The Common Denominators ?

I have written before about the “THREAT MASTER” http://www.pharmaciststeve.com/?p=1459

In communicating with RPH’s in various work environment.. there seems to be three common denominators – INTIMIDATION – FEAR – MONEY.. and it doesn’t seem to matter at what level you are at in the “pecking order”… from CEO… to  the janitor…  the same management style is utilized.

Generally you get employees to cooperate and do their jobs via either respect or fear/intimidation of you. I have worked in some places where management had neither the respect of the employees nor did the employees fear management… at times it was like being on a ship without a rudder nor anyone at the helm.. other times.. it was like working in a “three ring circus”.

There has always been a disconnect between the way that pharmacy is practiced and the view of how it should be practiced as viewed from academia.. but .. now with the increased dominance of PBM’s and unwillingness of corporate types to decline to sign contracts with ever decreasing reimbursement… we have seemingly moved away from the traditional dual disconnect … to having three separate and distinct camps’ vision of how pharmacy should be practiced…. patient safety is seemingly just a “buzz word” and patient compliance is more about the $$ generated per patient/month than anything else.

With delegating more and more tasks to technicians, the amount of automation that we have enabled and in some situations…. technicians are being praised/encouraged to be “stool pigeons” on RPH’s … and patient’s loyalty is based on where their PBM tell them who they must patronize… now that we have a growing surplus… are we of little more use than a warm body and a license to our corporate employer?

We talk a lot about MTM… which basically all of us do to some degree or another all along… but what else in our healthcare system is not prescriber or patient initiated but is insurer initiated? Isn’t this ass-backwards?

If one looks at the requirements to justify payments under Medicare Part D… the only thing in common between all the insurers is the $$ that a person must spend annually… each insurer has different disease states and number of disease states that the patient must have before they are eligible for reimbursable MTM. There are some situation where a patient could have all the disease states necessary for MTM… but all medications are $4/month .. so they would not qualify for MTM because of total $$ spent annually are not met.

We have been commoditized…. is the next thing marginalized as a valid part of healthcare ?

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