s HMR Moratorium – Killing Jobs in Pharmacy | I2P: Information to Pharmacists - Archive
Publication Date 01/02/2013         Volume. 5 No. 1   
Information to Pharmacists

Editorial

From the desk of the editor

Well 2013 has certainly begun and I must admit it has been hard to get out of “holiday mode” and back into “pharmacy mode”.
This year is looking quite challenging as many issues left in abeyance in 2012 are bubbling over , so I don’t anticipate a restful year.
One important issue we will cover for some time yet is the quality of drug  evidence in the Australian setting, and to kick off the debate the feature article  “Sense About Science”describes what is happening in the UK to help tidy up science in that country.
Comparisons have been made with the Australian experience and it seems that we have a long way to go before it can be regarded as “tidy”,

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News Flash

Newsflash Updates for February 2013

Newsflash Updates

Regular weekly updates that supplement the regular monthly homepage edition of i2P. 
Access and click on the title links that are illustrated.

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Feature Contribution

Sense About Science – or Up To Your Ankles in Waste Water

Neil Johnston

My recent holiday reading included catching up on subjects that have slipped off my radar, mainly because the issues themselves have adopted a lower profile.
Then an article in the 6Minutes e-publication caught my eye.
It concerned a UK initiative by a group called Sense About Science”, that has started a campaign to have all clinical trials registered and have the results published, while simultaneously urging the patients to boycott trials if the researchers cannot guarantee the findings will be made public.
They have published a petition (found at www.alltrials.net) and are encouraging people to sign it.
The petition has the support and backing of the BMJ, the James Lind Alliance and Ben Goldacre (author of Bad Pharma) and is designed to put pressure on researchers, pharmaceutical companies and institutions who are in a position to bury research data that may reflect on reputations and drug company profits.

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Face of Priceline - Australian of the Year 2013

Peter Sayers

Few would not recognise Ita Buttrose, an iconic Australian well-deserved of the Australian of the Year Award for 2013. The award was presented in Canberra on Australia Day (January 26 2013), by PM Julia Gillard.
And there must be a lot of backslapping going on in the Priceline camp for their recent signing of her to front for their 200 member pharmacy franchise.
Ita’s profile was already stellar, but with the added impetus of the Australian of the Year Award, the Priceline brand will now increase in value considerably.

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Determining needs and wants…

Joseph Conway

In pharmacy media commentary, I often come across the idea that we need to give people advice on what they need as opposed to what they want. This is understandable given that we have specialist knowledge on medication therapy and live our lives discussing health issues with patients and dispensing their medication. We get to know very intimate details about people and many pharmacists working in community pharmacy get to follow people as they grow older and are a tiny (but important) part of their lives sharing their health issues over ongoing chats at the dispensary counter if they choose to shop at our store.

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Is the ‘weekend’ an anachronism whose usefulness and relevance has passed?

Neil Retallick

When I taught Sunday School, which seems to be about a hundred years ago but was only about forty, we learned from the Bible that on the seventh day, God rested.
After all, he had been busy for six days.
I do not wish to belittle anybody’s religious beliefs in these comments but use them to focus attention on just how much our society has changed.
At the same time I was teaching Sunday School, the shops all closed at mid-day on Saturday and at 5.30pm during the week.
A trip into town to shop on the weekend meant getting up bright and early on Saturday morning and being at the bus stop by 8.30am at the latest.

Comments: 1

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Fitting Your Pharmacy for the Future - Funding & Depreciating for Best Tax Effect

Chris Foster

Editor's Note:
I2P will be developing a series on pharmacy designs - ideas and concepts in respect of clinical services spaces.
In designing such spaces it was realised very early in the exercise, that to be properly integrated in an Australian pharmacy setting it could not be just an “add-on” but a whole of pharmacy redesign.
Similarly with the introduction of automated dispensing machines (original packs and dose administration aids) it is important to design workflows properly to capture efficiencies, and this also entails a “whole of pharmacy” redesign.
2013 may be the year of decision in terms of the type of pharmacy design to house your market offering. To survive you need to be different and there is not a lot to differentiate one pharmacy from the other, even if you belong to a marketing group.

