News
Focus on Current Thinking: Pharmacists and the Cost of Health Care
Stephen F. Eckel, PharmD, MHA, BCPS, FASHP, FAPhA
Published Online: Wednesday, March 20, 2013
A lengthy cover story in TIME magazine explores in great detail why health care costs so much in the United States, but what are pharmacists and other health care workers willing to do to reduce those costs?
There’s a good chance you have heard about the cover story that appeared recently in TIME magazine called “Bitter Pill: Why Medical Bills are Killing Us.” The article, written by Steven Brill, has drawn a great deal of attention—both regarding its length (more than 24,000 words!) and its analysis of the economics of our health care system. The American Hospital Association, Forbes, and the Wall Street Journal are just a few of the health care associations and media outlets that have posted rebuttals to Brill’s exposé.
As pharmacists working within hospitals, do you have a sense that there is excess in your organization or that you inappropriately charge patients for their care? Before you answer, here are a few things to take into consideration, focused on our profession and our expertise:
1. Departments that charge for their services. It is recognized that there are a large number of people involved in the daily care of hospitalized patients. Besides the obvious ones—physicians, nurses, and pharmacists—there are the people who clean the rooms, transport the patients, monitor the telemetry, remove the trash, clean the linens, and prepare and deliver the food. While these individuals are essential to the care of patients and the efficiency of the organization, there is no mechanism for them to charge the patient for their services. While some of their pay might be included in the room charge, another portion of it might be drawn from the price and mark-up of medications. Do you think it would be more efficient for the organization and informative for the patient if every step and activity were to result in an itemized list of charges for each patient?
2. Pharmacist salaries. I routinely talk with students about the type of patient care activities that pharmacists can engage in. We discuss all the exciting things that pharmacists can do for patients, including medication therapy management, disease state management, and collaborative practice. When I ask them if they want to spend their career doing these things rather than just dispensing medications, they get excited and respond that they see these activities as the future of pharmacy. They believe that these activities contribute more to patient care and make better use of their training and education than simply preparing medications.
I tend to follow that question up with another one: Would you be willing to focus your career on these patient care activities if the salary was $80,000 per year, while the salary for a dispensing pharmacist was $100,000 per year? Very few students choose to take the position that pays less, even if it would allow them to focus on their preferred activities. This suggests that most pharmacists would opt for a higher salary, even if the benefit to patients is not as great or involves doing something they would enjoy less. I wonder if we are convinced our salaries are justified based on the work we do. Maybe our desire for higher salaries is contributing to the excessive costs of the health care system and, in the interest of reducing overall health care costs, we need to get paid less.
3. Costs of medications. While the $2 aspirin gets all of the media attention, how about the medications that cost $10,000 to $15,000 per dose? Many of these products are sole source, with their price dictated by the manufacturer. As a result, our organizations have no choice but to purchase them at the price offered. In general, health care professionals are reluctant to give a cheaper medication to patients if they are not as effective as the more expensive one.
Is the cost of the health care we provide out of balance with the quality of care patients receive? Maybe it is. However, before we start pointing to all the corporate excesses that tend to get the attention, we also need to recognize where pharmacy contributes to the overall expense. Are we are willing to take a 20% pay cut to reign in health care costs? Are we willing to offer our loved ones medications that are cheaper than but not as effective as the more expensive ones? I have not found many pharmacists willing to argue for either of these positions.
Sometimes all available options consist of bitter pills. I would appreciate hearing from you whether you agree with this perspective.
There’s a good chance you have heard about the cover story that appeared recently in TIME magazine called “Bitter Pill: Why Medical Bills are Killing Us.” The article, written by Steven Brill, has drawn a great deal of attention—both regarding its length (more than 24,000 words!) and its analysis of the economics of our health care system. The American Hospital Association, Forbes, and the Wall Street Journal are just a few of the health care associations and media outlets that have posted rebuttals to Brill’s exposé.
