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Monday, February 3, 2020

CVS Response to NYT Article

1. I wonder how many people researched and worked on writing this response. My guess is that it was way more than their average pharmacy employs to fill prescriptions.

2. "we are fierce advocates for expanding the number and role of pharmacy technicians at our stores." and "CVS Health has been on the forefront of advocating for states to increase pharmacy technician to pharmacist ratios."

-Having followed this story all day when it broke, I can tell you that all across social media, and from the colleagues with whom I spoke, there is not a single person who stated "my pharmacy is getting way more tech hours". In fact, to a person, everyone agreed they are continually getting their technician hours cut. Not exactly "fierce" in their advocacy.
-Of course they want a higher ratio. That way, they can employ cheaper labour to do more work. However, this does not address that there is a limit to the amount of professional work one, single pharmacist can complete in a day. More prescriptions to check, more errors to catch, more immunizations to give while also requiring more phone calls to be made and conference calls to attend, and reports to be completed is a recipe for disaster. More errors will be missed.

3. "One of the best examples (of our investment in technology) is electronic prescribing."

-You can't take credit for accepting an already existing technology. It's like Apple Pay. It exists. Either you accept it, or you don't. But you can't claim credit for its existence.

4. "The automation of electronic prescriptions has resulted in a reduction of some pharmacy labor hours."
- Yes. Yes it has. However, as I have long said, "electronic prescribing has not resulted in FEWER errors, only more, legible errors". These new errors often are more complicated to address and fix than handwritten prescriptions. The resolution often requires multiple phone calls and communications sent to offices. This "reduction in some pharmacy labor hours" results in more work for the pharmacy staff as we cannot dedicate the required time to fixing them properly. That's nothing to celebrate.

"By automating 90% of data entry for e-prescriptions, we’re preventing human error and improving efficiency."
-Again, automated does not mean flawless. When mistakes are made, someone needs to fix them and with these labor cuts, there is no one there now to accomplish this.

5. "our use of metrics mirrors what’s commonly used throughout the health care industry. Over the past 18 months we’ve focused in further by narrowing the number of metrics we measure in half."

-Phunny. Everyone I spoke with said the same thing: They are being measured more than ever. I will concede that metrics, when used properly (as a counseling tool to provide teaching and focus) have some merit; the way pharmacy uses them is deflating. If you as a company are using them to withhold bonuses, to threaten, write up, or fire employees, then that is counter to the reason metrics exist. (You are doing that by the way.)
-When you don't make enough MTM calls, meet your quota for immunizations for the day/week, make enough antibiotic counsels or press the red button enough times during your shift, it is not helpful to have your boss yell and threaten you by saying you don't care about your patients. You have a serious disconnect.

6. "we conducted a survey of all of our pharmacists to gauge their perspective on the culture of patient safety in their pharmacies, and the overwhelming majority of responses were positive. Another factor that indicates job satisfaction among CVS pharmacists is our extremely low turnover rate, which has decreased over the past three years."

Call me Cynical, but I know you don't bite the hand that feeds you. When any company can tell how many employees have or have not taken the survey and when they can identify the role(s) of those employees, forgive me if I question their claims of anonymity.
Also, cynically, of course turnover rate has decreased. CVS and Walgreens have spent the past years buying their competitors and often closing them on the spot. It's hard to find another job when it's an either CVS or Walgreens job market. Oh, and with market saturation, no one is going to leave if they do not already have another job. The jobs just aren't there.
-What did CVS expect their pharmacists to say in the survey? "It's impossible to do my job with the resources you give me so I don't worry about it."
-Also, who defines what a "legitimate concern" is anyway? Obviously pharmacists have concerns, hence the New York Times article. Apparently these were not legitimate enough to warrant exploration by CVS. Instead, we have this puff piece denying responsibility, or that a problem even exists.
-There is also a difference between pharmacists being "concerned professionals, caring about their patients' health and wellbeing, and being 'dissatisfied employees'". You may want to research that.

7. "Patients who enroll in our 90-day program can opt-out at any time or choose which eligible prescriptions to move on or off the program."
-There are benefits to 90 days. For the company and its STAR ratings.
-There are benefits to the patients - fewer trips to the pharmacy.
-It's a little troubling when you have to tell a patient she has to pay $600 for 90 days of Levemir because your Pharmacy/Insurance/PBM company requires 90 days instead of 30 days. She'd have an easier time with $200 every 30 days but that's not up to her.
-You also can't claim it's an option when comments across all social media exposed district managers telling their pharmacy staff to "just sign them up so we get the credit and let them ask to be removed". Nice tactic. Rather defeats the purpose but, hey, it's a measurable metric and you have to meet those, right?

Apparently the authors of this response spend all day shielded away from the actual pharmacies they represent. If your ground troops are telling you one thing, perhaps you should get out more and listen. Maybe walk into a pharmacy and see for yourself if their claims have merit. My friends across the country, across all social media echoed the same thing. This is nothing more than a fluff piece designed to make CVS look good to the general public that does not understand how their system works.
Don't let that happen.
Continue to keep the pressure on by (re)posting the NYT article.

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