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Ransomware - The New Kid on the Block

Steve Jenkin

Editor's Note:
Late in 2012, a medical practice on the Gold Coast of Queensland came under cyber attack in a unique way.
Instead of patient data being stolen, it was kidnapped in place, by encrypting all practice data so that it could not be read.
A key was then offered at a price so that the data could be opened.
Thus was born "Ransomware", and a a new threat had emerged.
i2P asked Steve Jenkin, our resident IT expert to give some insights to this new threat and what precautions we might all need, to eliminate this new approach to hacking.
If you need an incentive, just imagine if your PBS claim data was locked up for a week and your ability to generate a claim was locked up for six weeks, plus all attendant costs in restoring your data.
Would you survive in your business?
This reference article by Steve is important enough to use as a checklist for your IT provider or for your IT consultant to utilise in the next complete review of your entire system.
Steve's comments follow:

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Workplace Pressure in Pharmacy

Kay Dunkley - BPharm, Grad Dip Hosp Pharm, Grad Dip Health Admin, MPS, MSHPA

The psychological definition of stress is a feeling of strain and pressure.  Small amounts of stress may be desired, beneficial, and even healthy.  Positive stress helps improve performance.  It also plays a factor in motivation, adaptation, and reaction to the environment.  Excessive amounts of stress may lead to many problems in the body that could be harmful.  Symptoms may include a sense of being overwhelmed, feelings of anxiety, overall irritability, insecurity, nervousness, social withdrawal, loss of appetite, depression, panic attacks, exhaustion, high or low blood pressure, skin eruptions or rashes, insomnia, lack of sexual desire (sexual dysfunction), migraine and gastrointestinal difficulties (constipation or diarrhoea).  It may also cause more serious conditions such as heart problems.

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Arm Yourself For The Battle For The Mind

Barry Urquhart

Social media, and the internet in general, are largely “blind” media.
They can be frustrating, time-wasting and inefficient.
Entries and enquires about wide-ranging but pertinent topics, products and services elicit countless responses, most of which are irrelevant and unappealing. Information overload abounds.Use of SEO's (Search Engine Optimisers) simply cluster companies, brand and service names, among large, often spuriously ranked groupings.Being on the shopping list has very little quantifiable and lasting value. Nor does the standing of being “first amongst equals”.
Establishing and sustaining unique, differentiated presences in the marketplace is difficult.
In the brave and new world of digital, mobile, on-line, multi or omni-channel reality, the importance, nature and value of effective branding is deepened and broadened.

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Positive thinking has no negatives

Harvey Mackay

One of life's great annoyances is the tendency of folks who ask you to perform an impossible task, list the issues they foresee and the problems that have plagued previous attempts -- and then admonish you to "think positive."
Wow! Does that mean you are so good that you can achieve what no one else has? Or are you being set up to fail?   
Because I am an eternal optimist, I prefer to believe the first premise. Positive thinking is more than just a tagline. It changes the way we behave. And I firmly believe that when I am positive, it not only makes me better, but it also makes those around me better. I think that good attitudes are contagious. I want to start an epidemic!

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Feasting on Fat

Loretta Marron OAM BSc

With the Christmas and New Year opportunities to over-indulge, it was easy for girths to increase a little.
If so, it might be very difficult to lose those extra kilos.
Many advertised products and services allegedly help us lose fat without diet and exercise.
Most will fail; some might even be dangerous.

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Hanukkah, Oxygen Masks and Christmas

Mark Neuenschwander

I've been thinking about Hanukkah, oxygen masks, and the Christmas presents I am duty bound to muster for my kids and grandkids. Thank God dad asked for pajamas.
Today I’m flying from Las Vegas to Seattle. About the only thing I liked about Sin City was the fountain show at Bellagio, the Elvis Christmas songs that popped up here and there, and a pretty good keynote address by Bill Clinton. Just thinking of shopping makes me wonder if the cabin isn’t losing its pressure.

