The Value of Office-Based Prescription Dispensing

Urologists in Cancer Care, April 2013, Volume 2, Issue 2

Steve Dobbs, the CEO of Urologic Specialists of Oklahoma, Inc, discusses the viability, legality, and successful implementation of an office-based medication-dispensing solution.

Steve Dobbs

Chief Executive Officer

Urologic Specialists of Oklahoma, Inc

Tulsa, Oklahoma

Urologic Specialists of Oklahoma, Inc (USO) prides itself on innovations in urologic care as well as its commitment to constantly improving patient satisfaction. At the same time, however, rising costs and declining insurance reimbursement levels challenge physicians and medical groups to explore new revenue opportunities. To help meet these challenges while maintaining high-quality care and patient satisfaction, USO researched, tested, and fully implemented an office-based prescription medication dispensing solution. This was certainly not a concept or program we entered into lightly, however. Many of our physicians and staff were quite skeptical about the viability, legality, and successful implementation of a medication-dispensing solution for our practice.

Advantages of Office-Based Prescription Dispensing

Explore Options and Perform Due Diligence

Nationally, studies suggest that three out of four Americans would prefer to fill their medication prescriptions in their doctor’s office instead of having to go to a pharmacy. Unfortunately, only a very low percentage (approximately 10%) of physicians and clinics across the country currently offer this option to patients. At the same time, pharmacies report that as many as 20% to 30% of prescriptions written annually go unfilled, which contributes to therapy noncompliance for patients.Patients appreciate the convenience of being able to purchase their medications or supplements at the physician’s office. Office-based dispensing can save patients time and a trip to a local pharmacy. In addition, dispensing the medication prescribed by the physician in the office ensures that the prescription has been filled, thus increasing therapy compliance. Patients appreciate the confidentiality of discussing their course of treatment within the privacy of a physician’s office. Finally, office-based dispensing creates a new revenue and profit center for practices.Compliance and patient safety are paramount. Practices need to understand the laws and guidelines governing medication dispensing in their states, and also must select a top-notch strategic dispensing partner to help manage and implement the optimal platform for their offices. USO’s strategic partner, ProMentum Health (www.ProMentumHealth.com), emphasized three critical points up front: First, USO would not be a full-service pharmacy, but rather focus on dispensing the most commonly prescribed medications (mostly generic). USO had to resist the urge to overstock our inventory, and instead follow ProMentum Health’s recommendations to initiate dispensing with only 15 to 20 high-volume medications.

Second, physician and staff “buy-in” are critical in launching a successful medication-dispensing solution. Patients are not the only audience that may benefit from this efficient medication delivery model: The clinical staff will also benefit by actually saving hours each week from taking pharmacy calls about prescription orders and substitutions, and from handling prior authorization requests that are occurring more frequently in urology.

How Does the Office-Based Prescription- Dispensing Process Work?

Third, if possible, visit an existing dispensing site or two that mirrors your clinic size, patient volume, and technological capabilities. With over 20 providers and 275 patient visits per day, USO needed to validate that the dispensing platform and model we were considering was already working successfully in other large practices. Visiting other sites gave our medical leadership the opportunity to speak directly with peers about the pros and cons of operating an office-based prescription-dispensing program, including getting candid feedback from participating clinical staff. Ultimately, taking the time to visit other large dispensing sites validated our decision to move forward with a program that would increase our patient satisfaction scores, increase therapy compliance with our patients, and also provide a new revenue stream for our practice.The Web-based, easily customizable system scans, labels, and dispenses safety-sealed, FDA-approved, prepackaged prescriptions in about a minute. Additionally, the platform tracks medication inventory levels in real time, as well as directly reports the dispensing of Schedule II to V controlled substances to our state’s reporting agency, if applicable. The ability to ePrescribe medications is crucial in our practice, so the dispensing software has the distinct advantage of having a direct link to SureScripts so that our providers can ePrescribe from our electronic medical records (EMR) software (UROchart).

Increased Practice Revenue

Basically, the appropriate prescription therapy is selected during the patient encounter, immediately sent and recognized by the dispensing software from our EMR, then received, scanned, verified, and filled by our clinical staff. We have customized our dispensing platform with appropriate staff access and security levels, and streamlined the checkout process for our patients. They leave our office with an itemized invoice of their medication purchase, along with the system-provided patient instructions for their medication (also available in Spanish) reviewed during their visit. The work-and patient-flow process occurs without the need to hire any additional staff.The profit potential for office-based dispensing can be significant. On average, we generate between $7 to $12 per prescription, and on a few medications the margin is slightly higher, all while maintaining prices that are similar to patient copay levels, and often less than local area pharmacies. We’ve recently noticed an increase in the number of refills from patients taking medication for chronic urologic conditions.

Additionally, with the implementation of our urodynamics protocols, we expect to see an increase in the number of patients purchasing medications from our clinic simply due to convenience. With the platform’s ability to dispense nonprescription products (nutraceuticals, specialty urology products, etc), we’re now evaluating requests from patients to carry those items in our formulary, which will further improve patient satisfaction and potentially double the net revenue of the program.

As we continue to see shifts in reimbursement methodology, we must continue to evaluate programs and technology that will not only enhance the comprehensive care of our patients, but also optimize revenue for our practices. With those goals in mind, the adoption and implementation of an office-based prescription medication-dispensing initiative should be strongly considered as a new and emerging opportunity for urologists.