From Bad to Worse

I've had a lot of days like this at the pharmacy...

Lessons from Chuck Norris

Don't MESS with the PREZ

Heart Check Home Monitor

Going to the doctor is never a fun journey for anyone, but with the $279 Home HeartCheck, you might be able to skip that trip to the local doctor’s office, especially when you need to obtain a fast and yet accurate heart reading – which is an important role when it comes to home health preparedness. You can skip queues at the clinic, doing all in the comfort of your own home, allowing you to keep up with how your heart is going on regardless of the time in an easy and convenient manner.

Should you have a computer, the Home HeartCheck too can be used to help submit your ECG readings to your physician for he or she to offer advice based on your submitted reading. All readings of your heartbeat would be instantly obtained, where it can pick up regular, slow or rapid heartbeats. Another advantage of the Home HeartCheck would be this – it is small enough to be so portable, allowing you to take a reading the minute a symptom (including shortness of breath, dizziness, fainting, exercise-related symptoms, palpitations) is felt, regardless of where you are. Just bear in mind that this is not meant to be a substitute for regular cardiac care, and neither should you use this to diagnose yourself if you have a wee bit of medical issues. Powered by a couple of AAA batteries, the Home HeartCheck would be the ideal gift for your aging parents this coming Mother’s Day and Father’s Day.

Profound Insight

I think Tim Abbott must be one of my Goofmart Pharmacy corporate managers. His insight to this problem and his solution is profound:

No Tech Help on a Busy Monday

I walked into the pharmacy today and immediately discovered that Mickey my pharmacy manager had been working the ENTIRE morning without technician help. For one reason or another... sickness, car trouble, whatever... he was left alone and no replacements were sent in. As it turns out, although we're pretty busy, our pharmacy director and his goon squad of RPMs do NOT think we're worthy of getting one of the few floater techs available just for this purpose. Apparently they were sent elsewhere today.

What REALLY gripes me about this is that ONCE AGAIN profit is paramount over patient safety. I understand the need to send the floaters to the busiest stores. Yeah, I get that. What I do NOT understand is why there are not more floater techs hired, trained, and available for these kinds of occasions. People DO get sick. People DO have car problems. It's a fact of life. Pretending like these things don't ever happen is foolish-- SOMEONE WILL GET HURT. During Mickey's shift he did over 100 prescriptions on his own, filled the orders from the weekend (30+ Rx), did the order that came in (Monday, as you know, is the BIG one) which included a C2 order, and fielded all the phone calls and questions from patients. I'm sure there are some big box pharmacies out there that would just laugh at these numbers. That's fine, but our software and system is not the same as yours. What I've said here is quite a bit of work for one man or woman to handle alone at the Goofmart Pharmacy.

Essentially, when upper management and the office staff do not even have the courtesy to give us a phone call explaining that no one is available to step in and help... the message we get is that OUR PATIENTS' SAFETY is not important enough to matter. PROFIT is the underlying factor. Believe me, NO ONE understands profit more than I do. I was self-employed for many years. I understand profit. But this is an entirely different industry. PATIENT SAFETY should be the MOST IMPORTANT FACTOR running the business, or YOU SHOULDN'T BE IN THIS BUSINESS.

Oh, but we did get emails today about how we need to make sure our Zostavax signage is up and that we're drilling every patient at the pick up window about getting their Zostavax vaccination. Merck can spend millions on advertising but they still want to make US the carnival barkers pushing the goods. But not a mention about the tech situation. Even a "We're sorry we don't have anyone available to help" would have been nice. But we were just ignored... again. You see, this has happened before, and every time it happens, I get angrier and angrier.

I did the second shift and it was challenging. It wasn't as bad as Mickey's shift, but I was still running around like a squirrel in a forest fire. A few times I didn't get to answer the phone and a lot of prescriptions were not filled in 3.5 minutes. Did I make a mistake? I sure hope not. I do know I'll be up again tonight wondering if I did. Meanwhile, back at corporate they're sending out emails warning us that we better damn well have the correct number of Zostavax signs out in the parking lot! Yeah, I'll get right on that after you send us a replacement tech.

What's Wrong with this Picture?

There truly is a huge cost associated with entitlement programs. Nothing is "free" in this world. If you're not paying for something, someone else is paying for it in some way or another. That's all great until the people who are paying for everything run out of money themselves. Unfortunately, I'm afraid that time is coming, sooner than you think.

Here's one example where entitlement is wrong:

This is a portion of a label that prints when we process a prescription. It also has the patient and prescriber information (not shown) as per state board of pharmacy requirements. This is affixed to the back of the prescription.

As seen above, it has the name of the drug, quantity, NDC (National Drug Code), instructions, and some pricing information. That's what I'd like you to notice... 

With THIS prescription, OUR cost is $40.88. That's just for the medication. The price of the label, bottle, cap, cost to adjudicate, shipping fee, cost for tech, pharmacist, etc... would all be on top of that. Granted, it's not very much per prescription, but it does add up over time. 

So what's the point? The point is that THIS prescription was processed on MEDICAID, a state-funded program for low income people. My pharmacy was reimbursed from Medicaid $31.40. That means with this prescription we lost $9.48 BEFORE all the other overhead and variable costs I mentioned. Further, due to the way Medicaid is set up, the pharmacy has no choice in the matter... no way to fight it. There's nothing the pharmacy can do about it. This type of reimbursement doesn't happen with every prescription on Medicaid, but it happens enough (in my mind) to matter. With many other prescriptions on Medicaid, the reimbursement is so little over cost that when you add in the variable costs it turns out to be a wash in most cases.

Just so you know... ANY business MUST make a profit to STAY in business. If you truly don't understand that concept, you need to open a lemonade stand this weekend and figure it out on your own. The MORE people that go on state-funded Medicaid programs, the MORE this happens. The MORE this happens, the LESS profit there will be for the pharmacies involved. In that case, businesses will seek other ways to make up the deficit, and that will be higher prices for every day items. This means that people who are paying the taxes to pay for people on Medicaid will incur extra costs hidden in everyday items at the grocery or pharmacy. 

There's another factor associated with this entitlement... when a company is forced to work with less profit, the first thing they cut is the work force. As a result of less profit, my Goofmart pharmacy reduces tech hours. A reduction in tech hours puts more of the workload strain on pharmacists. That in turn leads to a higher rate of error. Eventually that will end up with a patient being seriously harmed. This is not conjecture. This is reality.

No one wants truly poor people to be hungry or not get their medication. There are people who truly need our help until they get back on their feet and can contribute to society and making a living for themselves. Unfortunately, the system doesn't police who is truly indigent and those who are taking advantage of the system (see EXAMPLE).

Sunday, Laugh, Be Merry