Watch Out, Sloopy. Here Comes Da Goose.

Jp Enlarged

Found this in my E-mails yesterday, from Goose.  Essentially, pharmacists are now in the same bucket as lawyers or accountants.  The employers are in an enviable spot, after years of scrambling just to get Warm-Bodies-With-Licenses.  They can pick and chose now.  Some employers will go for cheap and others for quality.

This will not last.  The demand for prescription drugs will skyrocket.  Again, there will not be enough of us to go around.  The fuckers who are disrespecting us now will get it right back.  Good riddance.  Just hang on, Sloopy.

A serious warning:  You cannot allow them to change or delete two laws. 

The requirement that we counsel.  (More on that later)

The requirement that a RPh be present when an Rx is sold.

If you are not watchful and allow them to do that, you are really fucked and it will be ON YOU.  Keep your eyes open and act like adults.  Blaming the ACA is bullshit, by the way.  The brains at HHS already have it figured out that RPhs are over-educated to be simply Prescription Mill Minders and they plan on using RPhs and RNs instead of MDs and Dos because we are cheaper.  Watch out, Sloopy.  Knowing pharmacists, you will go kicking and screaming all the way to paradise.  Jay Pee

Here starts the message from Goose.

Gentlemen,

Yesterday my hospital group laid off 5 of our 27 total pharmacists that covered 2 hospitals and 2 ambulatory clinics. Four of the five were RPhs. Out of the 22 pharmacists we have left, one is an informatics resource, one is the Director and two are Operations Managers for our two hospital campuses. We have 4.5 FTE of full time clinical and the rest is staff.

Official word is this is due to the ACA and decreasing revenues. Bigger issue I think is uncompensated care. Indiana has its own issues on that, decision not to expand Medicaid to cover low-income uninsured as with many other states really putting the squeeze on hospitals. They are required by law to treat everyone and cannot collect most of the time.

This is the first time I have seen a targeted reduction in force of pharmacists. We have eliminated positions by attrition before but never actual layoffs. In numbers we represented 20% of the total number of jobs eliminated.

Add to this the fact a few months ago our President of the Indiana BOP, Sara St. Angelo had her position eliminated at her hospital in Indianapolis. This would have been unheard of a few years ago.

Scary times brothers.

Peace out, Goose

 

31 Comments

31 Comments

  1. Pharmacy Gal  •  Oct 26, 2013 @12:55 pm

    Goose is correct. Uncompensated care is a huge issue now for hospitals. The central pharmacy in a hospital has become just a prescription mill without the customers leaning over the counter. As of now there is no legal requirement for a pharmacist to counsel inpatients about their prescriptions in my state. We are doing some targeted counseling of heart failure patients to improve patient satisfaction scores and to reduce re-admissions. I personally do not see the light at the end of the tunnel for hospital pharmacists. The industry is in a time of major upheaval due to the ACA. Administrators are panicking. I don’t know how many patients are going to use hospitals for elective surgeries now with these high-deductible plans. Acuity is likely to increase while patient census will continue to decline.

  2. AJ  •  Oct 27, 2013 @9:14 am

    JP, all the laws, rules and regulations in the world are worthless without enforcement. This is where the State Boards of Pharmacy have failed. There are in bed with the big corporate retail chains and don’t enforce the existing laws.
    .
    Take the good ‘ole State of Texas. I quote from their Strategic Plan 2013-2017, page 54. “Since 1982 the Board has followed a “preventive” approach to enforcement based on the belief that 98% of it’s licensees/registrants will obey the laws and rules governing the practice of pharmacy if the licensees are well informed as to the requirements of pharmacy rules and laws.”
    .
    What a crock of shit! Board inspectors could hand out violations like candy at Halloween if they actual went out, inspected and enforced the current laws. Until they do nothing will change.

  3. broncofan7  •  Oct 27, 2013 @1:56 pm

    And what has Pharmacy Academia been harping on for the last 25 years? That Pharmacists will eventually lose the dispensing function and that we should all be focused on taking blood pressure readings, looking at lipid panels and making recommendations and doing INR’s and adjusting doses.