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Antioxidants Prevent Cancer and Some May Even Cure It

Staff Writer

Orthomolecular Medicine News Service, January 24, 2013

Antioxidants Prevent Cancer and Some May Even Cure It

Commentary by Steve Hickey, PhD

(OMNS Jan 24, 2013) It is widely accepted that antioxidants in the diet and supplements are one of the most effective ways of preventing cancer. Nevertheless, Dr. James Watson has recently suggested that antioxidants cause cancer and interfere with its treatment. James Watson is among the most renowned of living scientists. His work, together with that of others (Rosalind Franklin, Raymond Gosling, Frances Crick, and Maurice Wilkins) led to the discovery of the DNA double helix in 1953. Although his recent statement on antioxidants is misleading, the mainstream media has picked it up, which may cause some confusion.

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HMR Moratorium – Killing Jobs in Pharmacy

Joseph Conway

It’s no secret that the Pharmacy Guild has called for a moratorium on HMRs until the alleged abuse of a tiny minority of Independent Pharmacists potentially rorting the system is investigated and the system is changed to reduce the possibility of such rorting.
They say that this is necessary as the budget for HMR’s has been overrun and any potential rorting could put the viability of future pharmacy-centric programs at risk too.
The Guild want payments stopped so that the business rules behind HMR’s are “tightened” to stop this apparent rorting.
If there is actually rorting going on, then I think that it’s in all pharmacists’ interest to “fix” this issue.
I for one have nothing against tightening the rules to stop pharmacists “Warehousing” HMRs?
This is great.

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Part one -HMR Evolution

Neil Johnston

With the furore created when the PGA went to print stating that the funds available for HMR’s were almost exhausted, it created an instant “blame game” and conjecture as to what really lay behind the belated PGA announcement.
I came to a conclusion early that it was a result of PGA mismanagement as the immediate problem, but also coupled with an underlying systemic flaw that was the major problem.
Between them they impact and threaten the long term development and survival of the consultant pharmacist program.
It has prompted me to create an analysis of some aspects of the program to evaluate what has gone wrong.

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Part two - Fixing the HMR Flaws

Neil Johnston

The PGA has succeeded in upsetting a broad spectrum of pharmacists that includes all accredited pharmacists, some employer pharmacists (with designs on creating a business model with professional services at the core), and employee pharmacists who see job opportunities being squandered.
It is obvious that the “engine room” for consultant pharmacists (The Australian Association of Consultant Pharmacy) needs urgent reform and a new focus, or be replaced completely.
And the PGA should stop its interference.

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Part three - a Better Umbrealla Organisation

Neil Johnston

Because a workable umbrella model for management consultants already exists, it is suggested that this model be adapted for consultant pharmacist use.
The existing umbrella model established for consultant pharmacists would need to be altered dramatically and be opened up to other organisations e.g Consumer Health Forum, APESMA)
Or an entirely new organisation could be developed from scratch.
This is, in fact happening and is unrelated to any of my activities.
However, I am suggesting that the umbrella model of organisation provided by the Institute of Management Consultants (Australia) provides an excellent reference to adapt to a consultant pharmacist version.

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Thought Bubbles From a Book Group Refugee

Gerald Quigley

Editor's Note:
One night recently, I received the following email from Gerald:
"My wife has a book-group here. I’m locked in my study and inspired to write!"
That's good news for an editor/publisher - getting copy in on time well in advance!
Then followed (the same night), three separate and disparate thoughts that were not directly concerned with a pharmaceutical issue.
But they all had application for pharmacy improvement, with a bit of applied creativity.
As these "thought bubbles" wafted in over the Internet I began to wonder how I might splice them together with some editorial ingenuity.
The following is the result.

