http://news.yahoo.com/s/ap/20100310/ap_on_go_pr_wh/us_health_care_overhaul

So Obama is going to use Bounty hunters to root out health care fraud by providers?   Mr President,  How about starting your fraud units on the OTHER side of the fence and go after welfare abuse?  You know, like Ms Choo, who lives in a country  mansion with her son and shops twice a year in Hong Kong but shows NO ASSETS and obtains food stamps and health care on MY tax dollars?  Or Mr and Mrs Patel who live quietly with their son but have 2 homes in India..and again live on MY tax dollars.

Sorry, Just gotta vent here.  I have no doubt that there are providers with no concience who abuse the system, kinda like the $125 screwdrivers the army bought…but Chick Pharmacy doesn’t fraud anybody and works hard to do things just and fair.  But it really toasts my cookies when everybody looks at the providers and nobody is going after the welfare cheats out there…the fake “poor”, the illegals, and the multi-state collectors..

I’m just sayin!

1.  Only three people on the face of the Earth know Pharmacy Chicks real Identity.

2.  I like Brussel Sprouts….butter and salt and pepper please!

3.  I prefer fine point ball point pens.  Keep your gel pens, I never use them and once a pen splotches, its history! I am a pen snob.

4.  Facebook’s “where I’ve Been” says I have seen 5% of the world.  Other than New Zealand and Australia and Bora Bora (still on my list), I think I have seen all that interests me thank you.

5.  I hate egg plant.  Even if you say YOU have THE recipe for egg plant, dont give it to me.  I’ve had people try to trick me and I still knew it was egg plant.

6.  I am a dog person.  I am NOT a cat person.

7.  I love new toothbrushes. I get a new one about every month.

8.  If its not sports, or HGTV it is probably not being watched on my TV.

9.  I have sung with a choir on the top of the Swiss Alps and the top of the Eiffel Tower

10.  Coke is quite possibly my favorite beverage.

11.  I do not like to be cold.  I may be the only person ready for a hot flash.

12.  I could never be a vegetarian. I grew up in beef country.  I embrace my carnivore-ness.

13.  I am a very forgiving person, but not always a forgetting person…Iwish I could forget more sometimes.

14.  When I delivered a prescription to a customer once, he tried to give me a pair of his pants as a thank you.  I still dont know what that means

15. I am afraid of moving water. I’ll never swim in  a river.  (little creeks, ok)

16. I am also afraid of edges, and large drop offs.   Heights are no problem but I start freaking out at a cliff edge.

17. Some people love to read. I am not one of them.  I like my reading material to be similar to sound bites. Quick and to the point.

18. I love Jesus.

19.  My favorite international foods are Indian and Lebanese….my least are Thai and Vietnamese.

20.  My highest bowling score ever was 237.

21.  Pharmacy is what I do and my profession, but it does not define me. I rarely talk about work away from it. 

22.  I have golfed 75 holes of golf in one day. 14 and 1/2 hours, all walking.  I shot in the 70’s for all four rounds and parred the last 3…nearly in the dark. I don’t think I will repeat that feat.

23.  I Have venison in my freezer.

24. I have over 20 white turtleneck shirts. 

25. My perfect home would be a huge log cabin in the mountains.

I made my 25…any other blogger care to contribute THEIRS??

Case in point:  LOL (little old lady) came to the drop off window for a Shingles shot (Zostavax for you professionals).  She asked “How do I get a Shingles Shot?”  In full “bullet points” mode I said.  “At the end of the pharmacy is a TABLE. Read the information sheet about Shingles. Fill out the consent form and turn it in to me”.  I pointed towards the card table marked “VACCINE INFO HERE”.

She replied and I quote:  “Just read the information sheet? That’s all? do you have it?” 

Blah Blah Blah “READ” Blah Blah Blah…

Just like my dog….blah blah blah treat? blah blah blah

I am a vaccinator, and jumped on board just 1 year after the legislature allowed pharmacists to do so.  Run by the local division it was a grassroots type of organization and it worked amazingly well.  People really liked the idea of having all adult vaccinations available at their pharmacy given by people they already know and trust.  We branched out and advertised our services to larger companies who might enjoy having us come to THEM by providing flu clinics.  This too was a huge success. 

Perhaps too much so.

