Elements Magazine Vol. 11 Iss. 4 December 2022

YOUR APP-SAVVY PHARMACY The best apps for your daily duties

PATIENT AGGRESSION Workplace well-being is plummeting

Billing for Patient Care

The challenges and opportunities as patient demand increases VOL. 11 ISS. 4 | DECEMBER 2022

CONTENTS

26

ON THE COVER

19

FEATURE | Billing for Patient Care The challenges and opportunities as patient demand increases

DEPARTMENTS

EWS 06 N

| Your HSA Piggybank

You don’t have to use it or lose it

TRENDS 08

| Your Online Review

Peeking into your pharmacy’s online presence

12 RETAIL

| Revenue-Revving Services

Reach a broader audience by expanding your services in 2023

SPOTLIGHT | Your App-Savvy Pharmacy

15 S OLUTIONS

| I Screen. You Screen.

Pharmacists are crucial to preventive care

32

26 29 32

SPOTLIGHT | Your App-Savvy Pharmacy The best apps for your daily duties

MONEY | Flu Prep Cashing in on the sniffles and sneezes

OUTLOOK | Patient Aggression

Workplace well-being is plummeting

ELEMENTS | The business magazine for independent pharmacy | DECEMBER 2022

OUTLOOK | Patient Aggression

3

E

ON THE WEB

ELEMENTS

The business magazine for independent pharmacy

VOLUME 11, ISSUE 4

Find more strategies, tips, and expert advice to improve your business.

DECEMBER 2022 PUBLISHER & EDITORIAL DIRECTOR Matthew Shamet EDITOR Gina Klein ART DIRECTOR Lisa Doherty

Reducing Patients’ Fall Risk One quarter of Americans aged 65 and older fall each year, according to the National Council on Aging. The good news is that you can help reduce the risk of your patients falling.

CONTRIBUTING WRITER Cecilia Vigliaturo

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ProfitGuard Helps You Hold the Line You know your primary wholesaler contract is the most important key to the future of your business. But do you know it well enough to unlock the best cost of goods for your pharmacy? Many pharmacies think they do, but they don’t.

Elements magazine is published quarterly by PBA Health. © 2022 PBA Health. All rights reserved.

Neither this publication nor any part of it may be reproduced without written permission by PBA Health.

Follow Elements magazine for pharmacy business tips and advice, news announcements, industry information, and exclusive offers.

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NEWS

YOUR HSA PIGGYBANK You don’t have to use it or lose it

Y

ou’re on your toes every second of the day in your independent

The catch is, you can only contribute to an HSA if you have a high-

pharmacy. Your patients come first, with everything else

deductible health plan (HDHP). If you’re covered by Medicare and

ensuing, including your own health and coverage. And with the end

Medicaid or claimed as a dependent on someone else’s tax return,

of the year just around the corner, you might be worried you’ll lose

you cannot open an HSA.

the money you didn’t use in your health savings account (HSA).

The good news is your health savings account has your back.

Another benefit is that you can change your payroll withholding rate at any point throughout the year. This means you don’t have

It’s not a use-it-or-lose-it account, so you won’t lose your money if

to determine the amount before the year starts like you would with

you don’t use it by the end of the calendar year. Your HSA allows

an FSA. And once you reach the magical age of 65, you can use your

you to set aside pre-tax dollars for qualified health expenses,

HSA money for any expense. However, if not used for healthcare

similar to a flexible savings account (FSA), and growth is also tax-

costs, the withdrawal would be subject to an additional tax of 20

free. Withdrawals used for qualified healthcare expenses are also

percent. It’s a requirement that you report any distributions not

untaxed. And while anyone can deposit money into your HSA, the

used for medical expenses on Form 8889 with your federal income

internal revenue service (IRS) does set an annual limit each year.

tax return. Of course, there are exceptions to this rule. If you’re 65

An FSA, on the other hand, is a special account used to pay for certain qualified, out-of-pocket healthcare costs. It’s a great tax

years old, disabled, or the distribution is made due to the death of the HSA holder, the IRS will not assess the additional penalty.

savings tool, and it has a little more variety of what it can be used for. One advantage is that your funds are immediately available the day you enroll. Depending on how much you contribute at the start, you will have access to that money immediately for qualified

HSA Q & A

medical expenses. However, be aware that an FSA requires you to use the money within the plan year, and if you leave your job, you forfeit your FSA funds.

In the meantime, you can keep your HSA account as long as you want. The money can be used on your family’s medical expenses: deductibles, copayments, coinsurance, and more. If you spend

What happens if you've opened an HSA and then drop your high-deductible health plan? You can keep your account, but you cannot deposit money into it.

However, you can spend or save the funds that are already in it.

what’s in your HSA on current healthcare expenses, you still benefit from the pretax contributions that reduce your taxable income.

PUTTING MONEY INTO YOUR HSA You can contribute to your HSA at any time throughout the year (up to the annual limit). Here are some ways you can contribute:

You can have a set amount

Deposit money that’s already

Invest the funds into your HSA

You can move money from an

taken out of your paycheck

been taxed. In fact, you can

to earn interest (they may

IRA to your HSA once. This is

before taxes.

deduct it from your tax return

require a minimum account

called a one-time rollover.

regardless of who it came

balance).

from.

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TRENDS

YOUR ONLINE REVIEW Peeking into your pharmacy’s online presence WEBSITE If you don’t have an online presence for your pharmacy just yet, don’t panic. Breathe in, breathe out, and keep reading. This is your first step. Your website will be your digital storefront. It’ll be your own space to publish all of the information about your products and services. The easiest way to whip up your own website is to check out free builder tools, such as Wix, Weebly, and Mailchimp, which provide easy-to-use templates for simple websites.

To get started, check out your competitions’ websites. What about their sites stand out most, the design or content? What are their unique selling points? If you don’t already have a site, think how you’d like your own website designed and laid out. If you already have one, check to see if you can improve it in any way. Does it need to be more personable?

Remember: Your website reflects your business. A good site includes a welcome message to its visitors and information on what sets your pharmacy apart from others. Give it your own personal touch, and add an emotional call to action. In other words, pinpoint the user’s problem and tell them how you plan to help them. Add photos of yourself, your employees, and your physical pharmacy store. By bringing out an emotional connection between you and

H

aving an online presence in today’s world is vital. It’s where the majority of customer journeys start. With a quick Google

search or the opening of an app on their phone, they can check out a store before they decide to shop there. The same goes for purchasing their medications.

E-commerce isn’t new. In fact, its growth has been quick due to customer demands and the recent pandemic. As a result, the days of running to the pharmacy to pick up a prescription have slowed way down. Healthcare services have gone virtual, and ordering prescriptions online has become crucial. What’s more, it doesn’t seem to be coming to a halt anytime soon, as many consumers have grown comfortable with the instant gratification the web offers.

This is why your online presence is paramount to keeping up with the Joneses.

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your website users, they’ll feel a genuine connection and find your pharmacy more relatable.

