The various disciplines in healthcare are constantly evaluating risks. Every therapy decision, from a complex surgical procedure to the treatment of a disease with medications, is associated with some measurable risk that has to be weighed against the benefit to the patient. More and more, risk is also associated with provider reimbursement. Institutions and practitioners alike are at risk of reductions in payments for their service if their patients do not meet performance goals. This change in the healthcare landscape, often referred to as pay for performance, has created an interesting and challenging game board upon which the healthcare campaign takes place.
There are many of examples of provider performance penalties in healthcare. A hospital or physician’s reimbursements may be impacted when too many of their patients are re-admitted to the hospitals shortly after discharge, or a pharmacy might be penalized if they have too many patients non-compliant with certain therapies. In theory, linking provider payments to performance and outcomes seems logical. The problem is that no practitioner is an island, and many of the measures being used depend on numerous variables outside their control.
There are countless examples of inter-dependent care that make many performance based penalties a country-wide legal lottery system for healthcare providers. One practice may be surrounded by healthcare colleagues invested in working together, resulting in good scores and performance rewards for all involved. Other practices, despite wanting to positively impact outcomes, might be surrounded by other providers that are not invested in collaboration, and as a result receive some or all of these providers receive poorer scores and reduced or zero performance payments. To make matters more complicated, the metrics being used across practitioners do not align, which does not help foster collaboration.
This is a difficult position for pharmacy. Pharmacists generally cannot make changes to prescriptions without involving the prescriber. And while they generally have great relationship with their patients, pharmacists can only go so far in coaching or working to modify patients’ behavior in metrics like compliance. For this reason, some pharmacy owners have elected to ignore performance measures. Others have elected to sell their stores. This stakes are that high.
When faced with risk, pharmacists need to become aggressive. This is the time to transform your practice. Write and send quality clinical notes to the patients’ providers. While you may not get positive responses right away, with time these efforts will allow you to reduce your risk of being left behind. Start now. Make Every Encounter Count.
