Family Medicine, 42% to 71% of visits to a physician result in at least one prescription for medication. In addition, according to the American Academy of Family Practice (AAFP), approximately 30% of calls to a physician’s office result in at least one prescription medication. 

The expenses of running an independent practice are increasing, and the cost associated with human resources marks one of the most significant, consistent expenses for the practice. Yet, physicians are paying their staff to spend a large percentage of their time managing prescriptions, which represents no source of revenue for the practice but are critical to optimizing outcomes for patients. 

Compounding the issue is the fact that more than 30% of patients do not fill their prescriptions. One way to decrease this critical first step to therapy adherence according to the AAFP is “continuity of care.” 

Point-of-care dispensing is a fast-emerging answer to this seemingly complex problem. Most states allow physicians to dispense prescription medications under their physician license, enabling practices to expand the continuum of care provided, benefiting the patient, practice staff and the physician.

Benefits to the Patient

1. Convenience: Consumerism has infiltrated healthcare, which means patients are choosing and staying with physicians based on more than just the physician.  In fact, patients rank convenience as more important to them than physician credentials.  The number one finding from a survey of 4000 consumers conducted by the Advisory Board Company on the topic of what they want from primary care was, “Convenience is king.”  And, getting a prescription filled at the clinic was among the top ten attributes consumers used to define the conveniences they want. 

For specialists, the data is similar. A survey by OncLive revealed that 75% of patients would prefer to obtain prescription drugs directly from their physician instead of making an extra trip to a pharmacy.

1. Education:  According to the US Department of Health and Human Services, adverse drug events result in more than 770,000 injuries and deaths each year, and 11%-14% of those instances can be traced back to the dispensing pharmacy. 

In observational studies, 17%-25% of prescriptions were not accompanied by instructions from the physician or the care team. Why? Weighted down by the increasing expenses of running a practice, physicians are spending less time with each patient in order to see more patients daily. And, ironically, staff members are spending 30% of their time fielding telephone calls about prescriptions. With a lack of communication between the physician’s office and the pharmacy, accountability for a detailed conversation with the patient about the prescription, side effects, adherence and potential adverse events is split at best and unclear, despite regulatory requirements.

With point-of-care dispensing, the staff and time are built into the process to ensure the patient gets the information he needs to begin and adhere to therapy. As well, the physician has an established relationship with the patient and is in a better position to forecast and assess the patient’s education needs, tolerance of side effects and barriers to adherence. The education, therefore, becomes more customized and patient-specific.

Benefits to the Practice Staff

1. Improved morale:  One of the top six reasons an employee quits is the employer’s “lack of vision.” In no industry do team members have a more noble passion for their customers than healthcare. Seeing their practice adding a service that will not only meet the convenience needs of the patient but also improve therapy adherence and patient outcomes communicates to the staff that the physicians are forward-thinking and visionary. As well, once experiencing the decreased number of prescription-related calls, staff members will also recognize the task-reducing benefit this ancillary service is providing directly to them.

1. Development: Two of the top six reasons employees leave a job are, “no future,” and “no challenge.” In a small to medium-sized practice, promotional opportunities are often limited, and physicians have to use other means to develop employees and create new and rewarding challenges for them. 

Point-of-care dispensing provides such an opportunity for select staff members. While the in-office dispensing supplier provides depth and breadth of support and training, the day-to-day business and clinical operations of the service is managed within the practice. As the clinic implements point-of-care dispensing, it will be critical for the physicians to engage staff members and share with them how this solution will reduce calls and free time for staff members to learn new skills and take on new responsibilities.

Benefits to the Physician

1. Improved adherence: As previously noted, patients not filling the initial prescription is a primary cause of lack of adherence. Enabling the patient to leave the physician’s office with the prescription in-hand and education about the therapy plan overcomes this barrier immediately. As well, point-of-care dispensing provides the physician and care team a more direct view of the patient’s refill habits, empowering the physician to intercede more quickly if adherence is compromised. 

1. Increased patient acquisition and retention:  As shared, consumers are expecting more from their physicians and demanding convenience and service levels they have grown accustomed to in other industries, like retail and hospitality. By the same token, they are also sharing their opinions about physicians through the same outlets they use to rate other services- i.e. Yelp, Google and social media. 

Surveys across the industry revealed that up to 75% of patients read online reviews before choosing a physician. According to a 2014 survey published in the Journal of the American Medical Association, of consumers that utilized online reviews, 35% chose a physician with positive reviews; 37% avoided doctors with negative reviews.

For physicians, offering convenience to patients is a competitive differentiator, especially when it is a service that is not common among physician practices. Point-of-care dispensing can set a physician’s office apart from the competition and provide a talking point in online reviews and social media posts that attract new patients.

For existing patients, point-of-care dispensing makes the relationship with the physician’s office more “sticky.” In the business world, this service would be described as increasing the “switching costs” for the patient. Switching costs are the costs that a consumer incurs as a result of changing brands, suppliers or products; switching costs include those that are monetary as well as psychological- i.e. effort- and time-based switching costs.

To move to another physician, the patient would not only have to transfer the prescription to a traditional or mail order pharmacy, he would also give up the convenience of in-office prescription filling and have to make another stop after leaving his new physician’s office. A lot of time is at stake, and most consumers do not have time to spare.

1. New revenue stream:  If as many as 71% of patient visits to a physician’s office result in at least one prescription medication, and each prescription is worth $10-$20, point-of-care dispensing equals a significant new revenue stream. Add to that revenue the increased productivity of staff members who will now be spending less time on the telephone with pharmacies, and the bottom line impact to the practice increases significantly. 

An example for a multi-physician practice: 

Assuming the practice sees 200 patients a day and 71% of those patients have a prescription worth $15 each, the daily gross revenue from point-of-care dispensing is $2,130; $42,600 per month; and $511,200 annually.  

Choosing the Right Partner

While most states allow physicians to purchase and dispense prescription medications under their physician licenses, they will also require physicians to satisfy various requirements. In addition to consulting legal counsel, it is important to choose the right point-of-care dispensing supplier. The supplier should fully understand the regulatory requirements in the state and be able to demonstrate compliance of the solution with these requirements.

As well, the supplier should:

• Provide full software and program support, including on-site staff training 
• Include reporting tools and appropriate connectivity to the physician offices’ EMR
•  Have a team with demonstrated experience, understanding and success in pharmaceutical distribution
• Enthusiastically provide references and the ability to have open discussions with other physicians’ that have implemented the supplier’s solution

The healthcare industry is shifting dramatically, and all stakeholders are trying to drive that shift. Point-of-care dispensing allows physicians to strengthen their ability to serve their patients and improve outcomes, while taking control over a revenue stream physicians have long supported but from which they have not measurably benefited. 

Published in the Executive Decisions in Dermatology, a publication by the Association of Dermatology Administrators and Managers.