    But guess what? Clicking one’s heels inside of the white ivory towers does not a profitable, viable business model make and with the implementation of the ACA and our “late to the table” designation as Healthcare providers Goose is providing a CONCRETE example as to why the most well intentioned designs of academia are falling flat in the face of REAL economics.

    Many physician’s groups, Nursing groups etc. consider the clinical model of Pharmacy practice as an infringement upon their respective professions. Many 3rd party payers are unwilling to provide ENOUGH clinical Pharmacist reimbursement to support even a SINGLE Pharmacist Salary per a single store (Solely providing MTM is NOT a viable business model CURRENTLY). I implore EVERY Pharmacist to heed JP’s advice above and whenever you read an article about how Pharmacist’s need to “Change how they practice”–IE lose the authority in the dispensing function—, remember to look for the author’s explanation as to what business model is going to support our profession financially the way that dispensing does now. Because, currently, there ISN’T ONE.

  4. AJ  •  Oct 27, 2013 @3:48 pm

    Bronco your ignorance has stopped being amusing and is now starting to annoy me. You don’t have a freaking clue!
    .
    Have you been living under a rock for the last three years? Goose is providing an example of the short sighted decisions being made in certain hospital systems by people with the same mentality as you! Healthcare delivery in the US is changing. People like you and these hospital administrators are choosing to ignore it or are just plain ignorant.
    .
    In one of my very first posts in response to you broncofan7 I said the profession of pharmacy is dead in the water unless we can figure out a way to untie ourselves from reimbursement based on distributing a product. That is a fact.
    .
    I will add to that. The profession is dead in the water because of pharmacists like you who have no vision or capability to think out side the box. You keep on distributing your product right into extinction.

  5. broncofan7  •  Oct 27, 2013 @5:27 pm

    “Bronco your ignorance has stopped being amusing and is now starting to annoy me. You don’t have a freaking clue!
    .
    Have you been living under a rock for the last three years? Goose is providing an example of the short sighted decisions being made in certain hospital systems by people with the same mentality as you! Healthcare delivery in the US is changing. People like you and these hospital administrators are choosing to ignore it or are just plain ignorant.
    .
    In one of my very first posts in response to you broncofan7 I said the profession of pharmacy is dead in the water unless we can figure out a way to untie ourselves from reimbursement based on distributing a product. That is a fact.
    .
    I will add to that. The profession is dead in the water because of pharmacists like you who have no vision or capability to think out side the box. You keep on distributing your product right into extinction.”

    You’re not a businessman AJ, you’re an employee and your post reflects that.

  6. Broncofan7  •  Oct 27, 2013 @5:41 pm

    And AJ, I am personal friends with 2 hospital CEOs and 1 hospital CFO. Hospitals are businesses first; even the ” non profits”.

  7. AJ  •  Oct 27, 2013 @6:31 pm

    If you’re personal friends with 2 hospital CEO’s and a CFO you have everything you need to make the transition.

  8. bcmigal  •  Oct 27, 2013 @6:49 pm

    Geez, you guys….you manage to twist each other’s words and make them a personal attack. Just cut it out!

  9. Pharmaciststeve  •  Oct 27, 2013 @9:15 pm

    The more I read the diatribe that you two are spewing out.. the more that I am coming to the conclusion that you BOTH are closed minded idiots

  10. Broncofan7  •  Oct 27, 2013 @9:48 pm

    Prudence makes perfect Steve….

  11. RalPh  •  Oct 28, 2013 @12:32 am

    Forget BF and AJ. Here’s an important point:

    I think the Boards of pharmacy are letting people down by not insuring that public safety be a higher mandate than profits, esp. in chains. If they were to do this, it would also help pharmacists to focus and make more of an impact on customers’ experience. The fact is that they side with chains, allow abuses of manpower and clinical judgment to get mixed in with ringing up someone’s groceries and keeping the line down or answering by the 3rd ring.

    We are WITHOUT A DOUBT a large part of most patients’ healthcare experience and we provide a service of being available to answer questions and figure out medication issues.