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What Really Causes Kidney Stones (And Why Vitamin C Does Not)

Staff Writer

Orthomolecular Medicine News Service, February 11, 2013

What Really Causes Kidney Stones
(And Why Vitamin C Does Not)

(OMNS Feb 11, 2013) A recent widely-publicized study claimed that vitamin C supplements increased the risk of developing kidney stones by nearly a factor of two.[1] The study stated that the stones were most likely formed from calcium oxalate, which can be formed in the presence of vitamin C (ascorbate), but it did not analyze the kidney stones of participants. Instead, it relied on a different study of kidney stones where ascorbate was not tested. This type of poorly organized study does not help the medical profession or the public, but instead causes confusion.

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For health's sake, time to take on food giants

Staff Writer


Food Industry marketing practices are increasingly being brought under the spotlight as are various other worrying problems regarding additives to manufactured food products, also how food is grown using genetically modified seed and the range of toxic herbicides and pesticides.
These latter substances now pollute the entire food chain and not enough is being done to protect our food chain.
Many illnesses can be traced back to ingestion of unnatural substances over a long period of time.
It's time to grow your own.

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Consultant Pharmacists Should Lead The Way - But They Have No Leaders.

Mark Coleman

Isn’t it time that consultant pharmacists took control of their own direction and carved out a future?
Or is the current system of a single-product (HMR) service controlled by the PGA and the PSA, sufficient to provide an interesting and creative future?
How can the aspirations of consultant pharmacists be serviced by an organisation controlled by two major pharmacy-political bodies, when one of them (PGA) is directly working against consultant pharmacist interests.

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APESMA Campaigns for Pharmacist Lunch Hour Entitlements

Staff Writer

Australian pharmacists have been warned to carefully check exactly how much compensation they are getting for routinely working through lunch after an APESMA survey found 28 per cent of Australian pharmacists reported that they receive no financial compensation at all for the lack of a lunch break.
CEO of APESMA Chris Walton said working through every lunchtime was an unacceptable practice that could cause dangerous levels of fatigue.
APESMA has advised pharmacists who have signed any agreement to remove their lunch breaks to immediately ask their employer to itemise any compensation they are being paid in lieu of all award entitlements such as their lunch breaks.

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CHC Emphasises the Importance of Research

Staff Researcher

In light of a recent paper published in the Royal Society's Open Biology journal, proposing a theory that antioxidants can be detrimental in the late stages of cancer treatment, the Complementary Healthcare Council (CHC) of Australia emphasises the importance of clinical trials and studies into the prevention and treatment of cancer. Executive director of the CHC, Dr Wendy Morrow, highlighted this theory as being interesting and warranting more research.

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Advancing our understanding and treatment of motor impairment

Staff Researcher

NeuRA has secured significant funding to expand research into motor impairment, a problem that arises from many diseases and aging, and a growing public health challenge.
Everything the human body does requires movement, but our muscles—and our brain and nerves that control them—are often the first tissues attacked by a long list of disorders that includes stroke, spinal cord and brain injury, multiple sclerosis, Parkinson’s disease, musculoskeletal injury and cerebral palsy.Prof Simon Gandevia is an expert in the brain’s control of human movement at NeuRA (Neuroscience Research Australia) and will spearhead the nearly $7 million multidisciplinary program of study, funded by the National Health and Medical Research Council of Australia.

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PSA WELCOMES GOVERNMENT’S HMR ANNOUNCEMENT

Peter Waterman

Media releases issued from the office of Tania Pliberseck and the PSA arrived this morning.
What follows is the PSA take on recent events surrounding HMR managent.

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Pharmedia - The Vaccine Poll Hijacked by Pharmacists?