Once corporate saw that we were making a lot of money on this, they decided to take it over, and in doing so, ruined it completely for everyone. By changing the appointment system to the on-demand system, they made a mess of monumental porportions. I responded by making appointments priority and walk-ins like any other prescription drop off…subject to what ever wait time is in effect at the moment.  This is the short version of a long story.

Does that mean that we vaccinators flee with abandon and jump ship?  Not so quick.  I will be the first to agree that vaccinations are a lot of work.  They involve more time and effort than a routine prescription. However, that being said,  giving a vaccine is something that cannot be done without the human involvement.  You cannot script-pro or Parata a flu shot.  You cannot mail-order a tetanus shot.  It is also something that possesses a product-service link that cannot be broken.  For every person who has ever whined about paying the administration fee, I have offered the syringe, bottle and offered they draw it up and do it themselves.  So far, I have had NO takers.

Your patients see you in a different light. You interact with them on a one to one basis. You arent just putting pills in bottles.  100+ years of trying to advance this profession and people STILL think that all we do is put pills in bottles.  APHA? you suck. You suck at representing pharmacists and you suck at educating the public.  (but that is a post for the more politically minded)

As technology advances to the point where human involvement is needed less and less, we have to find niches where the human involvement is still required.  And YOU DEAR PHARMACIST need to find your niche.  I can’t be good at EVERYTHING.  I dont have TIME for everything either. Therefore you wont find me doing Cholesterol screenings AND diabetic screens/educating, AND MTM, AND vaccinations, AND etc.  I chose vaccinations and I do it splendidly.  Its MY niche.  If I had more time, I’d love to add Cholesterol to my repetoire.

 I gave over $100,000 worth of vaccines last year.  That covers a lot of prescriptions I lost to mail order.  It covers some of the prescriptions I had to give away for $4. And, no machine could have done it. 

I have gained a pretty loyal following in the process as well.  Over the holiday season I had many of my customers bring in their visiting relatives for flu shots!  “Come on Aunt Esther, lets blow off the mall for now and get a flu shot instead!”. I don’t pretend to understand it but its money in the till, and sales mean less pressure from above.

Like all things, this wagon may leave town. Technology may makes all vaccines ORAL..who knows?  I am sure somebody is working on it.  Til then however I am going to ride it for all its worth. This pharmacist is finding a way to make myself “Indispensable”, by either linking product with a service (like a vaccine) or supplying a service that cannot be duplicated by a machine. Thats my future.

And you? If you think your future is holding that spatula, you are sadly  mistaken.

Pharmacy Chick has been a mission to maintain her health.  I wrote about me losing weight this summer and (woo hoo) I haven’t gained a single pound of it back.  I walk 3-4 times each week on this 2.6 mile loop around my neighborhood, play tennis 2-3 days a week and eat my food more cautiously than I used to.  I even started taking some vitamins, including Calcium (at Mr Chicks insistence since I HATE milk..it makes me cough.)    I also take about 4000 u of D-3 each day. 

I also decided to jump on the Omega-3 bandwagon.Mr Chick takes Omega-3 every day.  My Calcium is this wonderful gummy-creme chewy thing I love.  When I saw they had Omega-3 too, I took the bait (no pun intended).  It said “all the benefit of Omega-3 without the fishy taste”.  It too was a gummy kind of formulation.

So I tried it.  RE READ THE FIRST SENTENCE OF THIS POST.

Aaaack!  All I can say is imagine sweet fruity flavored fish.  I pawned them off on Mr Chick.  He’s not eating them either.

Liars.

My tech and I got to talking about the anual spring break phenomena that many Americans have come to love. I personally have no understanding of this springtime exodus.  In the state I grew up in, we had no spring break in grade school, jr high or high school.  WE had  a long Easter weekend. Thats it. Once I got to college, I got to experience this “spring break” that everybody yaks about, but for me, there was certainly  no “break” in Chickville.  I hopped on the 1:20 bus back  home and by 5 pm I was often already in my work clothes at the Dairy Queen. 

I kid you not.  I was spring BROKE.  I needed money and the lofty idea that I would spend the week frolicking on some beach in Mexico, or screaming my head off on the rollercoaster at Disney World was as unrealistic as my sprouting wings and flying under my own power.  I would pick up shifts at the steak house I used to work at in high school or I’d make ice cream cones at DQ.  Once I became an intern, I’d work  for $4.10 an hour filling rx’s all week.  What is MY intern going to do over spring break?   GO TO FRIGGIN HAWAII.  Oh, and just so you wouldn’t think I was lazy, I would fill rx’s during the day AND do the Dairy Queen at night. Now that is a brain trip!