    Maybe AJ and BF have some good points about the future, but I can settle this in my own mind by seeing that people HATE their insurance companies for micromanaging their care, and they LOVE pharmacists (overall) when *we* micromanage their care (calling doctors, verifying sigs, interactions). What is the difference? We do it for our calling of helping out our patients. WE MUST GUARD THIS DIFFERENCE BETWEEN BECOMING PART OF AN OUT OF CONTROL SYSTEM AND BEING ALERT TO OUR OWN CALLING OF LOOKING OUT FOR EACH PERSONAL PATIENT WE HAVE COME BEFORE US.

    Like JP says, we cannot ever allow Boards to take away the mandatory counseling rule and the pharmacist on site requirement to sell rxs. But it’s only a first step. We need to report to our boards whenever we are asked to risk public safety or our fiduciary (trust-based) relationship with any patient or all patients.

  12. Broncofan7  •  Oct 28, 2013 @1:33 pm

    For those who may be clamoring for Pharmacists to separate themselves from the dispensing of medication please remember the saying :” A bird in hand is worth 2 in the bush”….. Unfortunately for our profession and based on the current structure of MTM we don’t even know if we have even 1 bird in the bush…..

  13. AJ  •  Oct 28, 2013 @10:43 pm

    Speaking of Boards of Pharmacy…for those of you in the great State of Texas do you know on November 4th The Texas State Board of Pharmacy will vote to raise and/or eliminate pharmacist to technician ratios? I see this as a bad thing. What say all of you?
    AJ

    FYI. AJ will be testifying AGAINST this change, in person, live at the meeting. He is a member of The Pharmacy Alliance and therefore eligible for help with expenses. Members of The Pharmacy Alliance who testify before their board, lobby
    legislators or bring light to dark places with investigative journalists will be reimbursed up to $100.00 toward hotel. Gas money. Cost of two modest meals at a place like Chili’s. AJ, save your receipts. You can scan them and E-Mail to thepharmacyalliance@hotmail.com.

    Um, Broncofan…. maybe it is time for you and AJ to call a truce and tag team at this board meeting. Bring others with you. Go FULL FRONTAL with them. You both know that guys like Bronco are not behind this. You know, in the end it may not be a bad idea, but not like this. Not driven by the chains. They DO NOT run our industry.

    I am serious, man. Both of you. As Joe Zorek said, “A pissing contest does us no good.” You are both smart, well-placed and
    well-spoken. You guys certainly are not shy. Be like the United Nations. “Well, we have fundamental differences, but we have a common enemy”. Killing this proposal will show that pharmacists DO HAVE POWER. It will show that we are not brain-dead.

    Bronco, I don’t recall if you are a member of The Pharmacy Alliance. You can join with dues of $100.00. Attend the meeting and get more than $100.00 reimbursed. Visit http://www.//thepharmacyalliance.com You can find the JOIN button. Those of you who have not renewed, please do so. Renewal is $60.00. Just click on JOIN. You can figure it out.

    Come on, you guys. Not just AJ and Bronco. All of you. You know, disturbing the shit can be fun. It also may do good.

    Jay Pee

  14. Pharmaciststeve  •  Oct 28, 2013 @11:36 pm

    Kentucky has had this for years.. Oregon or Washington just did this. It will give LTC & Mail order a free hand to get some poor/stupid RPH’s to put their license on the line being responsible for untold number of techs/Rxs.. I worked in one LTCP.. where Pharmacist filled nothing.. only checked controls and Rx filled by techs were verified by the computer scan.. Of course.. since they were using unit dose.. the only thing that they were really verified was one dose.. all the other doses in the box.. could be a mixture.. when this happened we just hoped that the nurses at the LTCF… caught the mixture before giving it to pts. So many mistakes that we became pretty jaded .. as long as no one was hurt.. it was a non-issue. At one time there was a input tech… that had a documented 20%+ input error rate and they wouldn’t fire her.. because they had “too much invested in her training”.. Eventually they moved her to triage.. no longer keying in Rxs. I carried full personal/professional liability insurance and a million dollar umbrella.. Great idea for corporate bottom line.. not so much for pt safety…

  15. Broncofan7  •  Oct 29, 2013 @10:44 am

    Elimination of the TECH:RPh ratios is a horrible idea that I can’t imagine would have ever evolved from Independent Pharmacy. However increasing the ratio from 3:1 to 4:1 is reasonable to me.