Neil Johnston

Editor's Note:
Professional services development was stymied when the AMA reneged on an agreement to support pharmacist vaccination clinics.
It has caused anger and unprofessional behavior has evolved on both sides.
It also appears that while the professional bodies of the AMA and the PGA attempt to disrupt each other, patients at large will become the eventual losers.
The PGA is central to other clinical service disruptions, even those within pharmacy involving contractor pharmacists.
This is damaging to an orderly development of clinical services in a pharmacy setting and demonstrates that current leaders of the PGA and the AMA are not fit to claim the title of "leader".
We asked Mark Coleman to provide commentary on an article recently published in Australian Doctor.

Comments: 2

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HMR Moratorium – Killing Jobs in Pharmacy

Joseph Conway

articles by this author...

Joe Conway is an Irish born pharmacist who qualified in the UK in 1998.
After completing a residency in a hospital in London, he embarked on a 3 year locum stint that involved working all over the UK, Ireland, and Australia in over 350 pharmacies of all varieties (hospitals large and small, community, even a prison pharmacy).In 2002, Joe emigrated to Australia and worked in the Private Hospital sector gradually moving in to management positions with Slade Pharmacy where he developed a keen interest in Oncology services. In 2006, Joe took up a position setting up a Pharmacy service to a newly built Day Hospital in Frankston, Victoria. The Pharmacy now conducts over 40 clinical trials.
Joe is currently studying for a Master of Biostatistics to help him progress in the area of clinical trials, and think outside the square (or at least be left-field).

It’s no secret that the Pharmacy Guild has called for a moratorium on HMRs until the alleged abuse of a tiny minority of Independent Pharmacists potentially rorting the system is investigated and the system is changed to reduce the possibility of such rorting.
They say that this is necessary as the budget for HMR’s has been overrun and any potential rorting could put the viability of future pharmacy-centric programs at risk too.
The Guild want payments stopped so that the business rules behind HMR’s are “tightened” to stop this apparent rorting.
If there is actually rorting going on, then I think that it’s in all pharmacists’ interest to “fix” this issue.
I for one have nothing against tightening the rules to stop pharmacists “Warehousing” HMRs?
This is great.

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What I have an issue with is the method of choice by the Pharmacy Guild to deal with this as yet unproven rorting of the system.
It’s like blowing up a house because one room has might have mould in it?
I think that this action has jeopardized the futures of all Independent Pharmacists whose income source has now dried up and could strengthen the positions of the Members of the Guild – Pharmacy Business Owners who can still claim for pharmacy-centric services such as Medscheck.
This could reduce the overall pie for pharmacist positions and ultimately may end with more pharmacist under-employment and even pharmacist unemployment as current HMR pharmacists get disenfranchised with doing HMR’s , return to dispensing more often as at least the Guild is not going to call for any moratoriums that would directly affect its members. This may leave fewer positions in Community pharmacies for future pharmacist graduates.

Is the Budget for HMR’s sufficient?

I think that HMR’s were underfunded in the 5CPA.
Across the five years of the 5CPA, a mere $52.11 million was allocated for HMRs.
Compare this relatively small HMR pool amount to the Rural Pharmacy Maintenance allowance ($70 mill), PPI and accreditation payments to owners ($75 mill), clinical interventions ($97mill), DAAs ($137 mill), Guild admin fee 1%? ($150 million over 5 years).
I have roughly estimated that in the 2012/13 financial year, Community pharmacy owners stand to gain $235 million from the price difference on Atorvastatin alone (See Appendix).
The approximate $10.42 million allocated for HMRs in the 2012/13 financial year is chickenfeed compared to the money made from generic discounts on drugs such as Atorvastin, Pantoprazole, Rabeprazole, Clopidogrel, Olanzapine, Quetipine, etc...
Money could have been transferred from other areas to make HMR’s work if the Guild really wanted them to?
The HMR represents a tiny part of the overall PBS spend and according to many it more than pays for itself and is money better spent on improving patients health than other money spent on PBS.
Drugs get listed according to the strict criteria of Clinical trials.
However, when a drug gets listed, there can be a form of “creep” where drugs get used on patients not quite fitting the strict criteria in clinical trials and potentially may not work as well. Where is the quality assurance to help reduce “Creep”?
I think that HMR’s should be integral to ensuring that PBS-subsidized medication is utilized properly. Considering that the PBS costs taxpayers around $9-10 Billion (not a fixed amount) approximately per year a small percentage saving is a high dollar value.
If widespread HMR’s resulted in a 1% saving to the total PBS spend, that would represent a saving of $100 million.
The current HMR budget is $52.11/5year = $10.42 million per year.
If this was increased to say $30 million a year, and there was a confirmed 1% saving to the PBS budget, taxpayers would be still ahead in their investment in pharmacists.
This could also provide jobs for pharmacists as experienced pharmacists would have an inducement to provide HMR’s and the dispensary jobs that they vacate would provide jobs for early career pharmacists who would be a viable avenue for career progression in the field of Clinical pharmacy in the Community. The pie for pharmacist jobs would be increased? Also, your success in this area would be more reliant on your ability to write decent HMRs than your business acumen and personal wealth.