And basically the same thing applied to the Christmas holiday too.  I essentially would work from the night I got home until the day before I went back to school.  Mom and dad worked hard to help out with the tuition.  I wouldn’t even want to see their expression if I asked to VACATION during spring break when they couldn’t vacation PERIOD.

Times change apparently.  During the Christmas break, my intern (who initially said he wanted as many hours as we could give him) completed exactly 2 shifts in 2 weeks, but managed a trip to Phoenix to hang out.  Sadly… I had scheduled him…not as extra help but as regular help to relieve the corporate scheduler who was burdened by covering my tech who is out with medical treatment.    yea, that worked out well. 

My phone message went something like this ” Hey Chick, this is Mike, your intern  (like I needed reminding).  I’m not coming in this week, as my wife and I are going to see her folks in Phoenix”  “yea, sorry about that”..*click*.

Parents pack up their kids and haul them to exotic destinations, and for some, this 9 day period isn’t even enough.  My neighbor is taking their kids out of school 3 days early so they can jet out of here sooner.  Cabo, Orlando, Miami, San Diego, Acapulco, Hawaii…

My children (had I given birth to any) would have been the unluckiest children on the planet.  They would have had the same kind of spring breaks I had. And hopefully, learned a lot more about responsibility and accountability in the real world.

Now,  would you like that cone dipped in chocolate?

By the way, if you havent’ seen it, Stephen Colbert has a HILARIOUS bit on his bid to become a member of the US Olympic team.  His segment on the 4 man bobsled team (Night Train as it turns out) will have you in stitches. Find it on www.colbertnation.com  . In fact most of his coverage on the Vancouver Olympics is funny.

Congrats Night Train…now please…take off the Spandex.

I am an Olympic Junkie.  Dark circles under the eyes from watching hours of Curling to Slalom.  It doesnt’ matter what the heck it is, if its an Olympic winter sport, I am glued to the TV.  It could be the Olympic Asphalt Butt Scrape contest,  if there were medals involved I’ll be all over it. My DirecTV memory is almost full from events I haven’t had a chance to watch yet.   Summer games can bite it, but the Winter games? Give me the remote and step away from the TV.

In two days I’ll have a bad case of Olympic Withdrawal too. I’m in love with Apollo Anton Ono. (ok, he’s young enough to be my son, humor me ok?) I couldn’t WALK down a ski slope let alone fly off a mountain but I dream of ski jumpers…er JUMPING… heh heh.  And I am hooked on biathalon.  Mr Chick and I are shouting at a recorded event!  “OMG,  SVEN MISSED HIS TARGET!!!”

Yup, if the IOC ever needs an offical Olympic Pharmacist, I am your girl.

So, where is Sochi Russia?

Lets start from the beginning: explaining this concept to the patient.  We have a lovely hand out to explain this relatively simple concept.  If X has prescriptions he regularily fills,  we can do it for him automatically and he will be notified when they are ready. Simple huh?  Not.so.much.   Since we are have been asked (no, HOUNDED) by our corporate people to ask every single person to sign up, we nearly need a full time person to spend all day explaining over and over how this simple thing works.  This clogs up the checkstand when a customer wants to ask more questions which  requires taking the person aside to answer questions and taking another person from the work line to start checking.

Who gets it? Who doesn’t?  Not everybody can have it and just with about everything else in life, those who do not qualify seem to want it and those who seem to benefit the most want nothing to do with it, and after 4 months of asking are getting sick of being hustled about it. And, because every drug on their prolfile may not qualify for automatic refill ( but I fill my SOMA every month???) the customer still has to keep track of THOSE drugs.

Compliance:  This service was touted (to us anyway) as a compliance tool.  Um,  I think not.  Automatic refills does not a compliant person make. In fact what it has done is bring into focus the blatant noncompliance of the general public.  And while I cannot condone non-compliance or (reduced compliance), its truly not my problem. Its the proverbial bring-a-horse-to-water-but-can’t-make-him-drink senario.  This program is about MARKETING, nothing more and don’t even try to convince me otherwise.  What we can’t seem to do is guarantee the patient will PICK UP the completed prescription which leads us to the next point.

