Help! I Need Somebody…Help!

The easiest costs to control in any business are payroll. Everyone everywhere is told to control their payroll dollars. New bosses come in and they first thing they do is order everyone to rein in payroll expenses. New bosses also want to stimulate business growth so they launch new programs. Wonderful. The only problem is, they are asking the same people to continue to do their original work, add in the new work, and do it all with less help. This is easy to see in the pharmacy world where we have quotas (oops, corporate calls them targets or goals) for flu shots, shingles shots, other vaccines, MTMs, CMRs, new patient calls, prescriber office visitation/meet-and-greets, and customer service calls. They expect us to add all this to our daily dose of filling prescriptions accurately AND quickly.

How would this translate in your doctor's office? Let's try this example:

You walk into your prescriber's office and are met by your doctor who is standing at the check-in window. She checks you in, ushers you to the back, gets your weight, checks your blood pressure, grabs the rest of your vitals and your current med list, then walks out saying she'll be right back. She then goes out front to collect her next patient and repeats the process. After filling all of her rooms, she puts up a sign that says "back soon", then makes the procession through each room to listen to the patients' complaints, diagnose them, prescribe medications for them, determine which pharmacy they use, send an electronic prescription from the room, then walk the patients up to the checkout counter where she herself will collect the copay after checking the computer to determine the patients' coverage.  If needed, she will also schedule the patients' followup visit and any procedures deemed necessary during the visit. In between these rounds, she will swing by the fax machine to authorise any refill requests that may have been sent by any pharmacies, check her e-scribing queue for the same, and listen to her voicemail for messages. She will also carve out time to return any of these calls should she have committed an error while hastily urging a patient out of the room because she has a schedule to keep because corporate dictates she has to send so many e-rxs per hour, see so many patients per hour, collect so many copays per hour, and check in so many patients at the front desk per hour or her STAR rating will fall and she will be at risk of losing the ability to accept Medicare plans at her practice. On top of this, she will have to answer any calls she receives from other offices that need patient information transferred to them so they may conduct tests or sign them up as new patients. At this point, she already has a waiting room full of the next round of people banging on the doors, ready for the next cycle to begin. Despite her standing in full view of the waiting room, all the while briskly walking around from fax machine to computer, to drawers of charts to the cashbox, with a phone strapped to her head, the waiting room patients look like extras from The Walking Dead, constantly banging on the doors, hurling questions at her about "How much longer?" and "Why does it take so long to just put me in a room?" and "I just need a Z-Pak", or "I'm just here for my refills". No one sees that she is on hold attempting to get a patient's prior authorization to go through. No one sees the other patient in the shot room waiting for his second Hep B shot. No one sees the other lines on hold. No one wonders where the help is. No one wonders why things could be taking so long. They only know it shouldn't be like this. What happens? They call corporate and complain about the wait times. They call corporate and complain about how the prescriber seemed rushed and didn't smile long enough, pumped the blood pressure cuff too many times, sent the e-rx to the wrong pharmacy even though it was the one on file, forgot to ask for the new insurance card, tried to charge them too much because the patient left his new insurance card at home and she should have known it changed and offered to call the insurance for her.

Consequence? Practice closes and the patients have to find another prescriber. They move to another office associated with the same general company. This practice now has to deal with all of their own patients AND those of the other practice except the old prescriber does not move there. They do not add staff. They maintain the status quo. Wait times go up. Customer satisfaction goes down. Stress levels go up. Errors are made and people are outraged.

If this really happened at your doctor's office, do you think it would get this bad?
No. Then why is it totally acceptable at pharmacies across North America (need to include my Canadian brethren here as well)?