Do HMRs really need to be done in patient’s home?

Not always I think.
What if a patient has a history of deviant sexual behaviour or violence?
Some people may feel uncomfortable with a pharmacist entering their house and are capable of bringing a bag with their medication to a neutral place – often a Pharmacy or a Doctor’s surgery. Sometimes, we have to trust the power of the individual to want to help themselves. I think that a new type of review may need to be developed for patients who are not covered under HMR’s and RMMR’s. Maybe HMR’s need to be renamed so that they can be performed outside the home for proscribed reasons…

But the funding from the 5CPA was on behalf of pharmacy Owners?

It has been argued that there is a natural stepwise process from dispensing to HMR’s referral from within the pharmacy. This has dispensing of medication as the core trigger for positive clinical pharmacy interventions into patients’ lives.
Most patients receive their medication at a pharmacy and the dispensing process is the one time that a patient has to come to see a pharmacist.
It appears to be the Guild’s view that this point is integral to identifying potential problem patients and there is a natural stepwise referral system stemming from this to fund pharmacist intervention.
First, there is a Clinical Intervention – a small piece of advice that has a positive contribution to QUM. This works for most people, but if during a clinical intervention, it appears that there might be other problems, then, a Medscheck within the pharmacy can be performed.
If during this Medscheck, further problems are identified and it’s suspected that there might be other medication issues, then the patient is referred to their GP with a recommendation to refer for a HMR where a pharmacist visits the home to provide a more thorough review than a Medscheck.
If a patient has had a HMR during the previous 12 months, then a Medscheck will not be funded by Governmnet.
Pharmacy Owners argue that their process has been compromised by the Direct referral from GPs.
There have been reports of patients signing forms in a Medical Centre and a Medscheck like review performed and claimed as a HMR.
It has been said that such patients barely even remember the review and the pharmacist completing the Medscheck then doesn’t get paid for their service which must surely be infuriating for pharmacy owners.
However, the dispensing process is not the only point for identifying problem patients.
Many patients see their GP and then don’t bother to get their medication dispensed for many reasons. They may not have one set pharmacy. GP’s have much more medical information pertaining to patients that the dispensing pharmacist is not privy to. There has to be a system stemming from the Doctor-Patient visit so that GP’s can refer a patient to an accredited pharmacist for a Medication review.
The problem is to marry the pharmacy centric referral process with the GP referral process.
The HMR moratorium has compromised the GP referral process and isolates us as a profession from the rest of the healthcare team…

Success as an Independent Contractor is dependent of your ability as a Clinical Pharmacist whereas Medchecks don’t have the same inbuilt quality assurance systems:

When a GP refers to a pharmacist for a HMR and gets a “Rubbish” HMR back, then they are less likely to refer to that pharmacist again.
If the Pharmacist does a high quality review, then they will find success.
The GP may refer more patients to that pharmacist and tell his/her GP friends about this HMR pharmacist.
The better you are at reviews, the more success you can get.
Many HMR pharmacists are senior pharmacists with a wealth of experience working at the coalface in a Community Pharmacy or on the wards in a hospital.