Once designed, put yourself in your patients’ shoes. Look closely at your website and ask yourself: Is your website user-friendly and easy to navigate? Does the design match your brand? Is the text easy to read and understand? Did you highlight main points and customer needs? Do all of the pages have the same text size, font, and color scheme? If your site is missing even one of these, go back and fix it. You’ll be happy you did.

If you already have a website, when was the last time you updated it? If your site’s design and information date back more than a year, it’s time to take action. An outdated website is sure to make viewers click the little “x” in the corner and move on to another pharmacy’s site.

SOCIAL MEDIA Add personality and flair to your brand and connect with your audience in a more conversational way. But before you choose your platform, first identify your customer base. If you’re in an area surrounded by college students, having a presence on Instagram or TikTok would be appropriate. However, TikTok would not be a good choice for an older audience. Facebook, however, is the perfect place for consumers to find store information such as hours, location, and any promotions going on. Plus, it’s a great way for your pharmacy to interact with the community and maintain a presence with potential customers.

As part of your website’s update, include some of the following additions to help drive more patients to your site and keep them coming back: •

HEALTH BLOG: Have a blog page on your site where you write monthly or weekly articles on healthcare news, new drug

•

treatments, vaccines, or whatever is on your mind. Just be sure

GOOGLE MY BUSINESS

to market your blog effectively so it gets regular viewers, and

This is one of the most important social media marketing tools

add a photo to each of your posts.

for your pharmacy. Not only is it free, it’s easy to use and can help

REFILL/TRANSFER PAGE: In today’s world, your patients

customers find you. Be sure to include essential information like

want an effortless way to order their prescriptions. Adding a

your opening times, street address, phone number, email address,

page on your website where they can refill or transfer their

and website address.

prescriptions will have them coming back to your site regularly.

•

ONLINE SHOP: A shopping page on your website will make it easy for your patients to buy the things they want or need without having to leave their home. You can sell anything from personal-care products and diabetes supplies to vitamins and OTC medications. Offering next-day delivery is something people expect from online retailers. Implementing a system of paperless prescriptions and delivery will keep your patients happy.

•

CONTACT PAGE: This is important. Without your contact information, how will prospective patients know how to reach you? Include your pharmacy phone number, email address, and website address.

ELEMENTS | The business magazine for independent pharmacy | DECEMBER 2022

9

GOOGLE MAPS When people are finding directions to their destination, a good number of them rely on Google Maps. If your independent pharmacy isn’t already there, this is a wonderful opportunity to gain new patients. People searching for pharmacies on Google Maps clearly don’t already have one, or at least, one that they love.

Easily add your pharmacy to Google Maps by following these steps from broadly.com: •

Sign into your Google My Business account

•

Add new location on business homepage

•

Enter your business name and business address

•

Drop a pin (show where your business is located)

•

Confirm business details

•

Verify your business Not sure if your business already exists on Google Maps? Go

to google.com and enter your business name and city in the search bar. Click the Search button and then click a tab that says Maps.

You should see a map of your area with listings of business names similar to yours. If yours doesn’t appear, you’re not on Google Maps yet. If you do see your business appear, and you didn’t add it yourself, follow the necessary steps to “claim your business on Google.” From there, you’ll be verified and given access as the owner.

PHARMACY APP One of the top places your pharmacy needs to be seen is on your patients’ smartphones. According to Statista, the number of global smartphone users in 2022 is 6.648 billion, or 83.32 percent of the world’s population. Pharmacies that don’t have an online presence will find it difficult to keep up with consumer demands.

The simplicity of ordering low-cost drugs from the comfort of home has eliminated your patients’ need to go anywhere. They can order their medications online or through an app and refill their prescriptions easily. As an added bonus, most pharmacies now offer curbside pickup, in-store pickup, and/or home delivery.

If you don’t yet have an app for your pharmacy, now is the time to look into one. A mobile app makes it easier to increase brand awareness and competitiveness. Mobile access to your pharmacy and staff can lead to better prescription management, better customer service, and patients can manage their health more efficiently and discreetly. When you’re ready to start looking into building your own pharmacy app, here are a few of the top platforms to check out: •

Digital Pharmacist (digitalpharmacist.com)

•

Paubox (paubox.com)

•

Solutionreach (solutionreach.com)

•

Spruce Health (sprucehealth.com)

•

Weave (getweave.com) When you have an online presence, you’ll get the most out of

today’s consumer interest in online pharmaceutical services. You’ll improve care for your patients by adopting the right technology and software solutions, and your independent pharmacy will stand out from the crowd and remain competitive.

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CONSUMER DRUG TAKE-BACK

02 03 04 05

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USP <800> PHARMACY COMPLIANCE Subscription-based service providing an annual Assessment of Risk for handling hazardous drugs to protect your staff and patients.

Rx RECON AND COLLECTIONS Inmar’s Rx Recon and Collections Services mitigate receivables risk, improve cash flow and deliver critical business-building intelligence.

inmar.com | solutions@inmar.com | (866) 440-6917

RETAIL

REVENUE-REVVING SERVICES Reach a broader audience by expanding your services in 2023

S

pread your wings a little wider in the new year by adding more

SMOKING CESSATION COUNSELING: You can implement

revenue-building services to your pharmacy practice. While

smoking cessation counseling in several ways. Several states now

regulations vary state to state, adding an additional service or

have statutes or regulations addressing pharmacist prescribing

two will allow you to increase your clinical interactions with your

of tobacco cessation aids. You can try providing 30-minute

patients and generate additional revenue. The National Community

consultations with patients to discuss their smoking options,

Pharmacists Association shares this short list of some products and

including OTC nicotine replacement products and drugs the

services you may not have thought to implement.

pharmacists can prescribe. You can charge a consultation fee to the patient, but the prescription drug dispensing is covered by

VACCINE CLINICS: It’s one thing to give vaccines, but holding

insurance. A new Medicaid regulation provides payment for OTC

immunization clinics is the key to growth. Reach out to local

nicotine replacement products as well.

businesses, school districts, churches, government facilities, and daycare centers. Doing this will help you establish a baseline. Don’t

DISEASE STATE MANAGEMENT (ASTHMA AND COPD): Both

just focus on one vaccine; include all of them. Employers can benefit

asthma and COPD can result in various comorbidities. So, whether

from flu, COVID, pneumonia, shingles, travel vaccinations, and even

you offer one-on-one or group sessions for asthma/COPD

standard vaccines. Make sure you include information on the cost

management, your patients can see long-term benefits to proper

benefits of having employees vaccinated.

management and risk education. COPD patients need to stay up to date on their influenza and pneumococcal vaccinations, so focusing

According to the National Alliance of State Pharmacy (NASPA), 48

on free services is beneficial.

states, the District of Columbia, and Puerto Rico allow pharmacists to administer any vaccine, though some require a prescription,

PHARMACOGENETIC TESTING: Pharmacogenetics is the study of

and some have limitations by patient age. The exceptions are New

how a person’s genes affect the way he or she responds to drugs.

