Saturday, February 28, 2009

Customer Service or Not?

This is sort of an extension of a topic I've written about before, but it continues to be an issue in my workplace (which is a string of clinic/medical office building pharmacies, not a big corporate chain.) The organization is feeling the economic pinch and loss of revenues, just like many others. Our business is still quite steady, but cost-saving measures and ways to maintain our business are always at the forefront.

Some of the staff don't give a rat's ass and continue to do their job as they always have. But some of the 'good' technicians are conflicted as to how far they have to go to cater to people who don't present adequate insurance information, and they get varying directions from the pharmacist managers they work for. Some technicians feel they are now expected to get on the phone and track down insurance information for everyone who claims to have it --- they just don't have a card or don't know why our information is rejecting. Otherwise, the customer is either expected to pay cash price or (more often) walks out the door. It's slowly creeping into the realm of "customer service."

I'm conflicted about this. Don't get me wrong, I know that pharmacies are not obligated to verify insurance, period. That information has to be supplied by the customer. We don't expect the Target cashier to call our bank to get our credit card number. And the big chain pharmacies doing 800+ scripts a day have absolutely no capacity to do this -- the wait time on a prescription would be about a week! I get really annoyed when someone expects me to bill an insurance they can't produce. Being in a clinic environment, we do sometimes have access to more information than an outside pharmacy would, but I have actually told technicians on the phone with insurance, "look, we're just getting too bogged down here -- just give the customer their options. We can't solve this for them." But the technicians will tell me some pharmacists expect it of them, especially the managers in some of the smaller stores who are worried about their prescription volumes.

So I guess I'm not sure where to draw the line between being helpful and facing reality. I'll call an insurance provider if I believe it's something I can solve relatively quickly. Some of the insurance companies have websites, but the first thing they want is the patient's ID number and that's usually what you don't have. If it's a regular customer who's well known to me, and all of a sudden their insurance doesn't work, I'll try to help them. But I do NOT want people to expect this, and many of them now seem to.

Oh yeah, and if that prescription is $4 you can be darn sure the Insurance Detective Service will NOT be offered....

Tuesday, February 24, 2009

The Obesity Epidemic

There are some days when I am really taken aback by the number of our pharmacy customers who are seriously, morbidly overweight. They are young and old, male and female alike. I have to wonder what it's like for them at their doctor visits --- is the doctor laying it on the line? --as in saying, "Most of your health problems and the majority of your prescriptions could be eliminated if you JUST LOST WEIGHT." I know it's easier said than done, and doctors probably repeat it over and over (perhaps at some point they have to give up), but it is so true.

You look at the meds these people are on. A serious weight loss (and for some, we are talking 80-100 pounds that needs to go) would mean they could probably cut back or eliminate meds for blood pressure, blood sugar, joint pain, depression, breathing & wheezing, fungal skin conditions and many more. Next to quitting smoking, weight loss has to be the #1 best thing you can do for your overall state of health (that you have control over.) It seems so simple, but of course it isn't....

Most of us would love to drop 5-10 pounds anytime, but the folks I'm talking about are way past that. And you know the sad part is that exercise is out of the question -- they can barely MOVE. Where the heck do you go from there, other than into surgery? Way easier to just not let it get to that point. This kind of weight gain doesn't happen overnight and you wish these people would have looked in the mirror honestly a few years ago and said, I gotta change this.
It is a uniquely American predicament. I've been lucky enough to travel to some other parts of the world and I am struck by the fact that looking around you, you just don't see the fat like you do here.

Saturday, February 21, 2009

My Inner Voice helps me haggle over a price

We who deal with the public have to try and be polite even when the person we're dealing with is not. But that doesn't mean we don't have an inner monologue taking place that doesn't match the words that are actually coming out. Hey, it helps! A recent patient encounter of mine:

Young female customer picking up refill prescription (non-essential, I might add) for which she is paying cash price:
Has the price gone up?

My Inner Voice: I have no idea. I don't set the prices. I don't know who you are or what you paid the last time.

My Actual Voice: Well, it could have. Our prices are set by the head office in response to increases in what we pay for the drug.