Compare this with Medschecks.
These are no substitute for a proper Medical review. In many pharmacies, early career pharmacists are involved in the data collection for these.
There is less quality assurance to ensure the quality of these in-pharmacy reviews and this type of review is something that 80 or 90 percent of pharmacists do anyway.
The Guild has cleverly gotten its members who are owners to benefit rather than providing that extra funding to increase wages and respect for pharmacists.
It’s doesn’t matter whether the GP thinks that a particular Medscheck is useless as they are in no position to determine which pharmacist is doing the review on their patients.
This is a major flaw with the Medscheck system.
If you are good at them, there is little in the system to ensure personal success and the incentive is there to use cheap labour (i.e. Interns and less experienced staff) rather than more expensive experienced pharmacists.
There is a potential conflict of interest in Medschecks too.
An Independent Pharmacy contractor providing an independent of pharmacy review could provide an unbiased recommendation to stop a profitable drug like Atorvastatin generic whilst with a Medscheck review, there may be more incentive to keep a patient on the profitable Atorvastatin and instead try to upsell the patient something like Co enzyme Q10.
Is this best for patients?
Medschecks have flaws in their design too I think.

Another way to deal with potential rogue operators? 

Did the Guild really need to call for HMR moratorium?
I don’t see why the Guild feels the need to “Save” Independent contractors from themselves.
This appears as if someone in a backroom somewhere (in a Guild office) has made the decision that they know what is best for the HMR direct referral industry.
I think that someone thinking that they know what’s best for another group of people (i.e. saving people from themselves) is bad policy.
Individuals are capable of making their own choices and taking the consequences of such actions. Couldn’t the rest of the profession have been notified through an appropriate medium (e.g. APLF) to deal with a potential problem facing pharmacy?
The Guild could have led from the front.
If this is truly what they intended why then is the Guild not calling for an audit of the program?
It would be easy to develop a list of HMR providers who have recently been performing significantly more medication reviews than the average and are performing them outside of patients' homes (assuming they aren't lying on the claim forms as well).
They could, at the same time product a list of doctors who are claiming for HMRs above average, since the review must be initiated by a GP.
The data is there for this to be done but perhaps the Guild would prefer not to do this.
If the Guild produced this data and showed it to the rest of pharmacy, they could have led from the front to fix this problem if it exists. Instead of leadership, we got a bad decision inflicted onto the rest of the profession which could compromise future independent pharmacist job prospects…

Why weren’t Independent HMR providers allowed to be full members of the Guild?

These people were pharmacy businesses just like any other pharmacy business in Australia.
From afar, I see it as madness that such pharmacist business people weren’t allowed to be full members of the PGA.
There would have been a mutual benefit.
Independent Pharmacist practitioners have to abide by business rules and the Guild could have provided a platform and products for them to do this.
Also, with ever increasing numbers of graduates, the Guild is going to represent an ever decreasing percentage of total pharmacists in the coming years.
This has to reduce the political clout of the Guild and increase the power of the PSA.
Moving forward, the Guild will have to bow down more often to the wills of the PSA and in time the PSA could be seen as more representative of pharmacy by Government.
Allowing Independent Contractors to become full Guild members would have helped alleviate the creeping power of the PSA relative to the Guild and maintain the PGA political stronghold on pharmacy. There are many pharmacy businesses in Australia who don’t want to become a “Crazy Clerks Chemist”. They can’t.
You can’t have 5,500 Discount Chemists in Australia.
Many current Pharmacy Owners (with years of business knowledge) could have seen independent contracted pharmacy reviews in Medical Centres as a viable future business and in time a significant proportion of the patients consuming PBS subsidized medication could have yearly reviews.
This would have provided jobs and opportunities in pharmacy pharmacists who wonder what they will do when most of dispensing becomes increasingly automated.
The action of the Guild recklessly calling for a HMR moratorium which might have significantly compromised these pharmacist businesses and makes the likelihood of Independent Pharmacist operators becoming full Guild members even more remote. Is this a missed opportunity for the PGA?