Hampshire, New York, West Virginia, and Wyoming, which have

It’s used to learn ahead of time what the best drug or the best dose

limitations on what vaccines are allowed.

of a drug will be for a person. While it may seem new, the field isn’t new at all. The FDA has approved a long list of drugs that require or

POINT-OF-CARE TESTING: Research shows that point-of-care

recommend genetic testing as part of their prescribing. Pharmacies

testing is predicted to make more revenue than vaccines for

that offer this service usually partner with a lab. The pharmacist

community pharmacies. During point-of-care testing, screening and

collects the sample and can also help the provider interpret the

treatment are completed during a single encounter. This improves

results. Coverage for genetic testing varies based on insurance

access to care, counseling, and patient outcomes. Some of the

plan, the type of test ordered, and coverage considerations. While

common tests to offer include blood sugar, A1C, flu, strep, COVID,

it’s sometimes covered by insurance, those who are uninsured or

chronic disease screening, and chronic disease monitoring.

underinsured may have to pay up to $2,000.

LONG-ACTING INJECTABLE DRUGS: Pharmacies can serve as

MEDICATION SYNCHRONIZATION: This service is becoming

alternate injection sites for long-acting injectable antipsychotic

more common and is now offered by 79 percent of independent

agents (LAIAs) and other medications. This can take place under

pharmacies. Medication synchronization aligns all of a patient’s

collaborative practice agreements (CPAs) with mental health

refills on the same day of the month. This saves the patient from

practitioners or through partnerships with LAIA manufacturers.

making multiple trips to the pharmacy and keeps them from having to call in multiple refills throughout the month. That’s because you

WEIGHT-LOSS PROGRAM: Does your community struggle with

can call the patient prior to their appointment date and confirm

obesity? You can help them by starting a program to help them

all of their scheduled medications. Your patient then has the

become healthier, live longer, and reduce their overall medical

opportunity to request any as-needed medications. However, it’s

costs. A weight-loss service should focus on the long-term, overall

important for patients to understand that while pharmacies don’t

health and wellness of the patient.

usually charge a fee to provide this service, insurance doesn’t

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always cover the early refills required to align their medications.

Before making any changes in your business model, do your

So, as their pharmacist, it’s wise to try to find an appointment date

research. Not every clinical service will offer significant revenue,

that’s centered around a more expensive, branded medication.

especially when you’re just starting out. However, experts are hopeful that new opportunities for reimbursement will come

ADHERENCE PACKAGING: Offered by many independent

to fruition as insurers recognize the value of pharmacists’

pharmacies to help differentiate themselves from the chains,

contributions to healthcare. In the meantime, a little bit here and

adherence packaging is a service where medications are packaged

there can help your business grow.

into blister packs or strips rather than bottles. A patient’s medications may also be packaged according to the day rather than by medication.

TO KNOW WHAT WOULD BE BEST FOR YOUR PHARMACY, ASK YOURSELF THESE QUESTIONS: WHAT DO YOUR PATIENTS WANT OR NEED? WHAT DO PROVIDERS IN YOUR AREA THINK YOUR COMMUNITY NEEDS? In addition to the extra services, many independent pharmacies have been implementing a mix of different products for additional cash flow, such as:

•

HIGH-END SUPPLEMENTS: Be sure to offer a high-end solution to your patients, otherwise you'll miss out on that revenue. You’ll also need a team that’s trained to help sell the benefits of a higher-quality supplement. Be sure they’re able to effectively explain the difference between standard supplements compared to a higher-quality version to make

•

sales.

E-COMMERCE: These online stores have helped drive traffic, improve patient engagement, and compete with chains by allowing people to order online for same- or next-day pickup or delivery. They’ve helped showcase products at the same or lower costs, and highlight their products and services.

E-commerce has also brought in new patients by offering

•

products not available elsewhere.

CASH PROGRAMS: These are available for any patient whether they’re insured, underinsured, or uninsured. Common cash prescriptions are for sexual health, cosmetic, weight loss, or

•

chronic conditions.

NUTRIENT DEPLETION: Your team will need some basic training before offering this service. To get these products sold, everyone needs to know how to sell specific supplements to coincide with prescriptions. Unless your team is comfortable making supplement recommendations based on the patient’s

•

regimen, it’ll be tough for you to make many sales.

CBD: Whether it’s something a pharmacy should offer is up in the air with everyone’s own opinions. However, CBD has been a significant revenue generator for many pharmacies.

ELEMENTS | The business magazine for independent pharmacy | DECEMBER 2022

13

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By PBA Health

6300 Enterprise Road Kansas City, Missouri | 64120 800.333.8097 | customercare@pbahealth.com

SOLUTIONS

I SCREEN. YOU SCREEN. Pharmacists are crucial to preventive care

A

n apple a day might keep the doctor away, but routine screens stop the need to intervene.

Community pharmacists know this. But do patients know

LISTEN UP!

how important routine screenings are to their health? Apparently

With over-the-counter hearing aids now available, you

not. As of 2015, only eight percent of U.S. adults received all the

can test and treat your patients experiencing mild-to-

high-priority, appropriate preventive care recommended for them,

moderate hearing loss. Just help them take an easy,

according to researchers with the Agency for Healthcare Research

accurate test online. The instant result will give you

and Quality. Nearly five percent of adults did not receive any such

and your patients an idea of their “baseline” ability to

services at all.

hear. Then you can help them select the appropriate

“Some of the commonly known reasons for not getting the

device. Be sure to have a plan to refer an audiologist

recommended preventive services include lack of health insurance;

if a patient shows signs of a more serious hearing

lack of a usual doctor or nurse; and problems with healthcare

problem or an underlying health issue. Learn more

delivery, including wait times,” said Amanda Borsky, who led the

about how to profit while helping your patients by

study for the agency.

contacting PBA Health customer care at 800.333.8097

The National Academy of Medicine (formerly called the

or customercare@pbahealth.com.

Institute of Medicine) estimates missed prevention opportunities cost the United States $55 billion each year—approximately 30 cents on every healthcare dollar.

Pharmacists are in a pivotal position to provide healthcare screenings, which in turn can improve the health of their patients and communities.

ELEMENTS | The business magazine for independent pharmacy | DECEMBER 2022

15

PHARMACIES AT THE FOREFRONT Pharmacists already provide medication therapy management services. You might offer a relevant screening or assessment by appointment, which conveniently coincides with the time your patient already picks up meds. You get to know your patient better, learn about possible drug interactions, clear up any compliance confusion, or suggest a specific supplement or product.

For example, a patient may take high blood pressure medicine.

But a screening shows their blood pressure is still stubbornly high.

Do they understand the need to consistently take their meds?

Do they inadvertently take an over-the-counter product with a counteractive effect? The pharmacist might suggest purchasing an affordable, easy-to-use blood pressure monitor, then demonstrate how to use it.

Bremo Pharmacy in Richmond, Virginia, has offered a range of screenings for many years. “Our health screenings attract new patients into our pharmacy, and our current patients like having access to them as well,” said Regina Richardson, PharmD, PIC. “They serve both groups well.”

