Ever wonder how your Ontario government uses the tax dollars that it collects from the hardworking people of Ontario? This is the latest propaganda coming from the Ministry of Health regarding drug system reform in the province. As a citizen and taxpayer of Ontario I am offended that this is how they view us. Is it really necessary to release this condescending piece of amateur animation to convince Ontarians that their ridiculous plan is the "right thing to do?" The only explanation I can think of is that this is how Czar Helen was able to convince the Minister of Health and the Liberal MPP's that her plan would benefit Ontario. Fortunately, I have to think the people of Ontario have a bit higher IQ than the average Liberal MPP and will see this as just another piece of garbage from the Ontario Liberal Government. The next time you hit a pothole on the way to collect your unemployment cheque, keep this video in mind...This is your government working for you.
Wednesday, June 16, 2010
Tuesday, June 15, 2010
The fight continues...
This is a difficult time to be a pharmacist in the province of Ontario. The government has passed regulations that will make it very difficult for any of us to stay in business. Throughout the process they have relentlessly attacked the integrity of our profession and attempted to paint pharmacists in a very negative light.
Despite all of our efforts, and there were many, to have the government return to the negotiating table or have the regulations softened, the Minister of Health pressed on with her agenda. There are those who feel that we should have done more to stop the regulations from happening. Still others cling to the false hope that we can stop them from being implemented. I have seen and heard some of the most ridiculous suggestions to date coming from the fringe of the profession that believe riots, hunger strikes and all manner of idiotic behaviour are the answer to our problems. Of course, I respect these guys for their passion and commitment to their profession, but I have to believe their suggestions would do more harm than good in our current situation.
The government and many people in the province know that we are unhappy with the regulations in their current form. We have protested , collected petitions from over 500,000 Ontario voters, spent money educating the public through media and advertising, and have attempted to have an intelligent conversation with the powers that be in the Ministry of Health. It seems as though there has been little impact from any of our activities.
I think anyone who believed that the government was going to fully retreat from their position and that it would be business as usual was looking through rose-tinted glasses. It would have been nice to finish the war before the regulations dropped, but this phase was as much about setting the stage for the next 1-2 years as it was about achieving immediate change.
There has been much written about the plight of pharmacists and the potential impact that the cuts proposed by the government would have on our profession and our business model. We have warned that some pharmacies would go out of business, that dispensing fees would rise considerably, and that services that had previously been offered free of charge would no longer happen or would be subject to fees. We have set the stage to begin charging a fair fee directly to the patients for the services that we said would be affected by these changes. There is no one living in the province or working for the government who should be surprised when this happens.
Yes, we have entered a new phase in our battle for respect and fair funding from the government. This is the time to prove that we were not bluffing, we were not presenting distorted facts or misinformation, and the new reality in pharmacy practice in Ontario, as legislated by the Ontario government, is that patients pay a lot more than they have been used to. The intelligent operators will be able to survive and be able to clearly demonstrate that the government promises of lower drug costs for Ontarians were as sincere as every other promise this premier and government have made during their tenure.
The people of Ontario will have their chance to pass judgement on this government in 2011. Barring a major shift in public opinion, the majority of these Liberals will be out of a job and we can begin to negotiate a fair deal with the new regime at Queens Park.
Our mission now is to take the high road and work with the hand that we have been dealt. We need to find a way to make our business work to support our professional practice within the constraints of government policy. Every time we ask a patient to open their wallet before providing service, we need to make sure they know exactly who is responsible.
It is regrettable that the Loblaws of the world do not seem to share in our common goals for the profession, but we cannot let them dictate the terms of our practice. While we will probably lose a few scripts to them, my experience has been that most patients are looking for more from their pharmacy than simply the lowest price. We need to continue to serve the majority of our patients who appreciate and expect the level of care that they have been accustomed to receiving from us.
In the end, our victory will be achieved through the legions of pharmacy patients who appreciate the care they receive from us and support our efforts to be recognized by the government. We will not gain their support by acting like radical fringe groups or through taking destructive and unprofessional actions. We may gain their support by continuing to provide them with the care they expect and informing them of the reasons that it now costs them a lot more to receive it.
I urge every pharmacist to remain focused on our long term goal of gaining respect from the government and other payers through an adequate professional fee and professional services funding model. I also urge all pharmacists to fight, and fight hard, but to do it with class and professionalism.