What to do now?

I think that the data needs to be produced to prove that there are rogue operators.
We live in a Capitalist society and ultimately we need some innovation on the ground in order to find the best methods of delivering patient review in the Community.
Everything cannot be controlled if we are to get the best solutions.
We need the proof if it exists that HMR’s help to reduce the overall PBS spend.
We need proof that a Government investment in this program more than pays for itself.
The days of sitting in a dispensary and converting people to the most profitable brand of a medication and being paid generously to do this are coming to an end with price disclosure.
We as a profession need to plan for an age when dispensing is not as lucrative as it once was.
To do this, we need to change.
Change is scary as there is always a risk that you will fail. However, if you fail to change and wait too long, then you may fail anyway.
I think that it’s essential that all pharmacy organisations work together to get HMR’s funded as soon as possible and hopefully before the end of February 2013.
Any longer than this and the future prospects of Pharmacists working collaboratively in the area of pharmacy reviews will have taken a fatal hit and there will be fewer jobs for pharmacists in the future than there otherwise would have been…

Appendix: How I conservatively calculated that Australians are paying $235 million extra for Atorvastatin ($42,000 per pharmacy) in the 2012/13 financial year:

I would say that the average pharmacy in the current system could make $42,000 in difference between the price paid for Atorvastatin by the pharmacy and price used to pay us by Medicare for the current financial year. How I estimate this:

There were about 10.8 million scripts for Atorvastatin dispensed last financial year according to PBS stats.

If you assume that this will decrease by 10% in the 12 months from July 2012 (due to increased Crestor usage?), this might become about 9.82 million scripts for the current financial year.

Let’s assume that the average script costs approximately the average of a 40mg and a 20mg (pretty sure figure would be closer to 40mg though).

Assume price for July-November 2012 (5 months) inclusive is ($55+$39)/2 = $47 per script approx.

Assume price for December-June 2013 (7 months) inclusive is ($41.60+$29.55)/2 = $35.58 per script approx.

Number of scripts dispensed from July-Nov 12 = 9,800,000X(5/12) = 4.08million scripts

Number of scripts dispensed from Dec 12 to June 13 =9.8-4.08 = 5.72million scripts

Assume average substitution rate across all pharmacies is 70% to pharmacy preferred generic brand

Assume average discount of 85% off list price at time of supply for pharmacy preferred brand. Any pharmacy can assess Ranbaxy 90%++ discounts, but the pharmacy buying process has inefficiencies I think.

Actual discount when substitution rate factored in = 70% of 85% = 0.7X0.85 = 0.595 = 59.5%. Pharmacies are paying 100% for Lipitor brand.

Apply this % to list price for the two periods

July-Nov12 = $47 X0.595 = $27.97 difference per Atorvastatin script in price between average paid by pharmacy and average list price (not including dispensing fees and mark-up)

Dec12-June13 = $35.58X0.595 = $21.18 difference in price between average paid by pharmacy and average list price (not including dispensing fees and mark-up)

Multiple each by predicted number of scripts dispensed in each period

July-Nov12 = $27.97X4,080,000 scripts = $114,117,600 difference between what pharmacy pays and claims

Dec12-June13 = $21.18X5,720,000 = $121,149,600 difference between what pharmacy pays and claims

Add these two together to get a total figure

$114,117,600 + $121,149,600 = $235,267,200 difference between what pharmacy pays and claims predicted for current year

Divide this figure by about 5,600 pharmacies

$235,267,200/5,600 = $42,012 per pharmacy conservative estimate. The average pharmacy is pocketing a difference of $42,000 on Atorvastatin alone – not insignificant. That’s $800 per week alone in price difference on one drug. If the effective discount was 90% as in NZ, then you can see that Australians are spending a lot of money on this drug alone.

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