As pharmacists working within hospitals, do you have a sense that there is excess in your organization or that you inappropriately charge patients for their care? Before you answer, here are a few things to take into consideration, focused on our profession and our expertise:
1. Departments that charge for their services. It is recognized that there are a large number of people involved in the daily care of hospitalized patients. Besides the obvious ones—physicians, nurses, and pharmacists—there are the people who clean the rooms, transport the patients, monitor the telemetry, remove the trash, clean the linens, and prepare and deliver the food. While these individuals are essential to the care of patients and the efficiency of the organization, there is no mechanism for them to charge the patient for their services. While some of their pay might be included in the room charge, another portion of it might be drawn from the price and mark-up of medications. Do you think it would be more efficient for the organization and informative for the patient if every step and activity were to result in an itemized list of charges for each patient?
2. Pharmacist salaries. I routinely talk with students about the type of patient care activities that pharmacists can engage in. We discuss all the exciting things that pharmacists can do for patients, including medication therapy management, disease state management, and collaborative practice. When I ask them if they want to spend their career doing these things rather than just dispensing medications, they get excited and respond that they see these activities as the future of pharmacy. They believe that these activities contribute more to patient care and make better use of their training and education than simply preparing medications.
I tend to follow that question up with another one: Would you be willing to focus your career on these patient care activities if the salary was $80,000 per year, while the salary for a dispensing pharmacist was $100,000 per year? Very few students choose to take the position that pays less, even if it would allow them to focus on their preferred activities. This suggests that most pharmacists would opt for a higher salary, even if the benefit to patients is not as great or involves doing something they would enjoy less. I wonder if we are convinced our salaries are justified based on the work we do. Maybe our desire for higher salaries is contributing to the excessive costs of the health care system and, in the interest of reducing overall health care costs, we need to get paid less.
3. Costs of medications. While the $2 aspirin gets all of the media attention, how about the medications that cost $10,000 to $15,000 per dose? Many of these products are sole source, with their price dictated by the manufacturer. As a result, our organizations have no choice but to purchase them at the price offered. In general, health care professionals are reluctant to give a cheaper medication to patients if they are not as effective as the more expensive one.
Is the cost of the health care we provide out of balance with the quality of care patients receive? Maybe it is. However, before we start pointing to all the corporate excesses that tend to get the attention, we also need to recognize where pharmacy contributes to the overall expense. Are we are willing to take a 20% pay cut to reign in health care costs? Are we willing to offer our loved ones medications that are cheaper than but not as effective as the more expensive ones? I have not found many pharmacists willing to argue for either of these positions.
Sometimes all available options consist of bitter pills. I would appreciate hearing from you whether you agree with this perspective.
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Nihsfa Inahgelat
March 27th, 2013 - 01:58:32 PM
Your comments regarding Pharmacist salaries are entirely off base. Here are some examples to keep in mind, and keep dollars in perspective. At my large academic institution there are a significant number of Clinical Pharmacy Specialists and Clinical Staff Pharmacists; the combined interventions (over 85,000) of these pharmacists save our institution approximately $4,000,000 per year. This cost savings is adequate to pay the salary of the entire pharmacy staff, not to mention the significant improvements in quality of care provided to patients/patient care that cannot objectively be measured. In a recent article published in Pharmacotherapy, it was reported that each DOLLAR in pharmacist salary cost was associated with a $602.16 reduction in the total cost of care. Even if the savings reported in this study are exaggerated by 10-fold, I challenge you to report another investment with a similar return. In our practice setting, we perform drug-use evaluations, in-service educations, drug information, significant clinical research, ADR management, pharmacokinetic consultations, drug therapy monitoring, drug protocol management, TPN management, CPR/Code participation, participation in multi-disciplinary rounds, and admission drug histories. It's important to note that our salaries play a minimal role in the cost of health care and they are below average for our colleagues with similar educational and clinical backgrounds such as physicians. Not to mention that in the current economic environment, a $100,000/year salary is necessary for a reasonable, middle-class living environment for a family. The time when $100,000 per year was an exorbitant amount of money has long passed. So your to answer your question of whether we as professionals are willing to take a 20% paycut to reduce the cost of healthcare is a resounding "no". I am certain that my sentiments will be echoed by my colleagues in the pharmacy community, and I would suggest that before writing an editorial such as this, you should look at the forest, and not the trees.
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