Pharmacists and healthcare providers have traditionally focused on biometric-type screenings, such as blood pressure, blood sugar, and lipids.

Bremo added A1C tests last year and food sensitivity tests two years ago. “The food sensitivity tests are especially beneficial,” said Richardson. “It gives us a chance to educate our patients and take time counseling them about lifestyle, food choices, and any medications they take. Plus, the tests are sent out to a lab, so we don’t have to pre-order supplies that we might not use before their expiration date.”

PROMOTING YOUR SCREENINGS Bremo Pharmacy in Richmond, Virginia, offers one free health screening per quarter on a revolving basis, including blood pressure, glucose, and bone density (the pharmacy’s most popular). Regina Richardson, PharmD, PIC at Bremo, suggests several simple, low-cost ways to promote screenings.

IN-STORE PUBLICITY

E-NEWSLETTERS

WEBSITE

SOCIAL MEDIA

Put up posters and hand out

Highlight the importance of

Use a full list of screenings you

Piggyback on events like

fliers. Also, verbally remind your

screenings in your e-newsletter.

offer. Otherwise, patients may

February’s American

patients about your screenings.

Promote a different screening in

not know you provide them.

Heart Month to promote

each issue.

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complementary screenings.

IS YOUR PHARMACY UP TO DATE ON ITS HEALTH SCREENINGS?

GOING BEYOND BIOMETRICS The pandemic has highlighted the pressing need to focus on the whole person—particularly addiction and mental health.

Underscoring the urgency and scope of the issue, the U.S. Preventive Services Task Force recommended adults under age 65 get screened for anxiety and reiterated an earlier recommendation that all adults undergo routine screening for depression during routine care.

With screenings and clear, patient-prescriber-pharmacist communication and drug utilization reviews, pharmacists and staff can identify red flags such as “doctor shopping,” which can help mitigate the effects of substance abuse, particularly opioid dependency.

Screening is also considered the most effective way to prevent or reduce the impact of domestic violence. Seen as especially trustworthy and accessible healthcare providers, pharmacists don’t need expertise in interpersonal or intimate partner violence to help.

It's common to not quite know how to handle such situations— that’s okay. It’s a good idea to first determine, contact, and consult with local support services. Then, if a situation involving intimate partner abuse, assault, or stalking arises, you’re ready to talk about personal safety, health concerns, and suggest a referral to resources or programs.

The National Health Resource Center on Domestic Violence provides patient brochures, safety plans, and educational tools to help healthcare providers respond to interpersonal and domestic violence in healthcare settings. Visit aaf.hhs.gov for details.

Offering screenings for the whole person can be profitable for your business and valuable for your community.

Have a dedicated, private, and comfortable space for all screenings or other confidential interactions. You should review recent clinical suggestions or take a continuing education class to ensure you’re up to date with current testing. It might also be a good idea to have a list of physicians for referral. Here are some of the more common screenings and assessments community pharmacists can include in their offerings:

•

ALCOHOL DEPENDENCY

•

ANXIETY

•

BALANCE AND FALLS

•

BLOOD PRESSURE

•

BONE DENSITY

•

COMPREHENSIVE MEDICATION REVIEW

•

DEPRESSION

•

FASTING BLOOD GLUCOSE

•

FASTING CHOLESTEROL

•

HEARING

•

HEMOGLOBIN A1C

•

HIV

•

INTIMATE PARTNER VIOLENCE

•

NON-FASTING CHOLESTEROL (TC/HDL)

•

OPIOID DEPENDENCY

•

SEXUALLY TRANSMITTED DISEASE

•

SUICIDE

•

TOBACCO USAGE

ELEMENTS | The business magazine for independent pharmacy | DECEMBER 2022

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WE CREATE CONNECTIONS. PPRB is North America’s Premier Pharmacy Calendar Company—known for delivering high-quality, low-cost print products that keep you close to your customers all year long.

Our signature Wall Calendars feature useful and topical content, including fishing and gardening guides, and even recipes and health tips!

NOT YOUR AVERAGE PHARMACY CALENDAR Stunning Imagery

So, each PPRB Calendar you hand out is a connection made.

To view our 2023 calendar line-up and additional print products, like our coloring books & magnets, visit PPRB.com!

Each month features beautiful, print-optimized images that your customers are sure to love

Large Date Squares Large date squares are perfect for jotting down important events and appointments; and contain useful information, like daily fishing & gardening guides

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FEATURE

BILLING FOR PATIENT CARE The challenges and opportunities as patient demand increases

ELEMENTS | The business magazine for independent pharmacy | DECEMBER 2022

19

G

one are the days when dispensing prescriptions for your

requirements, credentialing, and the steps to enrollment. There

patients was your only task. Today, pharmacists are doing a

are inconsistencies in state and federal agencies recognizing

lot more and patient-care services are increasing. Many pharmacies

pharmacists as qualified care providers, which services are

out there now provide a growing list of additional services such as

permitted, and the payment parity laws that require health-plan

immunizations, medication synchronization, point-of-care (POC)

payment for pharmacist providers.

testing, medication therapy management (MTM), counseling,

“The business side of pharmacy today is questionable in a

chronic-care management, and patient education.

sense because you really have to push a lot of prescription volume.

Nick Smock, President and CEO of PBA Health,

Today, pharmacies are lucky to be reimbursed for the cost of the

PharmD, MBA, President of FPN, Vice President of

product. Previously, they could add their professional fee to

APHA, and member of various state pharmacy

the cost of the medication, but now the pharmacy benefits

and national associations, said pharmacies

managers reduced the professional fee to a ‘dispensing

today provide much more than medications.

fee’ that does not cover the prescription label

They provide not only prescriptions and

and/or vial. Reimbursements are so low that

education, but healthcare, too.

you’ve got to look for other avenues to bring

“Pharmacists can do more than

into your facilities,” Smock said. “The value of

dispense medications. Today, they provide

pharmacists and their help has increased since

physical assessments, therapeutics, and

COVID because we were able to bill for vaccinations

clinical services such as blood pressure and

and provide more for patients. Vaccines at your local

immunizations. All of these things are taught

pharmacy are an important resource offered to patients

in pharmacy schools, yet pharmacists still aren’t really known for that,” Smock, with over 40 years of industry experience, said. “People still view pharmacies as a place to simply pick up a prescription. We really need

since pharmacies are easily accessible.”

Phillip Rozell, PD of Medical Arts Pharmacy, said his store

NICK SMOCK CEO, PRESIDENT PBA HEALTH

is still going strong providing vaccines for their patients. “We are still administering 20 to 60 vaccines per day,” Rozell said. “So far

to expand consumers’ perception that you go to your pharmacy

our team has administered over 39,000 COVID vaccines. Our clinical

for healthcare.”

team has been involved and committed from day one.”

While the pharmacy workload is increasing, reimbursements

According to Smock, this may change as the PBMs and

for the clinical services provided lag. Many factors prevent

insurance companies continue to ratchet reimbursements lower

pharmacists like you from getting reimbursed for your services.

and lower and force pharmacies to sell or close their practices.