  16. broncofan7  •  Oct 29, 2013 @5:18 pm

    AJ, this is precisely what I was writing about:

    http://drugtopics.modernmedicine.com/drug-topics/news/do-new-pharmacists-face-joblessness-crisis

    “Brown said the 2001 job projections report also assumed an increase in pharmacist jobs due to a shift away from dispensing toward primary care services. “This role transformation is simply not happening, at least not at the rate or extent predicted,” the report said.”

    I WISH that there was a viable CLINICAL business model for Pharmacists but there simply ISN’T.

  17. AJ  •  Oct 29, 2013 @9:15 pm

    Broncofan7 your living in the past! I’m not talking about MTM theories from 10 years ago. I’m talking about the Affordable Care Act. I’m talking about a fundamental shift in how healthcare is paid for and delivered. It requires a whole new plan and a whole new way of thinking. If you can’t see this your not alone. The ones who figure it out now will still be standing in 5 years.
    .
    From your link, this is the primary driver leading us to a massive oversupply:
    .
    “In 2000, there were 80 colleges and schools of pharmacy in the United States. Since then, 48 new programs have been established and 2 schools combined into 1 college, bringing the total to 127 accredited colleges and schools as of fall 2012—a 60% increase from 2000″

  18. AJ  •  Oct 29, 2013 @9:36 pm

    I had a argument with another pharmacist over this very topic about a year ago except I was broncofan7. I didn’t get it. I thought this guy was crazy. I will tell you the same story he told me.
    .
    A Tale of Two Shoe Salesman.
    .
    There is a tale about two shoe salesman who traveled to a third world country in search of new business opportunities.
    .
    One man calls his wife ans says “Honey, I’m coming back home. There’s no hope here. Nobody is wearing shoes, so there’s no one to sell to.” He boards the next flight home.
    .
    The second salesman calls his wife and says, “Honey! You are not going to believe what I found here.” There is so much opportunity. No one is wearing shoes! I can sell to the whole country!
    .
    The bottom line is this, are you going to be one of the pharmacists who looks at the Affordable Care Act, shrugs your shoulders and says “Nothing here for me, I’ll take another dispensing fee please.” Or will you be the pharmacist who looks at the Affordable Care Act and says “Oh yeah! Look at all this brand new ripe for the picking, opportunity!”

  19. broncofan7  •  Oct 29, 2013 @9:43 pm

    As per usual, you miss the most important aspect of that article…

    WHY DO YOU SUPPOSE THAT THERE HAS BEEN A 60% INCREASE IN COLLEGES OF PHARMACY??

    I’ll answer it for you: BECAUSE THEY ARE CASH COWS FOR UNIVERSITIES.

    Now, and stay with me, I’m leading you right up to the water trough:

    WHY DO YOU THINK THAT WE ARE now SEEING ARTICLES ADDRESSING THE COMPLICATIONS ARISING FROM THIS INCREASE IN THE NUMBER OF COLLEGES OF PHARAMCY PRODUCING NEW GRADUATES?

    ANSWER: Because the business fundamentals ARE NOT PRESENT TO SUPPORT CLINICAL PHARMACIST PRACTICE. (see the quotation from my post that you were responding to)

    And you’re welcome.

    In Conclusion: No one’s transforming the practice of Pharmacy WITHOUT getting 3rd parties (LIKE YOUR EMPLOYER) to begin paying us at a sustainable rate for providing clinical services AND the corresponding expansion of Pharmacy practice laws in each state…….

