Written by: Tom Yavoski, R.Ph
Clinic Rx Partners
I have learned one really important thing working as a Consultant Pharmacist in Free-Standing ERs and Ambulatory Surgery Centers – there is always something new to learn! I learn from everyone, and over time I hope to share some knowledge, experience and perspective with others through this Journal.
As the Journal of Free Standing Emergency Medicine grows, so will our knowledge. My desire to be a part of this Journal is to support a forum that allows us all to learn, share, and get better at what we do – ultimately improving the service & care we give to our patients, and demonstrating the value of our service to the health care community.
As a pharmacist, I plan to write about issues that will help you as a clinician, administrator, or operator of a Free-Standing ER. I plan to focus on topics in three areas as they relate to pharmacy: clinical, operational, and regulatory. With this in mind, I will start this first Pharmacists Corner with a topic that I hope adds value to individuals who are opening their first Free-Standing ER as well as those who have already opened a number of free standing facilities.
Choosing a Pharmacy Provider
In my experience, I have become acquainted with groups and individuals who have opened several Free-Standing ERs and feel that they are getting the best pharmacy services possible. Many of these groups “haven’t had any issues so why look elsewhere?” And then there are individuals opening their first facility who, “don’t yet know, what they don’t yet know”. With these profiles in mind please consider the following.
Individuals with experience opening multiple facilities who work with just one pharmacy provider might be leaving money on the table, as the benefits of having a long term working relationship with any vendor seem to lessen (financially) as the length of the working relationship increases.
These facilities usually receive good service, but without competition, they pay for it (literally). Consulting fees creep up over time and services that were once included may now be optional or no longer available. This can be seen in Texas, where the more established Free-Standing ER market (Houston) seems to have more pharmacists competing for centers and correspondingly has a lower fee structure than other markets within the State. There may be other factors in play, but in general a little competition in this market seems to be a good thing for the facility.
So it may be important for this operator working on new facilities, to reach out to a few consultant pharmacists to see if fees are in line with the services each facility needs. By going through this process, the experienced operator may be pleasantly surprised to hear about an added service provided gratis, that their current pharmacist either charges for or doesn’t even offer. Since all consultant pharmacists work from the same set of State & Federal regulations, the actual service you receive should be similar. All pharmacy consultants do there best to keep their facilities out of trouble with the State.
As you look over each pharmacist’s proposal, remember that you are dealing with a small business owner (maybe like yourself), so it is important to treat them as you would want to be treated. If you are asking for a bid just to go back to your current pharmacist for a better price, let the new pharmacist know your intention before they put a lot of time into writing a proposal. I’m sure you will agree – there is nothing more disheartening than investing time & money on a proposal, and in the end you hear through the grapevine that the current contract was renegotiated early, and at a lower rate.
The flip side of this argument is that ongoing pharmacy services are a very small part of monthly operating costs, however to most small business owners a “dollar is a dollar” – especially if you are just starting out. Either way, it is important to note that pharmacy set up fees can run the gamut – from all inclusive with a commitment from the facility for a contract for ongoing consulting services; to a la carte for specific set up activities.
Many times ones comfort level with change will be the catalyst for reaching out to a new pharmacy provider (or not doing so). Of course a bad State survey noting serious yet preventable errors will almost always signal a need for change. I’d argue that getting outside of one’s comfort level is rarely a bad thing, especially when it gives you options.
For the individual opening their first facility, recommendations of names of pharmacists qualified to help set up a new pharmacy can come from colleagues having opened their own free standing facilities. Put the names from a trusted colleague at the top of the list, as well as the recommendations of colleagues from your
ER residency. Most docs view this market from the standpoint that “a rising tide floats all ships”, and they are willing to lend a hand with recommendations. Be sure to get a few names, as working with a pharmacist who is competent at facility startup & licensing may not be the same person who works well with you week in and week out over the course of a year.
In my practice I take time to discuss current needs as well as learn about the individual’s ability (and desire) to take responsibility for specific setup activities; such as handling all the licensing paperwork and agency follow up), physical pharmacy set up, drug formulary selection, and so on. While none of us want to give away our trade secrets, you should have a sense that the pharmacist is volunteering enough information to help the individual who “doesn’t yet know what he doesn’t yet know”.
Finally, with so many expenses coming due in the early months of opening a facility, it might be important to consider vendors who can work with you on payment terms. Until the patient load is reliable, a new facility might see value in a vendor who is flexible with invoicing. Early on, the cost savings that come from even a small operating expense line item like pharmacy can really make a difference. To me it is also a reflection of that pharmacist’s character.
So the take home from this first Pharmacists Corner is that competition for services is good and complacency is (not so good). By reaching out and identifying new options for pharmacy services you will gain a new set of eyes on your business. As a newbie, you will better understand what you need to worry about and what you can delegate. For the experienced individual, reaching out provides the opportunity to add a little polish to the apple, by learning something new in an operational area that has become old hat.
With this in mind, please feel free to reach out to me, as I have put together a document entitled “A Menu of Services for a New Pharmacy”. I put this list together after being asked by clients for something other than a one size fits all pharmacy set up. I will send it to you upon request. You may find this very useful in choosing your pharmacist.
“Our thanks to Tom Yavoski for his insight into the set up and polishing of the Free-Standing ER Pharmacy. We look forward to more discussion of this topic in your next article.”
– JFSEM Editorial Staff