First, there is a lack of resources that explain the required steps to implement clinical services (especially as a billing provider).

“In my view, PBMs and insurance companies are shortsighted and should be paying pharmacies for their service to help reduce

Add to that the obscurity of what services are covered, charting

I

PLAN CREDENTIALING AND ENROLLMENT

FIVE STEPS TO A SUCCESSFUL REIMBURSEMENT OF CLINICAL SERVICES

2 3 4 5

FIND A SOFTWARE

PROVIDE ADEQUATE

VISIT WITH PATIENTS

SOLUTION THAT

TRAINING FOR YOUR

AND SUBMIT CLAIMS

WILL SUPPORT ALL

TECHNICIANS

Be sure it enables you to

REVENUE CYCLE

MANAGEMENT (RCM)

YOUR NEEDS Who are the top

REVIEW AND ACCESS

REPORTING Include such things

Alas! It's time to put all

This is the final

medical payers for your

support medical billing

as claims submission

of your hard work into

step. Confirm claim

patients? Find out what

and documentation for

requirements; service,

action. You now have

transmission, monitor

their requirements are

all services provided

state, or protocol

the foundation and tools

through rejection and

for credentialing and

during the visit, along

requirements; company

to successfully bill for

denial management, and

enrollment and fill out

with your workflow

policies; workflow; and

clinical services offered.

follow up on claims.

the provider applications

needs.

billable services.

and contracting steps.

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the overall medical cost of patients. In the past, and even today, prescription cost of healthcare is only 10 percent of the overall health cost of patients. The larger cost is medical care, accounting for 90 percent of spending. Pharmacy has been shown to reduce the cost while improving patients’ quality of life,” Smock said.

While the procedures by which pharmacists can receive reimbursement for patient-care services have advanced in recent years, the billing process remains inconsistent across systems and settings of care. Clearly, it’s your greatest challenge and opportunity.

TECHS TO THE RESCUE To be successful, you need strong support from your pharmacy technicians. Technicians play a big part in combining services into pharmacy workflow and taking control of the process. Allowing your technicians to take on more significant roles can also help improve job satisfaction. Provide adequate training for them on:

“They said years ago, ‘Get into politics or get out of pharmacy,’” Smock said. “I have been thinking, ‘Today, get into services or get out of pharmacy.’ Pharmacists will have to get into services.

You don’t want to let go of the product because we’re licensed

Claims submission requirements

to purchase, store, handle, and dispense. We don’t want to let go of that function, and we want to expand pharmaceutical and healthcare services. Today, pharmacy is positioned to offer a dual type of healthcare: product and service.”

Technology systems

Interpersonal communication with patients and providers

Company policies/procedures, implementing new workflows, and documentation steps

Billable professional services (patient assessments, contraceptive education, emergency refills of insulin, opioid overdose prevention, and tobacco cessation counseling)

Billing management software systems and electronic medical records

Billing the claims to the health insurance plans

ELEMENTS | The business magazine for independent pharmacy | DECEMBER 2022

21

BILLING PATIENT-CARE SERVICES There are several methods for billing pharmacist patient-care services. The use of a particular method is dependent on the type of benefit providing coverage for the service, provider-payer contracts, care settings, and professional service agreements. The National Council for Prescription Drug Programs (NCPDP) shares this list of billing types.

CONTRACT-BASED REIMBURSEMENT: Pharmacists may be reimbursed based on contracts with payers or through professional service agreements with or between providers. The pharmacist and the health provider negotiate rates and billing methods. Right now, there is little standardization in such agreements. Payment can be fee-for-service or may be covered under a global rate, capitation, or similar arrangement.

DIRECT PATIENT PAYMENT: As a pharmacist, you can charge patients directly for their services on a cash transaction basis. You set the cost structure. Patients pay out of pocket for the service.

They may receive documentation to get potential reimbursement through a flexible benefit program or from their health plan.

BILLING USING PROCEDURE CODES: Procedure codes can be found in the Healthcare Procedure Code System (HCPCS) and the Level I American Association CPT codes. Specific CPT codes were developed in 2005 for the payment of a Medication Therapy Management (MTM) service provided by a pharmacist. You can find information on the use of these codes at www.pstac.org.

INCIDENT-TO BILLING: The services provided by pharmacists may be delivered across various settings of patient care, such as a physician office or clinic, under the supervision of and in collaboration with a physician or recognized practitioner. The approach to filling in these settings is “incident-to” billing. This means the practitioner or clinic bills for the services of the pharmacist “incident-to” the practitioner or clinic service. The billing subject receives payment and then reimburses the pharmacist.

Medicare provides these further requirements:

•

The services must be part of the patient’s normal course of treatment during which a physician personally performed the

•

initial service and remains actively involved during treatment.

The supervising physician must provide direct supervision. For group providers, any physician member of the group may be

•

present in the office to supervise.

The patient record should document the essential requirements for an incident-to service.

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Here are some points to consider within the definition. It’s

You might find that administrators believe pharmacists are

noted that the physician bills Medicare Part B as if they were the

not eligible to perform incident-to billing because they’re not

one performing the service. It’s not the pharmacist who is billing

classified as a “provider” by Medicare Part B and are not specifically

Medicare. Instead, you are providing the service incident-to

mentioned in Medicare rules as being able to perform those

the professional service of the physician. Because pharmacists

services. However, the American Academy of Family Physicians

are performing the clinical service, however, they’re eligible to

(AAFP) directly contacted and asked Medicare if pharmacists

receive partial to full financial credit when the practice submits

were eligible to provide clinical services in an incident-to manner.

for reimbursement from Medicare by including the pharmacist

Medicare agreed with AAFP that pharmacists are eligible to provide

as a secondary provider on the encounter sheet or superbill. The

clinical services in an incident-to billing model if they meet all the

physician must also have performed the initial patient service

additional requirements.

before subsequent visits by the pharmacist to be eligible for

The implementation of a signed collaborative practice

incident-to billing. This provides the physician a chance to establish

agreement (CPA) between the physician and the pharmacist

the diagnosis and put together a treatment plan for the patient

provides specific criteria for future services provided by the

(which is another requirement for incident-to billing). Last, but

pharmacist. It’s an established and accepted mechanism to fulfill

not least, the physician must provide direct supervision of the

the intent of the Medicare incident-to billing provision. CPAs

pharmacist performing the incident-to service; but there are three

require physicians to guide patient care, including determining

different levels of supervision.

which patients are seen by the pharmacist, which conditions or

•

General supervision: It’s required that the physician provides

medications the pharmacist will manage, and what degree of

supervision of the service, but the physician is not mandated to

responsibility the pharmacist will have.

be at the place of service.

•

Medicare openly supports clinical services performed by

Direct supervision: The physician is required to be at the

pharmacists in an incident-to manner. Though pharmacists aren’t

place of service and be immediately available to assist, but is

recognized as providers at the federal level, most states have

not required to be in the room where the service is provided.

language authorizing CPAs, which offer legal authority at the

Immediate supervision: The physician is required to be

state level.

physically present in the room where the service is being provided.