  20. broncofan7  •  Oct 29, 2013 @9:50 pm

    As it’s currently constructed, PHARMACISTS cannot create ACO’s, but physicians, and hospitals can. And the focus of the ACA is centered around the ACO…so from the very construct of this government program that excludes PHARMACISTS FROM FORMING ACO’S, you think that it’s going to be a panacea for what ails our profession?!?!?!? The devil is in the details young grasshoppa’!

    http://www.pharmacist.com/walgreens-forms-three-new-acos

    “While the ACO final rule DOES NOT LIST PHARMACISTS as eligible professionals to form ACOs OR BE ELIGIBLE FOR SHARED SAVINGS, pharmacists can participate in ACOs. Asked if Walgreens pharmacists will somehow be able to participate financially in the new ACOs, Cohn said, “Walgreens as a whole will be participating in the savings, but we cannot provide more information about potential future financial elements of the ACOs at this time.”

    Again, our profession is left out in the COLD by big corporate interests……..

  21. AJ  •  Oct 29, 2013 @10:02 pm

    Broncofan7 you really have no clue. There is not one report, not one study that even hints that the current oversupply is anything but minimally effected by a projected shift away from dispensing.
    .
    The current oversupply is a result of academia operating under the premise there is a shortage of pharmacists and Walgreens, CVS and Rite Aid are still planning on opening 10,000 plus stores. In 2004 Walgreens had plans to have 10,000 stores up and running by by 2010. CVS had a business plan to put a pharmacy no further than a 5 minute drive from every person in the United states.
    .
    Then along came the great recession and the collapse of the real estate market. The big chains realized having all their money tied up in real estate and inventory was not smart, efficient or cost effective. And then along came Obamacare.

  22. AJ  •  Oct 29, 2013 @10:16 pm

    Again I ask, will you be the shoe salesman who goes home because no one is wearing shoes or will you be the shoe salesman who stays and says look at all the people I can sell shoes to?
    .
    You know as well as I do the big chains do things for one reason only…money. Do you think Walgreens would be venturing into this if there wasn’t a greater than not chance of making money?

  23. broncofan7  •  Oct 29, 2013 @10:21 pm

    I will post this again because apparently you have reading comprehension issues:

    “AJ, this is precisely what I was writing about:

    http://drugtopics.modernmedicine.com/drug-topics/news/do-new-pharmacists-face-joblessness-crisis

    “Brown said the 2001 job projections report also assumed an increase in pharmacist jobs due to a shift away from dispensing toward primary care services. “This role transformation is simply not happening, at least not at the rate or extent predicted,” the report said.”

    BF7 says: I WISH that there was a viable CLINICAL business model for Pharmacists but there simply ISN’T.

    BF7 also shared this:

    “While the ACO final rule DOES NOT LIST PHARMACISTS as eligible professionals to form ACOs OR BE ELIGIBLE FOR SHARED SAVINGS, pharmacists can participate in ACOs. Asked if Walgreens pharmacists will somehow be able to participate financially in the new ACOs, Cohn said, “Walgreens as a whole will be participating in the savings, but we cannot provide more information about potential future financial elements of the ACOs at this time.”

    But keep clicking those heels Dorothy!!!

  24. broncofan7  •  Oct 29, 2013 @10:25 pm

    RE: “You know as well as I do the big chains do things for one reason only…money. Do you think Walgreens would be venturing into this if there wasn’t a greater than not chance of making money”

    ANSWER: BECAUSE THE ACO MODEL WILL INCENTIVIZE PATIENTS TO USE A SINGLE PHARMACY!! THAT’S WHY! THEY ARE STILL GOING TO MAKE MONEY VIA DISPENSING!!! THAT’S PRECISELY WHY THEY MERGED WITH BOOTS ALLIANCE IN EUROPE AND BOUGHT PART OF AMERISOURCE-BERGEN BECAUSE THEY KNOW (AS YOU SO Eloquently stated) HOW TO MAKE $$$$$ AND THAT DISPENSING IS T-H-E BUSINESS MODEL THAT FINANCIAL SUSTAINS OUR PROFESSION.

  25. broncofan7  •  Oct 29, 2013 @10:27 pm

    AJ, you still don’t know what you don’t know….as soon as Walgreens,CVS, etc. get out of the dispensing business then I’ll lean towards your line of “reasoning”……..

