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.