As national pharmacy organizations continue to push towards formal recognition as providers, the use of incident-to billing in the meantime will allow the services performed by pharmacists to be billed at a higher level. This will vastly improve the financial sustainability of clinical pharmacy services as well as increase the incorporation of pharmacists into care teams. It’s been proven that adding pharmacists to care teams improves clinical outcomes, increases patient access to care, and reduces healthcare spending.

"PHARMACISTS WILL HAVE TO GET INTO SERVICES. YOU DON’T WANT TO LET GO OF THE PRODUCT BECAUSE WE’RE LICENSED TO PURCHASE, STORE, HANDLE, AND DISPENSE. WE DON’T WANT TO LET GO OF THAT FUNCTION, AND WE WANT TO EXPAND PHARMACEUTICAL AND HEALTHCARE SERVICES. TODAY, PHARMACY IS POSITIONED TO OFFER A DUAL TYPE OF HEALTHCARE: PRODUCT AND SERVICE.” ELEMENTS | The business magazine for independent pharmacy | DECEMBER 2022

23

KNOW THE FACTS ON BILLING FOR CLINICAL PHARMACY SERVICES FACT 1 To receive reimbursement for your patient-care services, negotiation-specific contracts are required in non-institutional, physician-based offices and clinics. As another option, pharmacist-based services can be included into a pay-for-performance (PfP) incentive or a capitated model of payment. Billing defaults to Medicare regulations if there are no specific contracts with private payers.

FACT 2 If you’re employed by someone else but also practice in a physician-based clinic, you can bill your services using incident-to billing. However, keep in mind the basic nine requirements of Medicare.

FACT 3 Medication Therapy Management (MTM) codes are not recognized, especially when Medicare beneficiaries are seen by you in a physician office. This is because physician offices fall under Medicare Part B. MTM services are only recognized under Part D and are paid through administrative fees to a Prescription Drug Benefit Plan (PDBP).

FACT 4 You can bill for clinical/cognitive services (which may vary by state) and the Medicare Part D Prescription Drug Plans (PDP) available to you at your location. Several states will pay you to provide various levels of cognitive services to state Medicaid beneficiaries. And while you can submit bills to any provider, they will need to determine which providers are eligible under a patient’s particular health insurance plan to submit bills. There are also rules of participation, so they may need to sign a participation agreement, and then standard procedures will need to be followed in submitting the bill.

FACT 5 Under a Medicare program called Transitional Care Management, services are used to bill physician and qualified non-physician providers’ care management following discharge from an inpatient hospital setting, observation setting, or skilled nursing facility. As a pharmacist, you can serve as a qualified non-physician provider to provide some of these services. Be aware that the claim for these services must be submitted under a Medicare-recognized provider, so a pharmacist in this role must collaborate with a licensed Medicare provider.

FACT 6 While recent legislation enacted in several states now enables you to provide clinical services through collaborative protocols with physicians, specific rules exist under which you can practice. Services such as medication monitoring, dosage adjusting and regiments, and changing prescriptions when required are commonly acceptable across most states, but with a few exceptions. However, most collaborative protocols between you and a physician are narrow in scope, thus limiting pharmacist clinical services to specified patients and disease states.

FACT 7 Payments for pharmacy services provided through state Medicaid programs vary from state to state. Smoking cessation, counseling, and other preventive services are the most commonly reimbursed services in the 15 states that provide Medicaid compensation for direct patient care.

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SPOTLIGHT

YOUR APP-SAVVY PHARMACY The best apps for your daily duties

K

eeping up with the times in your independent pharmacy can be

CDC VACCINE SCHEDULES: This is a free app that

a challenge, especially after the pandemic. With added services,

provides the most current versions of child/adoles-

fewer employees, and nonstop busyness, you don’t always know

cent immunization schedules, a catch-up schedule for

where to turn for help.

children and adolescents 4 months through 18 years,

Believe it or not, your phone can be a very useful tool in your

adult schedules (including recommended vaccines by

pharmacy. Download the right apps, and you can have everything

age group and medical conditions), and an adult

from drug information to patient education at your fingertips. This

contraindications and precautions table.

list of mobile apps can lighten your load as you navigate your to-dos each day:

DRUGS.COM MEDICATION GUIDE: This guide is full of information that allows you to check drug interactions, identify pills, and create custom lists and reports. It also offers in-depth consumer information, FDA alerts, and a complete database of drug information.

DRUGS@FDA EXPRESS: This mobile version of the agency’s online database of information on approved drugs, allows you to search and browse by drug name, active ingredient, or application number. You can also view a list of recent approvals that are organized by date in the ‘Last 7 Days Approval’ option.

EPOCRATES: Widely regarded as a useful tool for pharmacists, this medical app is reliable, easy to use, and updated regularly. In the free version, you’ll find a drug interaction checker, pill identifier, resources for COVID-19, and drug coverage information for insurance plans. For a monthly fee, you can access premium features such as access to labs, disease monographs, ICD-10 codes, and even an infectious disease treatment selector.

GOOGLE TRANSLATE: If you work with non-English speaking patients, this app translates words and phrases in more than 60 other languages. The app also offers the option to do an instant, two-way speech so you can answer your patients’ questions.

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LEXICOMP: This app is great for when you need to

UPTODATE: If you’re looking for general clinical

look up evidence-based drug information. Some of its

information, this is a great resource. It’s an evi-

unique features include pharmacogenomics

dence-based, physician-authored clinical support

databases, drug monographs, IV compatibility data,

resource. Simply search by topic, including diseases,

patient education forms, toxicology, and drug inter-

drugs, or procedures. The app covers 25 specialties,

actions. View more than 20 databases that feature

including internal medicine, psychiatry, infectious

updated, in-depth information on drugs, natural

disease, and cardiovascular medicine. It also includes

products, interactions, medical calculations,

a number of medical calculators.

and more.

With a few exceptions, most of the apps listed MERCK MANUAL PROFESSIONAL: This longtime,

have a free version you can try out. If you decide

go-to source for medical knowledge now fits in your

you’d like to use their premium features, you’ll pay a

pocket. The app contains thousands of regularly

monthly or annual fee. Check reviews, try out the free

updated articles, drug reference information,

features, and decide what apps might come in handy

Illustrations, how-to videos on outpatient procedures

in your pharmacy.

and physical exams, and more.

Mobile phones can be a distraction in the workplace, but with these apps they can also be a

MONTHLY PRESCRIBING REFERENCE (MPR): Opti-

blessing. You owe it to yourself to have the tools you

mize medication management with this app’s drug

need when you need them. Not only will you benefit,

database with real-time updates, a news feed, and

but so will your patients.

tools such as medical calculators, quick-reference charts and guidelines, and prescribing information.

You can also personalize your settings to therapeutic areas relevant to your practice.