  26. AJ  •  Oct 29, 2013 @10:36 pm

    Broncofan7 have you been living under a rock? The change is here. You are arguing as if this is some theoretical possibility. The Affordable Care Act passed and is in effect. Whether you want it, believe it or ignore it healthcare payment and delivery in the United States will under go a historic shift in the coming years because of it.
    .
    This isn’t some far away future event. It’s here right now. Walgreens is making a move. Several of the largest hospitals systems in Dallas have ACO pilot programs.
    .
    I suggest you do some reading and then do some more because you are woefully behind. Are you so clueless and naive to think there is no role for a pharmacist in an ACO? Really? Because if we don’t grab this opportunity there is a whole bunch of nurses out there that will be glad to take it. Just to clue you in nurses (NOT nurse practioners) aren’t recognized as healthcare providers and cannot independently bill for their services either. Yet a funny thing is happening at those hospitals in Dallas. Nurses are playing a key role in the establishment of ACO’s.

  27. AJ  •  Oct 29, 2013 @10:58 pm

    You are getting warmer…keep thinking about it. Read and research and you will connect the dots…maybe. You are pretty hard headed.

  28. Broncofan7  •  Oct 29, 2013 @11:06 pm

    You made the best argument against your position yourself when you stated ” the big chains do things for one reason only… Money”. You still don’t seem to comprehend ( despite me spelling it out for you) how WALGREEN Is going to continue to remain profitable in the age of the ACA…… It’s the SAME WAY THAT THEY Made MONEY PRIOR TO THE ACA, by dispensing medications AND WHAT THEY DID THIS YEAR WAS LEVERAGE THEMSELVES INTO A MUCH STRONGER POSITION IN PURCHASING THEIR MOST EXPENSIVE ASSET, medications.

  29. Broncofan7  •  Oct 29, 2013 @11:08 pm

    AJ, why don’t you amuse all of us with the billing codes and clinical services and related fees that the ACA us going to allow us, as individual Pharmacists, bill for…….

  30. AJ  •  Oct 30, 2013 @9:06 am

    I thought I was making progress! Getting colder…getting colder…

  31. broncofan7  •  Oct 30, 2013 @9:44 am

    Tick tock, tick tock………..

    http://www.pharmacist.com/walgreens-forms-three-new-acos

    “While the ACO final rule DOES NOT LIST PHARMACISTS as eligible professionals to form ACOs OR BE ELIGIBLE FOR SHARED SAVINGS, pharmacists can participate in ACOs. Asked if Walgreens pharmacists will somehow be able to participate financially in the new ACOs, Cohn said, “Walgreens as a whole will be participating in the savings, but we cannot provide more information about potential future financial elements of the ACOs at this time.”

    In black and white for you…the ACA (via ACOs)as it’s currently constructed does not provide a model for INDIVIDUAL Pharmacists to establish a profitable business model while offering clinical services. As you can decipher (or maybe you can’t) from above, the ACA does not allow individual Pharmacists to “participate financially” AT ALL!!

    As currently constructed, it will allow large corporations like WAGs to expand the RESPONSIBILITIES of IT’S EMPLOYEES in an effort to FATTEN THE CORPORATION’S BOTTOM LINE. This will be no different than expanding our practice to allow the administration of Immunizations and it will become just another corporate metric that diversifies the corporations ability to make a profit; but it WILL NOT replace dispensing; not with the current rules of the ACA.

    Further, if you are working as an agent of change (and I doubt you are as you are employed by one of the modern constructs that are helping to suppress our profession)why are you looking at this current model of the ACA which again does not allow Pharmacists to “participate financially” as a good thing for our profession. The ACA is tying profit into a corporation that has a relationship with a MAJOR hospital group via an ACO agreement….it has the potential to cause consolidation of Community Pharmacy jobs via the hospitals steering patients to only use a select Pharmacy chain. That is anything but productive for our profession……..Again, the real change won’t come until your employers (the PBMs) allow us to bill patients for clinical services on a fee schedule that’s congruent with positive financials….MTM is barely a drop in the bucket and the ACA looks like nothing but a money/patient/rx grab by big corporate chain stores as it’s currently constructed.

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