Cheri Garvin counseling a patient

Providing top-notch customer service is something that independent pharmacies have always been good at, according to Cheri Garvin, executive vice president and chief executive officer of Leesburg Pharmacy Inc in Leesburg, Virginia. What's changed a bit is why this element of doing business is so important.

"We operate by the golden rule: we treat our customers the way we would want to be treated when we go into any retail establishment," Garvin said. "We try to greet them by name whenever we can, and just make them feel like a person instead of just a number coming through the door."

Garvin has worked in pharmacy since high school. She was recruited by the founder of Leesburg Pharmacy, Bruce Roberts, RPh, who is now executive vice president and chief executive officer of the National Community Pharmacists Association (NCPA), and she worked as a pharmacy technician, then a staff pharmacist. When Roberts decided to leave the pharmacy to head the NCPA, he asked Garvin to take the helm. She has been in her current post for 7 years.

Garvin believes that excellent customer service is, in many cases, the only way that independent pharmacies can compete, largely because of reimbursement challenges, increasing difficulties in collecting claims payments, and more competition as a result of mail order. "Typically, when you think of retail, one of the things that sets you apart are your prices," she said. "That's a bit fixed in pharmacy because no matter where you go, your copay is the same. Then people are going to want to shop where it's convenient and where they get good customer service."

At Leesburg Pharmacy, customer service extends to offering services such as compounding and specialized products and medical equipment such as walkers, wheelchairs, nebulizers, and breast pumps. Leesburg also has an assisted living department, as well as a wellness center that handles immunizations and screenings for cholesterol and bone density. A physician and lactation consultant are available for consultation.

Douglas Hoey, RPh, chief operating officer of the NCPA, notes that a number of the organization's members are using this strategy. "They are broadening their revenue streams from prescription-only. They are still maintaining their prescriptions, but they recognize that it is a tremendous attraction to bring patients through the door, and those patients need more than prescription medications," he said. "They are looking at themselves as more of a health care center than as a pharmacy only."

As a result, pharmacy retailing has witnessed a wave of diversification. "Traditional dispensing is still the... core function. Making sure that patients are taking their medicine properly is what pharmacists do," Hoey said. "At the same time, medications expand into other areas, such as compounding, specialty medications, the combination of medications with the use of durable or home medical equipment, servicing assisted living centers, servicing long-term care centers, institutional settings. Any place where people use medication, the pharmacists have broadened their role to be a part of those environments."

"It would be hard to survive as an independent pharmacy if all we did was stand here and fill regular prescriptions," Garvin said. "There isn't enough money to sustain a business based on that model anymore. We have to offer these other products and services to make it work." This is not to say that Leesburg, which bears the name Leesburg Pharmacy, after all, is out of the business of filling prescriptions. "But it's not where we advertise; it's not where we market. We are trying to stay focused on those products and services that make us different from mail order and from the other stores in our area," she said.

Jay Gill, Lisa Strucko, Cheri Garvin, Adle Joseph, and Lee Allison Boris

Medication therapy management (MTM) for senior citizens is one such service that Leesburg Pharmacy advertises. "We would rather promote any clinical services that we can offer than just fill someone's prescription," Garvin said. "We focus on our compounding center and what we can do for patients with compounded medication. The same goes for our medical department or our assisted living department. That's what we are trying to do to stay viable as a business—to focus on those areas that set us apart from the other pharmacies that are around."

The key in benefiting from this lies in devising a way to be compensated for the expertise that pharmacists can provide, according to Hoey. "For some of the core dispensing that we do, we are having to reverse the tide a bit. We have done counseling for so long, and 30 or 40 years ago the counseling was supposed to be compensated in the dispensing fee," he said. "Now, the dispensing fee does not even begin to cover the cost of counseling the patient."

MTM is playing a part in chipping away at this, Hoey notes, and opportunities exist related to compliance and persistence. "That seems to be a low-hanging fruit for the pharmacists," he said. Certain health care plans, namely those that are responsible for the entire health care bill, want assurance that their patients are taking their medications properly; pharmacists can serve as the vital link in the chain. "Who better to help patients take their medication on a regular basis? It benefits everyone. Everyone wins when patients take their medicine like they are supposed to, and who better than the pharmacist to help them do that? Those managed care plans that look at the whole benefit have a greater incentive to make sure that the patients are taking their medication like they are supposed to, and there has been some interest in paying pharmacists to help do that," said Hoey.

Hoey points to what he calls MTM-like services as another source of revenue for today's pharmacies. "MTM is just one facet of it. There are payers out there willing to pay pharmacists for managing the patient's compliance and persistence, or providing de-identified data about the use of the medication to help in identifying patients for clinical research," he said. This is a tremendous opportunity for pharmacists because they have the competitive advantage of having solid data as well as daily contact with hundreds of patients that are demanding face time with the pharmacist on duty, according to Hoey. "That is the competitive advantage that we need to use to grow our businesses."

Garvin admits that independent pharmacy is facing its fair share of challenges that at times may seem insurmountable. "The margins are already so slim, and to think that they are going to get even tighter makes it difficult. There will be some hard decisions for a lot of pharmacies as to whether they can continue to provide care to their Medicaid population," she said. Garvin also said that the independent pharmacies that are able to focus on the positive stand to survive and prosper. "On the positive side, with MTM being very successful its first year out, it opens up a lot of opportunities for pharmacy to show that we are an integral part of the health care team. We have a positive benefit if we are kept in the loop of patient care."