Customer, sourly: Do you send out letters to people without insurance when your prices go up?

My Inner Voice: Sure, lady. Right you are. We actually mail out thousands of letters every week to all our customers who we've determined don't have insurance to let them know of price increases. In fact I just finished putting the stamps on myself.

My Actual Voice: No, unfortunately we don't have the capability to do that.

Customer, rolling her eyes: Well, that's convenient.

My Inner Voice: OK, you have now crossed the threshold into snottiness. Do you want the damn thing or not?

My Actual Voice: Well, we can hold the prescription if you would like to price-shop around.

Customer, sourly again: Well no, I need it.

My actual voice: Thanks, have a good day.

My Inner Voice: Go away now.

Tuesday, February 17, 2009

A 100% Gripe Post about Personal Phone Calls

I would think that anyone who works in a pharmacy would tell their friends and family to: (a) avoid calling me at work , (b) if you do call me, the chances are very good that I won't be able to have more than a 15-second conversation with you, and (c) call me on my lunch or break, IF I get one.... better yet, I'll call you.

When you're calling a pharmacy, you are calling a place where the phone rings constantly. There are some people who get so many calls from their kids or spouse I think to myself, DON'T you people TALK to each other AT HOME? Sure, I know some personal calls at work are necessary, but some etiquette needs to apply -- keep it short, don't stand in the middle of the pharmacy where every customer who's waiting can HEAR that you're on a personal call WHILE they wait, and maybe find a few minutes where you can go in the back room and use your own cell phone. I've had both pharmacists and techs settle in for long, leisurely chats punctuated by uproarious laughter while a roomful of pissed-off patients glares at them (they are oblivious, however). If THEY were the patient waiting, they would be the first to complain.

I even had the boyfriend of a co-worker get pissed because he was on hold too long! Called back, said "I'm STILL waiting for (girlfriend), and I've ALREADY been on hold."

Oh NO, you didn't just say that!! Time for a little chat with your girlfriend about what she does for a living...

Saturday, February 14, 2009

Stupid "News" Reporting

Lately there have been 'news' reports claiming that the economic stimulus bill contains provisions for a 'health czar' who will oversee doctors' treatment decisions and extend the long arm of the government into your doctor's office; who would decide what treatments are acceptable and not acceptable for payment. The claim is false -- the bill is referring to the expansion of electronic medical records to HELP guide medical decisions. Who could argue that care is improved when any provider within your health system can pull up your records instantly, whether you're in the ER, clinic or post-op recovery? Some organizations already do this quite handily.

I had the misfortune to see this scare story reported on CNN the other day, breathlessly announced by CNN Newsroom host Heidi Collins (who solemnly intoned the words "National Health Care") and poorest-excuse-for-a-medical-correspondent-ever Elizabeth Cohen. After discussing it in the vaguest terms for a minute or two, Ms. Cohen then admitted that she had looked at the language of the actual bill (I give her credit for that, wow, you go , journalist!) and lo and behold, it didn't exactly SAY what people were claiming. There was no language stating that the government would tell doctors what to do. So I'm thinking, just where is the story here? But far be it from CNN or any news organization to pass up hinting at a sensational revelation, if only to kind of back off it later.

But regardless of your political philosphy of any of this, what drives me nuts is that I have YET to hear ANYONE on these shows mention the fact that there is ALREADY someone who tells your doctor what to do! Every single damn day we pharmacists call doctors to tell them "Your patient can't have that drug, they have to use this one." "Your patient can only get 12 tablets per 30 days." "The insurance company won't pay for two tablets a day, only one." "Your insurance company needs a prior authorization, and that means THEY will decide if you really need this drug." And that's just the pharmacy side of things, never mind the doctor visit/treatment/lab test/ procedure part. I kept waiting for Ms. Collins and Ms. Cohen to mention this as an aside, but it never came. Whether it's true or not, is it actually NEWS that treatment decisions are made by 3rd party payors? Are these people just not aware of this? Have they never been to a doctor or a dentist? No, I think it just makes for a better story when people think some government bureaucrat is going to be sitting in the examining room with them, instead of a desk jockey from Blue Cross or Aetna.