Despite all of our efforts, and there were many, to have the government return to the negotiating table or have the regulations softened, the Minister of Health pressed on with her agenda. There are those who feel that we should have done more to stop the regulations from happening. Still others cling to the false hope that we can stop them from being implemented. I have seen and heard some of the most ridiculous suggestions to date coming from the fringe of the profession that believe riots, hunger strikes and all manner of idiotic behaviour are the answer to our problems. Of course, I respect these guys for their passion and commitment to their profession, but I have to believe their suggestions would do more harm than good in our current situation.
The government and many people in the province know that we are unhappy with the regulations in their current form. We have protested , collected petitions from over 500,000 Ontario voters, spent money educating the public through media and advertising, and have attempted to have an intelligent conversation with the powers that be in the Ministry of Health. It seems as though there has been little impact from any of our activities.
I think anyone who believed that the government was going to fully retreat from their position and that it would be business as usual was looking through rose-tinted glasses. It would have been nice to finish the war before the regulations dropped, but this phase was as much about setting the stage for the next 1-2 years as it was about achieving immediate change.
There has been much written about the plight of pharmacists and the potential impact that the cuts proposed by the government would have on our profession and our business model. We have warned that some pharmacies would go out of business, that dispensing fees would rise considerably, and that services that had previously been offered free of charge would no longer happen or would be subject to fees. We have set the stage to begin charging a fair fee directly to the patients for the services that we said would be affected by these changes. There is no one living in the province or working for the government who should be surprised when this happens.
Yes, we have entered a new phase in our battle for respect and fair funding from the government. This is the time to prove that we were not bluffing, we were not presenting distorted facts or misinformation, and the new reality in pharmacy practice in Ontario, as legislated by the Ontario government, is that patients pay a lot more than they have been used to. The intelligent operators will be able to survive and be able to clearly demonstrate that the government promises of lower drug costs for Ontarians were as sincere as every other promise this premier and government have made during their tenure.
The people of Ontario will have their chance to pass judgement on this government in 2011. Barring a major shift in public opinion, the majority of these Liberals will be out of a job and we can begin to negotiate a fair deal with the new regime at Queens Park.
Our mission now is to take the high road and work with the hand that we have been dealt. We need to find a way to make our business work to support our professional practice within the constraints of government policy. Every time we ask a patient to open their wallet before providing service, we need to make sure they know exactly who is responsible.
It is regrettable that the Loblaws of the world do not seem to share in our common goals for the profession, but we cannot let them dictate the terms of our practice. While we will probably lose a few scripts to them, my experience has been that most patients are looking for more from their pharmacy than simply the lowest price. We need to continue to serve the majority of our patients who appreciate and expect the level of care that they have been accustomed to receiving from us.
In the end, our victory will be achieved through the legions of pharmacy patients who appreciate the care they receive from us and support our efforts to be recognized by the government. We will not gain their support by acting like radical fringe groups or through taking destructive and unprofessional actions. We may gain their support by continuing to provide them with the care they expect and informing them of the reasons that it now costs them a lot more to receive it.
I urge every pharmacist to remain focused on our long term goal of gaining respect from the government and other payers through an adequate professional fee and professional services funding model. I also urge all pharmacists to fight, and fight hard, but to do it with class and professionalism.
Wednesday, June 9, 2010
Billable Hours
The last bill I received from my lawyer included charges for every phone call made on my behalf, every stamp used to mail a letter, every photocopy made and every hour he spent thinking about my matters. The last time I was at a garage, I paid for shop time, shop supplies used, delivery charges for parts ordered on my behalf, and labour at a much higher hourly rate than I ever made as a pharmacist. The last time I visited a physician, I paid a ten dollar fee to obtain his signature on a form and pick it up the next day. We pay service charges, convenience fees and surcharges daily without batting an eye. Why then, should we believe that pharmacists and pharmacy services should be different?
For years, pharmacists have been happy to receive compensation for one task- dispensing prescriptions. Professional allowances have covered the gap between the charged fee and the actual cost of filling prescriptions as well as all of the other services that pharmacies typically offer. At the end of the day pharmacies survived with a respectable profit margin and the system, though far from perfect, worked as well as any other aspect of the health care system. The problem with the system, though, is that only pharmacists and those closely tied to the industry understand how it all works. The average consumer and government official does not understand the intricacies of the system, and it is hard to explain in 15-second sound bites that dominate our media.
The regulations proposed by the Ontario government represent devastating cuts to the profession. The government and many of the groups supporting them have grossly underestimated the value that they receive from pharmacies on a daily basis. The Health Minister has stated that the business model for pharmacy will need to change. There really is no question in that regard. It is certainly a tall order to replace about $300,000 in lost revenue virtually overnight, but we all need to take a hard look at how we operate and rationalize our business. Rita Winn said it best- “it’s time to start charging what we are worth!” Additional paid professional services are an exciting prospect for the future, but we need to be able to survive until these are a reality.