PEPID: You’ll find all the tools you need to treat patients anywhere and at any time in PEPID. You can access their drug database, medical calculators, high-res pill photos, illustrations, news and alerts, pill identifier, drug-drug interactions, and hundreds of reference videos.

POCKET PHARMACIST: Need to look something up quickly? This app can be useful. As the company description says, “It feels like you’re talking to a live pharmacist versus reading through an encyclopedia.”

If you need to search drug information or interactions, this is the app for you. You can also test your own knowledge through medication quizzes. Pocket Pharmacist is available for iPhone and iPad only.

SANFORD GUIDE – ANTIMICROBIAL THERAPY: This tool includes clinical references for the treatment of infectious diseases, dosing tables, information on clinical syndromes as well as pathogens.

SKYSCAPE MEDICAL LIBRARY APP: This is a great decision-support tool for healthcare professionals that includes a comprehensive drug guide, a clinical resource with over 850 topics, a calculator with over 200 interactive tools, and breaking clinical news and drug alerts.

ELEMENTS | The business magazine for independent pharmacy | DECEMBER 2022

27

MONEY

FLU PREP Cashing in on sniffles and sneezes

F

lu season is back with a vengeance, and it’s been hitting unusually hard this year. While the sniffles, sneezes, and fevers

Use this checklist below to make sure your pharmacy has what your patients will need most during this cold, flu, and COVID season.

usually begin around October, they arrived about six weeks earlier this season and with uncharacteristically high illness. Experts are projecting the worst flu season in 13 years. Add to that the threat of COVID-19 and RSV (respiratory syncytial virus), and you’ve got patients lining up at your pharmacy counter in droves. But are you ready?

If you haven’t already, set up your scheduling system so you’re prepared. Make sure you and your staff have a system in place

OTC COLD MEDICINES

• • • •

for when things get busy. Be sure it’s clear what vaccines you are

Fever, headache, and body aches: ibuprofen, acetaminophen, aspirin, and naproxen Congestion: oxymetazoline, phenylephrine, pseudoephedrine Cough: guaifenesin and dextromethorphan Multi-symptom: Nyquil, Dayquil, Mucinex, generic equivalents, etc.

administering and prepare for multiple lanes of both scheduling and vaccines. You’ll need enough room to accommodate a swarm of patients needing immunizations while also maintaining social distancing. It’s also a good idea to know where required areas will be for service delivery.

Get your staff members ready by giving them specific tasks

PRESCRIPTION FLU TREATMENTS

• • • •

Oseltamivir (Tamiflu) Zanamivir (Relenza) Peramivir (Rapivab) Baloxavir (Xofluza)

for the duration of their shift. Split the tasks up according to roles (pharmacy students, interns, technicians, or assistants), and be sure they’re supervised. Make sure that all staff members are trained on

SUPPLEMENTS

•

Elderberry: This is a powerful alternative to both prevent

pharmacy protocols, injection-related policies, appropriate personal

and fight cold and flu. Studies have shown it to significantly

protective equipment (PPE) use, hand hygiene, and infection

reduce the severity and duration of symptoms. Patients

prevention and control procedures.

who have taken elderberry syrup reported symptoms

The workflow at and behind your pharmacy counter needs to be established for each part of the vaccination process. Your staff should be ready to: gather patient information and provide

clearing up on average of four days earlier than those

•

instruction before the patient arrives at your pharmacy; screen the patient for COVID-19 and answer any questions upon their arrival at the pharmacy; wear the appropriate PPE; perform hand

taking a placebo.

Vitamin C: Studies have shown that this vitamin can boost your immune system. It may even help protect against

•

heart disease, cancer, and stroke.

Vitamin D: When the sun is behind the clouds, it’s hard to

hygiene when delivering the immunization; clean and disinfect the

soak up enough of this vitamin. Vitamin D can strengthen

immunization area; and monitor the flow of patients between and

both your bones and your immune system.

after immunizations.

•

Now that your pharmacy staff is ready, take a look at your store

Iron: An immune booster that has shown to help keep energy levels up, iron is essential to blood flow and oxygen

shelves. Do you have all of the products your patients will need this

transfer in the blood. It’s a key component to heart, lung,

flu season? Do you have enough? Increasing your store’s inventory

and neurological function.

of flu-related items is vital if you want to keep up with patient

•

Zinc: If used regularly, zinc can help to prevent the

needs and demand. Shortages will happen, but the more flu- and

common cold. Like elderberry, it strengthens the immune

cold-related inventory you stock up on ahead of time, the better

system and can aid in reducing the length and severity of a

prepared you’ll be.

common cold.

ELEMENTS | The business magazine for independent pharmacy | DECEMBER 2022

29

NON-MEDICINE ITEMS

• • • • • • • • • • • • • • • • • •

Canned chicken noodle soup Facial tissues Hand sanitizer Heated blankets Heating pads Hot/cold packs Hot tea Humidifiers Lotion (for sore noses)

Orange juice Sports drinks Thermometers Throat lozenges Vaporizers

arrive early.

PREPARE INFORMATION PACKETS Put together some informational materials on vaccines and prepare consent forms for patients.

Vapor rubs Warm socks

better. You want to reduce overstock by the end of the season. Here are some ideas to get your customers interested in purchasing their cold and flu needs at your store:

•

to last the season. This will ensure that they

Neti pots

Once your pharmacy is stocked and ready for the flu season,

•

ESTIMATE AND ORDER EARLY Your best bet is to preorder enough vaccines

Nasal strips

it’s time to get the word out to your customers. The sooner, the

•

QUICK TIPS FOR FLU PREP

REVIEW VACCINATION PROTOCOLS Be sure your staff understands the current protocols for vaccines, so they’re not administered improperly.

Email: Your theme is cold and flu season. Your goal is to draw attention to your flu season inventory.

Social media: Post offers for cold and flu items on all of your pharmacy’s social-media pages.

Outdoor signage: Use banners to remind passersby that your store has everything they need for cold and

REGISTER ON LISTING SITES Find websites that advertise locations that administer the vaccine, and register your pharmacy.

flu season, including vaccines. Window clings also draw

•

attention.

In-store signage: Set up a small counter sign reminding patients that you stock all the cold and flu essentials they need.

‘Tis the season for various, infectious bugs floating through the air. Give your patients everything they need to fight them off by

PACK IMMUNIZATION KITS Put together other supplies you’ll need when administering vaccinations (e.g. cotton, needles, and bandages).

stocking up on cold and flu products. Take advantage of seasonal sales with these essential items and be sure to market them properly.

DETERMINE VACCINATION SCHEDULES Will you give vaccinations only during certain hours or all day? Will you allow walk-ins, or will it be by appointment only?

STRATEGIZE YOUR ADVERTISING Will you rely on a sign advertising your flu shots, or will you also advertise via television, radio, or social media?

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Sell OTC Hearing Aids in your Pharmacy Partner with PBA Health and Soundwave Hearing The Hear Me Now Program offers Sontro® OTC Hearing Aids that pair with the free otoTune® app allowing your customers to customize their hearing in 3 minutes from the comfort of home.