Return to stock:  A direct relation to the compliance issue, we get calls every  single day (no exaggeration) telling us “I got a call about my automatic refill…I dont need it yet! put it back”.  According to the schedule, a compliant patient would have 2 pills left in the bottle. If X has 15, he has surely missed doses.  But Mr X is not coming in so back it goes….along with a dozen more each day of prescriptions left on the shelf for more than 14 days.  More labor wasted.  Since we started auto refilling rx’s our RTS’s (return to stocks) have skyrocketed.

Our system is not the brain trust of all computer systems either.  We have to override the enrollment process for prescriptions IT THINKS should be autofilled.  If a patient is considered “autofilled” then brings in 4 prescriptions from a dentist for Peridex, Ibuprofen, Vicodin and Clindamycin, both the ibuprofen and the Peridex will get flagged for autofilling, unless we stop the process and take them out.  They aren’t all getting caught and I find them in the que quite often.

Variable prescriptions: Inhalers, insulin, creams and eye drops.  Yes, these can be autofilled, but assigning a schedule for these had been a nightmare. Even if I ask “how often do you want these to be filled”, its still wrong.  Tis either too soon or too late.  And Birth control prescriptions that are taken Active-tablet-only? fuggetaboutit. Our computer hates those and no matter what we do, it schedules them too late.

Staggered dates. People who are organized tend to order most of their meds on the same date. Its easier for them and makes perfect sense. And I think thats a great idea.  BUT this happens all to often: Auto order- X orders 5 prescriptions Feb 26 , 2 of which need a Dr auth, which comes in Feb 28.  His first 3 are filled on the 26th and they are on the shelf. They get scheduled to be done March 24 of next month. The other two which are done on the 28th get scheduled for March 26 of next month.  March 24 comes and X gets a call that he has prescriptions filled to pick up. He comes in and 3 are done. “but I get 5 each month… he says”.  Thats because 2 aren’t scheduled to be done for 2 more days, and he has to either wait for us to do them or come back for a second trip.  The phrase ” I seem to be here almost every day” AND ” I have no idea what I have here, but I got a call”  seems to be rather prevalent since we started Auto Filling prescriptions.

But I want it sooner!  We have spent more than 15 years at Chick Pharmacy training people to call in their refills early enough so if we need to contact the dr, we have time to do it.  Mr Automatic Refill is an idiot and regarless of the prescription, schedule it 2 days before the patient is to be out….whether it has 10 refills or 0 refills.  Good judgment is out the window as well, for calling for a prescription with a no-refill status on a Saturday is not smart, but Mr Automatic Refill doesnt care.  If its discombobulated math figures it for Saturday, then saturday it is.  The flip side of this grotesque coin is the people who have been trained to call early.  They start calling us 4-5 days before the automatic refill kicks in wondering ” do I have anything on the shelf? I am getting low”…better yet, they ORDER IT, we fill it and it defeats the system.

I honestly wonder why insurance companies even allow it. We are filling a prescription that hasn’t been technically ordered. I dunno, go figure that one out Giant PBM.

And lastly, the blame game. I heard this one yesterday. “I signed up for your autorefill service. I am out and YOUR SYSTEM didn’t autorefill my prescription….gripe gripe gripe gripe and now I have to wait for you to fill it”. I checked the computer. He filled it December 24….for a 60 days supply. Simple math would tell me it should have scheduled him on or around Feb 24.  Mr Auto Refill scheduled him March 13.   I didn’t have an answer.  But apparently I needed an apology.

I ask him the usual questions and ascertain that what he really needs is an expectorant and cough suppressant. And in this blog I prefer to avoid endorsements, so lets just say I recommended Gunk-away DM as the perfect med for his symptoms.  He was at the tail end of this cold and he needed no deongestants, antihistamines, pain relievers, etc.   I told him to drink a lot of fluids, it won’t keep him awake (OR put him to sleep), and lookie, its even on sale!  He had just enough questions to be annoying.  (this isn’t rocket science dude. you are 50 years old, this cannot POSSIBLY be your first cold!). Finally I escaped back into the pharmacy and let him ponder all I told him.

A few minutes later he was at the cash register with a box of Tylenol PM.  “Um, did you want the Gunk-Away?” I asked him.  He just snorfled a bit and said “Nah, this always works”.  (resist the urge to tear hair out…or tear HIS out)

And so dear readers, If you ever wonder why your pharmacist doesn’t seem overly interested in your cold, your hemorrhoids or the rash on your elbow…think of this man and realize this sort of thing happens All..the…time..