What's So Difficult About Pay-for-Performance?

Pharmacy practice is being challenged by a new reimbursement model called pay-for-performance, as if this is something new.

Changing the way pharmacists are paid for providing services can seem challenging at first, until you realize that pharmacists have always been paid for performance.

The performance that is being paid for is changing, though. Instead of a quick, inexpensive filling of a prescription, the focus will be on how that prescription is used by the patient to achieve the intended outcome.

Rather than being frightened by the change in reimbursement models, just accept that you will now be paid for a different performance. If you see it as an opportunity, you can then help define the elements that will improve drug therapy outcomes for your patient, think about how you can incorporate them into your routine by delegating some activities to your technicians, and consider which types of direct patient communications will help that patient achieve the desired outcomes. When you realize that you are just being paid for a different performance, you can then begin the process of adapting to a new care process.

Taking a positive approach to change is important because I have seen how adaptable pharmacists can be when given the chance.

I recently had an opportunity to reflect on my early-career efforts to introduce hospital pharmacy practice into North Carolina and incorporate clinical pharmacy into hospital pharmacy practice. When I came to North Carolina in 1966, only 19% of hospitals had a pharmacist in charge of the pharmacy. In a few years that number increased to 98%, using community pharmacists to serve part-time as pharmacy directors. This was my first opportunity to see how adaptable pharmacists can be with a little coaching, encouragement, and support.

I hired my first clinical pharmacist in 1969 in my hospital before schools of pharmacy were training them. He learned on the job and did so well that we were looking for many more to employ. Again, this is another chance to observe how adaptable pharmacists can be to new roles when given a chance.

It was demonstrated to me again, when we started the Asheville project, that any willing pharmacist, regardless of age or practice setting, could help manage chronic disease if given opportunity, training, and encouragement.

Today, we are developing, within community pharmacy, enhanced pharmacy care networks to help manage care transitions, chronic disease, and adverse consequences to drug therapy.

My previous experience tells me that pharmacists will adapt to this new opportunity well because pharmacist have always been paid for performance. When the performance measures change, pharmacists adapt easily.

In a few years you will see that I am right, as we observe many community pharmacists integrated into care teams helping to manage patient drug therapy and still getting paid for performance.