SEPTEMBER 2018 - It would be fair to say that Brett Jackson epitomizes that famous slogan from Nike, “Just Do It.” The associate-owner of a Shoppers Drug Mart pharmacy in Oromocto, New Brunswick, and his pharmacy staff have embraced every possible authority under the province’s expanded scope of practice—and they’re successfully billing for all of them.
This is quite the accomplishment, considering that New Brunswick has close to the lowest level of public funding for pharmacists’ services, second only to Manitoba. In a way, though, that’s probably been a good learning experience for pharmacists, notes Jackson, because eventually you have no choice but to bill patients if you want to practice to your full scope. You can’t afford to keep doing it otherwise. And the good news is, patients will pay when they know they’re getting value.
In Jackson’s pharmacy, patients appear to be getting the most value from pharmacists’ services for minor ailments (for urinary tract infections first and foremost, and then mainly for cold sores), which are billed at $22.50, and injections for a whole host of reasons (flu, travel, shingles, vitamin B12, etc.), for which billings vary according to the injection. Pharmacists in the province can also prescribe for most travel vaccines (except those that require special certification), which has boosted the frequency of travel vaccine injections.
“In terms of personal value, our interventions for UTIs make the most impact. Patients are really appreciative of our ability to help them. In terms of value from the convenience perspective, UTIs are up there as well, but I would say injection administration and prescribing in the case of travel health are most popular. For patients to be able to pick up their injectable product and get the shot right away, rather than having to book a doctor’s appointment, is really great for them,” observes Jackson.
The pharmacy currently averages three to five minor ailment assessments a week, and Jackson notes that growth has been steady thanks to word of mouth. “For UTIs especially, I’m amazed by how quickly the word spread.” Injections come in at about a dozen a week, though of course that increases significantly during flu season.
When it comes to workflow, Jackson suggests that some pharmacists may be overthinking things. “You don’t have to make major changes—even the busiest pharmacy can do these services. You might be surprised how attainable it is,” he notes.
Having said that, Jackson has taken a number of clear steps to ensure that expanded services are least disruptive to the pharmacy and most convenient for patients:
Part of the regular workflow
Over time, the pharmacy has come to prefer accommodating patients as they arrive, rather than setting specific appointment times. Or if there is an appointment, it’s enough for the patient to indicate they’ll come during a certain time period, rather than a fixed time. “The convenience we provide is very important to them, so we found this is the better approach. At the same time, we’ve found that if you say, ‘You may have to give me 20 minutes so I can finish up this one task,’ then that’s fine for them. Twenty minutes is still better than the wait they would have had at the doctor’s office or ER,” says Jackson.
Support staff are vital
The pharmacy’s assistants take care of all the paperwork, bill for the service and prepare the medication. “My job becomes pretty straightforward. I just focus on the patient.” In his pharmacy, there are five full-time assistants, three or four part-time assistants and three full-time pharmacists (plus himself). Pharmacists are never without at least one assistant, and there is pharmacist overlap during busy periods.
All services, all pharmacists
All of the pharmacy’s pharmacists are injection-certified and have the confidence to provide minor ailment assessments, which can include prescribing and counselling for smoking cessation. “You can’t just have one who offers this, and another who does that. You never want a patient to have to come back when this or that pharmacist is working,” stresses Jackson.
On a related note, pharmacists need to up to the task. “Our pharmacists here are great, they don’t view these services as something ‘extra’ but as part of their regular job. That’s important, because patients pick up on that,” says Jackson.
The right billing conversation
Consistent messaging is important. “It starts with the pharmacy assistant really having the knowledge of what we can offer. For example, when someone drops of a prescription for an injection, they immediately ask if they’d like to get the injection when they pick it up, and they explain the cost for this service.”
What if patients hesitate? “The odd time when we do have pushback, once you really explain that this is just one of their options and they’re free to do what they’d like, they often come around. We also explain that it is our hope that the service will be covered in the future, but it’s not at the moment, and they really do understand."
The bottom line is, cost is not an issue where there’s value. For UTI interventions especially, “patients don’t even bat an eye,” says Jackson. “They really love the fact that after 20 to 25 minutes, they can get on with their day.”
When it comes to pushback, one service tends to generate the most of it: prescription renewals. “We do a lot of renewals, but bill only in certain circumstances. Instead we use it as an opportunity for education, and really try to empower patients to take initiative for their own health, and give them tips on making appointments ahead of time so they don’t run out of their medications.”
Volunteer for research studies
While this is not something that happens every day, Jackson urges pharmacists to be part of research studies if the opportunity comes up. His pharmacy was one or 39 to participate in the recent RxOUTMAP study that assessed the impact of pharmacists’ interventions for uncomplicated UTIs.(1)
First, you will likely learn strategies or get tools that can be used after the study is over. You’ll certainly hone your skills with participating patients. And last but not least, you’ll contribute to advancing the profession. “While we were already billing patients for this intervention, we had a glimpse into the future, when these services will be covered. We no longer had to have payment conversations with patients. It was a very good feeling to be part of this, to be able to help show government the value of what we do,” says Jackson.