The first area to look at is all of the services that we currently provide without receiving any compensation. These were never funded, but since pharmacies received sufficient PA funds to operate, they were provided gratis in most cases. These include services like requesting refills for patients, compliance packaging, home delivery, providing rush orders of vacation supplies, answering telephone requests for information, advancing emergency supplies of medications, providing duplicate receipts for prescriptions, contacting third party insurance plans on behalf of patients, contacting physicians for changes in cases where it is not a therapeutic intervention, providing patient profiles to patients or lawyers, and the controversial co-pay waiving practices. In my world, these will become either fee for service (ie-charge of $5 for prescription authorization requests, $5 for duplicate official receipts) or services billed by the minute (ie-$5 per minute for calls to third parties on behalf of patients.) These are all interventions using a pharmacist’s unique knowledge and expertise, or supplies and equipment. We need to be directly compensated for every second we are using our expertise on behalf of our patients.
The professional fee for dispensing a prescription also needs to be raised to an appropriate level to compensate for the actual costs involved in dispensing a prescription. The most recent research indicates that the actual costs of dispensing are around $14 per script. The fee needs to be set to achieve an average of about $15 per prescription, recognizing that the maximum collected from ODB is going to be $8 or $9. In most cases, the appropriate professional fee will be between $17 and $21. The cash paying and privately insured will end up subsidizing ODB recipients which is unfair, but that is the system that the government is endorsing through this legislation.
Once the fee schedule is established for all of the routine, non-professional, and low-level professional activities that comprise the average day in the pharmacy and the usual and customary fee is set at a level to appropriately recognize the realities of dispensing we can look at the additional professional services that we will provide in the future.
This will require a huge paradigm shift for a profession that has for too long provided most of their services and expertise for free. The first time we ask our patients to pay us directly for the services that they are receiving will be an uncomfortable experience. I have to believe it will also be very liberating. We will no longer be under the thumb of the Executive Officer or Minister of Health.
Any consumer should realize that nothing in this world is free. Pharmacists have been able to provide numerous services for free BECAUSE of the indirect funding they were receiving from other sources. The funds are gone and not coming back, but the expenses associated with them are all still there. We have no other choice, and I would expect the majority of patients to understand this. We also must be sure the majority of pharmacy operators understand this. We are a profession and we need to compete on professional value and service, not on charges and fees.
If we are successful in implementing new service fee schedules across all pharmacies, the independents may not suffer the dire fate that they have been predicting. In fact, we may find that the new revenue streams allow us to offer even better services and care than we have in the past.
When patients realize the true costs of the services they receive from pharmacy, they can take up the battle with the government in demanding that they become insured services under the Ontario Drug Benefits plan.
I do not support the government or their handling of this whole situation, and I will strongly campaign against them in the next election. In the meantime, however, we all need to take a hard look at our practice and accept the fact that the way we operate must change. Change is never easy, but the only way the government will be able to see the effects of their legislation is by pharmacists taking the necessary steps to protect their profession and their livelihood operating under the legislated system. It will not be an easy summer, but at least we now know where we stand and can made decisions based on actual knowledge and not hypothetical situations.
For years, pharmacists have been happy to receive compensation for one task- dispensing prescriptions. Professional allowances have covered the gap between the charged fee and the actual cost of filling prescriptions as well as all of the other services that pharmacies typically offer. At the end of the day pharmacies survived with a respectable profit margin and the system, though far from perfect, worked as well as any other aspect of the health care system. The problem with the system, though, is that only pharmacists and those closely tied to the industry understand how it all works. The average consumer and government official does not understand the intricacies of the system, and it is hard to explain in 15-second sound bites that dominate our media.
The regulations proposed by the Ontario government represent devastating cuts to the profession. The government and many of the groups supporting them have grossly underestimated the value that they receive from pharmacies on a daily basis. The Health Minister has stated that the business model for pharmacy will need to change. There really is no question in that regard. It is certainly a tall order to replace about $300,000 in lost revenue virtually overnight, but we all need to take a hard look at how we operate and rationalize our business. Rita Winn said it best- “it’s time to start charging what we are worth!” Additional paid professional services are an exciting prospect for the future, but we need to be able to survive until these are a reality.
