“[Gaining provider status] will provide the option for pharmacists to divorce themselves from sale of product if they choose. Pharmacists will be directly recognized and compensated for what they know and not for what product they sell.”
I want to thank Dr. Schuh for taking the time to share valuable career advice, explain his intrapreneurial journey and share how you can become involved in pharmacy’s battle for provider status.
Q: How did you first get started consulting?
Actually, I felt like a health consultant as a pharmacy intern and before that as a veterinary technician, working my way through pharmacy school obtaining the BSPharm. I was officially a licensed consultant pharmacist in the state of Florida from about 1999 to the present and performed nursing home consultant work from 2002 through 2004 while working in the skilled nursing facilities part-time.
In addition to my regular job, I serviced 2 to 6 nursing units per month. In 2004 I resigned the nursing home job and my management job at Mayo to pursue a post –baccalaureate PharmD.
After the degree, the ambulatory clinical position came open, I applied for it and have been in that position ever since, developing the pharmacist consult service, an intrapreneurial endeavor. I have an entrepreneurial orientation.
Other positions held while a practicing pharmacist are, life/health insurance agent, wholesale auto parts company owner, and executive officer of a couple of other small, closely held family companies.
Q: What does a typical day working at Mayo look like for you?
Arrive at work about 6:30 AM. Finish patient documentation from previous day, review the current day’s patients before the students and residents arrive at 7:30 AM and catch up on emails, etc. One morning per week at 7:30 devoted to clinical topic discussions, one morning per week meeting with the palliative care interdisciplinary team. We start seeing patients at 8:30 AM, four days per week and see patients on the various services until early to mid-afternoon.
The afternoons are reserved for documentation time and practice, departmental and strategic planning meetings regarding the clinical pharmacy practice and many times how our services will collaborate or coordinate with the various medical practice departments. I still work one day a week in the clinic outpatient pharmacy filling prescriptions. The day is done when the work for the day is done.
Q: You are a big proponent of provider status, how would it change our profession?
Widely recognized provider status can possibly be the biggest paradigm shift in the history of the profession. This change will ripple through many aspects of the healthcare system to change how pharmacist clinical skills are utilized to create better patient health outcomes and effectively reduce the overall cost of healthcare.
It will provide the option for pharmacists to divorce themselves from sale of product if they choose. Pharmacists will be directly recognized and compensated for what they know and not for what product they sell. We now have the clinical capacity and training to rightfully be a major player on the medical team and in many practice models move entirely from product to patient care.
The thing that holds us back is the ability to directly or indirectly cover the immediate costs of us being on the team. Lack of provider status requires us to demonstrate cost avoidance….a very difficult thing to easily show because it is promising back end cost savings when you have to pay a pharmacist NOW.
It is also not the medical practice or pharmacist that directly benefits from these savings either, which makes the task of selling pharmacist services more difficult. It is the payers or the client of the payers who benefit most! Therefore, we still need to forge methods of payment to support pharmacist services TODAY to make the services widely available to the general public. Especially, the indigent population where the biggest cost savings can be had and who need our services the most.
We are the 1st healthcare professional required to demonstrate healthcare savings before consideration by payers for provider status. Unfair? Maybe. But we have demonstrated we save the system money over and over again. Not only do we save the healthcare system money, we save A LOT of money by being involved in the patient care process.
Q: Widely recognized provider status will not happen overnight. It is a marathon, not a sprint and there is much opposition, mainly by those who don’t really understand what positives we bring to the table. Changes at the national level cannot be implemented without similar parallel legislation regarding scope of practice at the state level.
It is slowly happening and momentum is growing nationally and state by state. We have to be analogous to “The Terminator” of movie fame. “We will not stop”….until we obtain equal standing with other providers.
Q: What should pharmacists be doing to prepare for such a change?
Not all pharmacists feel comfortable seeing patients or performing these services even though they are competent to do so. And there are different levels of clinical services. To prepare, keep up clinically. Obtain and maintain up-to-date training, whether it is certifications, going back for another clinical degree or residency or changing to another, more clinical job to obtain the necessary experience to make that change if that is what you wish.
Q: Can you give any advice for marketing pharmacist consultation services to physicians?
Our primary pharmacotherapy service is treated internally as a specialist consult service. We have no patients unless we convince physicians or other providers to send patients to us. There are four types of patients I generally recommend sending:
- Any patient you don’t have time to review Rx meds, OTC’s or herbal supplements with. Polypharmacy patients, transplant patients, pharmacogenomics patients, and supplement patients are patients that require extra physician time
- Any patient that may benefit from increased adherence, medication reduction, or medication/disease state education
- Anything regarding medications/supplements you don’t feel comfortable with where the patient may benefit from seeing me or my colleagues
- Any medication problem at all…….
When I get that 1st test referral or two, I always over deliver on the clinical note and provide any/all issues I find while triaging the most important to the physician and patient 1st. By adding value to the consult, I demonstrate more utility to the physician so they may decide to refer a wider variety of patients. It helps to have 100% access to the EMR which opens the door to value added recommendations. When meeting referral sources at departmental meetings or other organizational functions I always try to get to know them and if the opportunity presents itself, educate them about the service if they have never used it or ask how we can make the service better if they have. I also always thank them for the referral after we have seen one of their patients.
Q: Do you have a specific MTM story that you can share that relates to SAVING MONEY/CUTTING COSTS for the organization?
- Recent research points to post-transplant pharmacist consults helping to keep patients in therapeutic range regarding tacrolimus levels, possibly decreasing lab and office visits…saving money
- Physician time is leveraged by pharmacists helping to solve medication problems so physicians don’t have to. This helps with more efficient and effective clinical decision making…saving money
- Pharmacist patient medication education keeps physicians from spending time educating patients about their meds…saving money
- We routinely streamline therapy, delete therapeutic duplications, reduce ADR risk and identify and reduce the risk of possible iatrogenic disease…saving money
- Revenue-wise, we do bring in income to offset pharmacist costs by billing what we can, when we can….earning money. Lucky we have a billing department to help with this.
Q: What piece of advice would you give to the pharmacist who is just beginning to explore consulting as a career choice?
Know your market and what specific pharmacist clinical services are the most financially viable in your market. All models will not work in every geographical area, state or specific population demographic. This is why they have an entire course dedicated to practice models and creating a business plan for clinical practice in the MTM Master’s program at UF.
Know what your interests are and do they match the model or models that work best where you would practice.
Starting a consulting practice requires an entrepreneurial mentality and one must possess entrepreneurial characteristics to have the best chance of success. Because it is difficult to sell and bill for pharmacist services in many current locations enough to cover the costs to perform them. This is where provider status will help. Be willing to over deliver on services. If your service is a referral service, over deliver to the referral source and patient. If marketing directly to the public, do the same, especially if patients are paying out of pocket for your services because you want their repeat business. Patient consulting is a relationship business. Relationships build trust. Trust provides better clinical outcomes due to better patient adherence. Trust also provides repeat business from referral sources and patients.
Wow, thanks for that fantastic advice Dr. Schuh!
Here are some key takeaways that I got from this interview:
- Prepare yourself now, for gaining provider status in the future
- If entrepreneurship was easy, everyone would do it
- Give more value than it costs to obtain your service and your business will grow
- Gratitude and a job well done will do more than any “marketing material”
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