I know, I know, --- I admit I was pretty naive about news reporting until well into adulthood. I thought these people must be smart and well-researched --- I mean, how could it be on TV if it didn't pass the smell test? I am convinced they are the true culprits when it comes to the continual dumbing down of America. Nothing new I guess, but this story in particular left me pounding my forehead on the TV.

Now, I must go and watch more coverage of the Octo-Mom.

Tuesday, February 10, 2009

Unrelated Random Thoughts, Cont'd.

There are certain senior citizens I see often who are always impeccably dressed -- the men have a tie or jacket on and the women have jewelry, nice blouses and beauty-shop hair. It's not necessarily because they are well-off. It's because they come from a generation where you would never go out in public in a t-shirt and sweat pants. I admire that.

It seems like everyone who calls the pharmacy is on a cell phone, and it's either cutting out or impossible to hear. The rest of them are calling with a TV blaring in the background, a kid screaming or a dog barking. C'mon people! Better yet, use the automated refill line. People are just too impatient to take the time for it, and it ties pharmacy staff up on the phone while other customers are staring us down. I get kind of irritated picking up the phone and discovering it's someone who just wants to give me a list of prescription numbers. Especially when they specifically asked to speak to a pharmacist !!

The other day a customer tried to swipe his insurance card through the credit card machine.
How awesome would that be? --- Patient walks up to drop-off window, hands over prescriptions, swipes insurance card -- pharmacy computer populates with all the patient information, and away we go! And if insurance is inactive, card immediately "Declines"!!
What a fantasy. Of course, no one ever has their card with them, but that's another story.

Friday, February 6, 2009

Calling It In

Being in a medical building/clinic pharmacy our customers often hold us responsible for every prescription written in the building. We recently had a woman throw a fit when we requested Rx insurance information and she could not produce anything for us to work with. Somehow we were supposed to figure it out from her medical card. She then demanded we 'call' her prescription to another pharmacy. We told her the doctor could call it in, or send it electronically, or she could simply carry the prescription to the other pharmacy. She accused us of poor customer service. Two things, lady -- the prescription originates with the DOCTOR. The insurance information originates with YOU.

There have been times when I have called another pharmacy to get someone's insurance information. I'll also attempt to help someone out if I don't have the drug, IF I suspect it's going to be hard to find, and IF I suspect the person may have trouble filling it otherwise (elderly, disabled or just clueless.) I'll call other pharmacies in my organization, and then I'll try others in the neighborhood to see if they have the drug in stock. That's a courtesy ONLY. They still have to get the prescription there themselves. I'm not responsible for calling or faxing it there so that it will be 'ready when I get there.' (Okay, I can't say I have never done that either, but it's not something customers should expect. It don' work that way.)

It's like, if I go to Sears to buy a lawnmower and they don't have the one I want -- am I going to ask the Sears clerk to call Home Depot for me?

Thursday, February 5, 2009

A Happy Cell Phone Encounter?

Today I attempted to offer my pharmaceutical counseling skills to a guy who was ordering chicken wings on his cell phone as he stood at the counter while I rang him up. That didn't go so well. Normally I would be irritated as hell by this, but I felt strangely serene -- perhaps it was the thought of chicken wings, which I couldn't shake all day. Honest to God, I actually picked some up on the way home --- honey BBQ sauce, and they were good.

Too bad it was a whole bunch of calories I probably didn't need. Damn you, cell phone guy!!
Good thing I am a professional pharmacist.

Monday, February 2, 2009

Scent of a Monday

OK, customer comes up to the register, I ring them up, tell them about the prescription (Z-Pack, I believe) and off they go. Seconds later, I start to smell something very strong -- kind of like Keflex suspension, but more acrid. I look over at the technician, who is smelling it too. It gets stronger and stronger. Another customer approaches and hears us discussing the source of the smell. She supplies the answer: "That, my friends, is CAT pee !!"

I can't describe how strong this smell was. This person must have washed their clothes in it!
Holy COW, was it bad! I've never had cats or been around them much, so I really had no idea of the unbelievable pungency of this odor. It took a good half hour for it to dissipate.

Gawd, that was NAST-EEE !!