The first area to look at is all of the services that we currently provide without receiving any compensation. These were never funded, but since pharmacies received sufficient PA funds to operate, they were provided gratis in most cases. These include services like requesting refills for patients, compliance packaging, home delivery, providing rush orders of vacation supplies, answering telephone requests for information, advancing emergency supplies of medications, providing duplicate receipts for prescriptions, contacting third party insurance plans on behalf of patients, contacting physicians for changes in cases where it is not a therapeutic intervention, providing patient profiles to patients or lawyers, and the controversial co-pay waiving practices. In my world, these will become either fee for service (ie-charge of $5 for prescription authorization requests, $5 for duplicate official receipts) or services billed by the minute (ie-$5 per minute for calls to third parties on behalf of patients.) These are all interventions using a pharmacist’s unique knowledge and expertise, or supplies and equipment. We need to be directly compensated for every second we are using our expertise on behalf of our patients.
The professional fee for dispensing a prescription also needs to be raised to an appropriate level to compensate for the actual costs involved in dispensing a prescription. The most recent research indicates that the actual costs of dispensing are around $14 per script. The fee needs to be set to achieve an average of about $15 per prescription, recognizing that the maximum collected from ODB is going to be $8 or $9. In most cases, the appropriate professional fee will be between $17 and $21. The cash paying and privately insured will end up subsidizing ODB recipients which is unfair, but that is the system that the government is endorsing through this legislation.
Once the fee schedule is established for all of the routine, non-professional, and low-level professional activities that comprise the average day in the pharmacy and the usual and customary fee is set at a level to appropriately recognize the realities of dispensing we can look at the additional professional services that we will provide in the future.
This will require a huge paradigm shift for a profession that has for too long provided most of their services and expertise for free. The first time we ask our patients to pay us directly for the services that they are receiving will be an uncomfortable experience. I have to believe it will also be very liberating. We will no longer be under the thumb of the Executive Officer or Minister of Health.
Any consumer should realize that nothing in this world is free. Pharmacists have been able to provide numerous services for free BECAUSE of the indirect funding they were receiving from other sources. The funds are gone and not coming back, but the expenses associated with them are all still there. We have no other choice, and I would expect the majority of patients to understand this. We also must be sure the majority of pharmacy operators understand this. We are a profession and we need to compete on professional value and service, not on charges and fees.
If we are successful in implementing new service fee schedules across all pharmacies, the independents may not suffer the dire fate that they have been predicting. In fact, we may find that the new revenue streams allow us to offer even better services and care than we have in the past.
When patients realize the true costs of the services they receive from pharmacy, they can take up the battle with the government in demanding that they become insured services under the Ontario Drug Benefits plan.
I do not support the government or their handling of this whole situation, and I will strongly campaign against them in the next election. In the meantime, however, we all need to take a hard look at our practice and accept the fact that the way we operate must change. Change is never easy, but the only way the government will be able to see the effects of their legislation is by pharmacists taking the necessary steps to protect their profession and their livelihood operating under the legislated system. It will not be an easy summer, but at least we now know where we stand and can made decisions based on actual knowledge and not hypothetical situations.
Monday, June 7, 2010
Never give in
"I have nothing to offer but blood, toil, tears and sweat."
We have before us an ordeal of the most grievous kind. We have before us many, many long months of struggle and of suffering. You ask, what is our policy? I can say: It is to wage war, by sea, land and air, with all our might and with all the strength that God can give us; to wage war against a monstrous tyranny, never surpassed in the dark, lamentable catalogue of human crime. That is our policy. You ask, what is our aim? I can answer in one word: It is victory, victory at all costs, victory in spite of all terror, victory, however long and hard the road may be; for without victory, there is no survival.
-Winston Churchill
While I would never compare our struggle with the Ontario government to the threats facing the world when Churchill delivered his first speech as Prime Minister, I can draw great inspiration from his words, some 70 years after they were so eloquently spoken.
The pharmacy community is understandably feeling frustrated as weeks have passed since the announcement of massive front-line health care cuts by the government with little change from their original position. Pharmacists, pharmacy staff, students and patients have rallied at Queen’s Park and at MPP offices, have presented hundreds of thousands of signatures on petitions and have been the subject of hundreds of newspaper articles and media pieces over the past two months. Yet today, the Health Minister announced that the regulations will pass essentially unchanged.
The days and weeks ahead will be very difficult for many pharmacists. Pharmacists will question whether the entire campaign was worth the effort since very little movement was made on the part of the government. We will struggle with the difficult decisions that will need to be made in order to keep our practice afloat. If we want to survive, we can no longer be the easygoing, friendly health care professional providing countless services to patients for free. The days of walking up to a pharmacy counter and obtaining free advice or services from the pharmacist are over.