Features: • 45 day risk free money back guarantee • 1 year warranty • Midwest-based customer support • Designed, engineered and assembled in the USA

Soundwave has partnered with Amptify to provide 1 month free of Amptify DTx and includes: Sontro Hearing Aid Set-Up, Auditory Training & Hearing Coach

•

MSRP $999, earn $200 gross profit on each sale of the Sontro OTC Hearing Aid.

•

In stock, order now!

•

Order Sontro OTC Hearing Aids and Marketing Materials from PBA Customer Care, 1-800-333-8097

OUTLOOK

PATIENT AGGRESSION Workplace well-being is plummeting

Y

our pharmacy should feel safe. Not only to your patients, but to you and your staff as well. Unfortunately, patients can get

irate, and things can get unruly pretty quickly. Burglaries, crime, and angry behavior in healthcare workplaces were endemic even before the COVID-19 pandemic and opioid epidemic. But now, bad behavior is even more common.

According to the 2022 Healthcare Workplace Safety Trend Report produced by Stericycle, 71 percent of healthcare providers believe COVID-19 has had a negative impact on their sense of safety in the workplace. A whopping 82 percent of healthcare workers reported at least one episode of workplace violence during the pandemic, and 64 percent have been verbally assaulted.

That general data is echoed by the initial findings of the 2022 National Pharmacy Workplace Survey sponsored by the American Pharmacists Association (APhA) and the National Alliance of State Pharmacy Associations (NASPA).

“Workplace issues across pharmacy practice and their relationship to personal well-being and safety continue to be a critical issue,” said Ilisa Bernstein, PharmD, JD, APhA interim executive vice president and CEO. “We are concerned to see the

KEEPING CALM AND CARRYING ON While you may not be able to completely cool down a heated situation with a patient or customer, you can avoid raising the temperature by following these four dos and a don’t.

DO FORGIVE

DO MIND BODY

DO MIRROR VERBAL

DO OFFER

DON’T

QUICKLY

LANGUAGE

LANGUAGE

OPTIONS

INTERRUPT

Often, your patient will

Avoid crossing your

Listen. Then once your

No matter how vexing

Let your patient let off

apologize. Even if not, cut

arms, which is a sign of

angry patient has calmed

the circumstances,

steam. You deal with

them some slack. Smile

defensiveness. It may

down, use their words

alternatives will bubble

similar problems every day—they don’t. It’s

and shake hands. This

be appropriate to smile,

to reiterate frustration.

up. Offer some choices to

helps them recover some

but take care not to look

Show you've listened and

your patient so they can

tempting to offer a

respect and shows your

patronizing.

understood.

feel more in control.

solution, but don't. Just

professionalism.

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let them vent.

most recent reporting confirms observed trends of pharmacy staff encountering threats and harassment from patients, consumers, and work colleagues.”

Reported experiences included verbal, emotional, and sexual harassment; threatened or actual physical harm; and microaggressions. In addition, incidences of threatening emails, social

LIVE, LEARN, AND IMPROVE Anthony Spalitto, pharmacy manager of family-owned Spalitto’s Pharmacy in Kansas City, Missouri, suggests a few hard-won tips to counter robberies.

media harassment, and doxxing have also become more common.

Doxxing involves the release of personal information online, including contact information or home addresses.

Spalitto’s Pharmacy in Kansas City, Missouri, has survived and thrived through rough times and tough customers since 1929.

Anthony Spalitto, pharmacy manager and great-grandson of the pharmacy’s founder, works alongside his father, Pete Spalitto, pharmacy owner, and cousin, Tony Spalitto, PharmD. Anthony said the family-owned business emphasizes empathy.

“My dad always says, ‘Our patients are on medications for a reason,’” he said. “That thought reminds us to sympathize with what they might be facing—they’re sick, they’re worried, they don’t feel well, and more. It helps us stop and listen.”

USE A WIRELESS ALARM SYSTEM WITH REMOTE MONITORING. If thieves cut the electricity to your business, you'll still be connected.

RISE IN ROBBERIES The rise in opioid addiction has resulted in a rise in pharmacies singled out for burglaries or robberies. Not surprisingly, oxymorphone, oxycodone, methadone, Percocet, Xanax, and Valium are the most common drugs to get stolen, according to the Drug Enforcement Administration (DEA). Even cough syrup makes the list, as it can be used as a party drug and is not classified as a controlled substance.

In the past 10 years, Spalitto’s Pharmacy has been burgled about five times—fortunately, all occurred while the store was closed.

CLEARLY LABEL ALL MOTION SENSORS AND SECURITY CAMERAS. “Breakroom door” is much clearer than “Camera-13,” especially if you’re looking at a text message in the middle of the night.

REACH OUT TO LOCAL POLICE. After response time to one break-in was slow, Spalitto contacted the Kansas City police and discovered pharmacy burglaries weren’t highly prioritized. Once he explained thefts included narcotics and other drugs, the police department raised the priority, quickening response times.

ELEMENTS | The business magazine for independent pharmacy | DECEMBER 2022

33

71 PERCENT OF HEALTHCARE PROVIDERS BELIEVE COVID-19 HAS HAD A NEGATIVE IMPACT ON THEIR SENSE OF SAFETY IN THE WORKPLACE. During one break-in, thieves cut all electricity and entered the pharmacy through the roof. Because the electricity was cut, there was no alarm. Burglars were in the pharmacy from late Saturday night to early Monday morning.

“We don’t know of a vulnerability until something happens,” said Spalitto. “Now we have a wireless alarm system with remote monitoring, and we receive notifications via text and phone. We

WORKPLACE VIOLENCE DEFINED According to the Occupational Safety and Health Administration (OSHA), workplace violence is “any act or threat of physical violence, harassment, intimidation, or other threatening, disruptive behavior that occurs at the worksite. It ranges from threats and verbal abuse to physical assaults and even homicide.” Sexual harassment is also considered workplace violence..

have an attitude of learn and adapt.”

A philosophy of learn and adapt is indicative of community pharmacy as a whole—and it has served Spalitto’s Pharmacy well for 93 years.

WHAT TO DO IF YOU ARE ROBBED If you’re robbed, it’s easier said than done to avoid panicking. But try to keep in mind this advice from the DEA.

12345 MOVE SLOWLY

BE A GOOD WITNESS

No matter what, your top

COMPLY

Sudden movements

Focus on characteristics

The majority of pharm-

Call 9-1-1. Lock the store.

priority is the safety of

might provoke an already

such as race, height,

acy thieves pass notes. If

Secure the note, the

you and your employees.

skittish robber. Move

weight, piercings, tattoos,

you can hang on to it, do.

scene, and anything else.

Do exactly as you’re told.

deliberately.

hair, and facial features.

34

pbahealth.com/elements

KEEP THE NOTE

AFTERMATH

Do not touch anything.

with Quality Choice offers:

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Need assistance with your Quality Choice order or have questions?

Contact Customer Care 800-333-8097 ext. 5707 | customercare@pbahealth.com