Our profession will be forced to evolve if we are to remain viable. The way we deliver services and the way we charge for the services that we provide will need to change dramatically. We will need to actively seek new practice opportunities and take full advantage of our expanded scope of practice, even if it means direct patient billing for the services provided. Our dispensing activities, once the main source of pharmacy revenue and main focus of our day will need to become streamlined and more efficient. The fees charged for dispensing will need to increase considerably to cover the previous subsidized funding gap, as well as the gap left on the public drug plan side.
We were all warned in the beginning that this was going to be a marathon and not a sprint. This is truly a war, and one that we must be determined to fight to the end. We have spent a lot of energy educating the public and warning of the potential effects of the funding cuts. The hour is upon us, and the public will soon feel the effects of the reckless Liberal health care cuts.
As pharmacists, we can choose to fight, or we can choose to die. We will do what we need to do to survive, and Ontarians can decide what type of pharmacy care they prefer. My bet is that they like what they are receiving now a whole lot better than what they will be getting by November 2011. We need to make sure they are reminded every day of the people who caused the change.
June 7th will forever live in history as a dark day for the profession of pharmacy in Ontario. The only advice I can give my fellow pharmacists today is this- again from Sir Winston Churchill...
Never give in. Never give in. Never, never, never, never--in nothing, great or small, large or petty--never give in, except to convictions of honour and good sense. Never yield to force. Never yield to the apparently overwhelming might of the enemy.
We have before us an ordeal of the most grievous kind. We have before us many, many long months of struggle and of suffering. You ask, what is our policy? I can say: It is to wage war, by sea, land and air, with all our might and with all the strength that God can give us; to wage war against a monstrous tyranny, never surpassed in the dark, lamentable catalogue of human crime. That is our policy. You ask, what is our aim? I can answer in one word: It is victory, victory at all costs, victory in spite of all terror, victory, however long and hard the road may be; for without victory, there is no survival.
-Winston Churchill
While I would never compare our struggle with the Ontario government to the threats facing the world when Churchill delivered his first speech as Prime Minister, I can draw great inspiration from his words, some 70 years after they were so eloquently spoken.
The pharmacy community is understandably feeling frustrated as weeks have passed since the announcement of massive front-line health care cuts by the government with little change from their original position. Pharmacists, pharmacy staff, students and patients have rallied at Queen’s Park and at MPP offices, have presented hundreds of thousands of signatures on petitions and have been the subject of hundreds of newspaper articles and media pieces over the past two months. Yet today, the Health Minister announced that the regulations will pass essentially unchanged.
The days and weeks ahead will be very difficult for many pharmacists. Pharmacists will question whether the entire campaign was worth the effort since very little movement was made on the part of the government. We will struggle with the difficult decisions that will need to be made in order to keep our practice afloat. If we want to survive, we can no longer be the easygoing, friendly health care professional providing countless services to patients for free. The days of walking up to a pharmacy counter and obtaining free advice or services from the pharmacist are over.
Our profession will be forced to evolve if we are to remain viable. The way we deliver services and the way we charge for the services that we provide will need to change dramatically. We will need to actively seek new practice opportunities and take full advantage of our expanded scope of practice, even if it means direct patient billing for the services provided. Our dispensing activities, once the main source of pharmacy revenue and main focus of our day will need to become streamlined and more efficient. The fees charged for dispensing will need to increase considerably to cover the previous subsidized funding gap, as well as the gap left on the public drug plan side.
We were all warned in the beginning that this was going to be a marathon and not a sprint. This is truly a war, and one that we must be determined to fight to the end. We have spent a lot of energy educating the public and warning of the potential effects of the funding cuts. The hour is upon us, and the public will soon feel the effects of the reckless Liberal health care cuts.
As pharmacists, we can choose to fight, or we can choose to die. We will do what we need to do to survive, and Ontarians can decide what type of pharmacy care they prefer. My bet is that they like what they are receiving now a whole lot better than what they will be getting by November 2011. We need to make sure they are reminded every day of the people who caused the change.
June 7th will forever live in history as a dark day for the profession of pharmacy in Ontario. The only advice I can give my fellow pharmacists today is this- again from Sir Winston Churchill...
Never give in. Never give in. Never, never, never, never--in nothing, great or small, large or petty--never give in, except to convictions of honour and good sense. Never yield to force. Never yield to the apparently overwhelming might of the enemy.
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