PHARMACIST STEVE

We opened our independent pharmacy in 1976, back then the PBM industry was a minor part of paying for prescriptions, the vast majority of prescriptions were paid by cash/check/credit card.

In the early 80’s as the DRG reimbursement was implemented in the hospital system. Basically, when a person was admitted to a hospital, the hospital was given a fixed $$$ based on the pt’s diagnose and if the hospital spent less than the budgeted $$$ they made money… if they spend more than the budgeted $$$ the hospital LOSS MONEY.

The phrase quickly coined discharged “quicker and sicker”… The need/demand for various hospital equipment for the pt recuperating at home grew dramatically.  So we began being a supplier for home medical equipment.  Providing hospital beds, wheelchairs, walkers, crutches/canes, bedside commodes and the like.

As we got requests for items we did not normally stock, we expanded into new areas including home oxygen and related respiratory equipment & supplies, Home IV’s, Enteral feedings, T.E.N.S unit and both Barb and I got certified as prosthetic and orthotic fitters. Which allowed us to provide custom fitted back braces and Jobst custom compression stockings. Eventually we expanded adding a Mastectomy Center and Barb became our master fitter/trainer for women who had breast cancer and mastectomy surgery.

We had moved from our little 1200 -1400 sq ft pharmacy to a 5000 sq ft pharmacy, home medical equipment and Mastectomy center and a off site 2800 sq ft warehouse.  We went from a one pharmacist and one full time and one part time pharmacy tech to a total staff of 18 employees.

We also moved from being primarily a cash/check/credit card business to one doing a great deal of billing to Medicare part B, Medicaid and numerous other insurance companies.  To survive, we had  to become experts in billing and dealing with all the different rules and regulations of all those various insurance entities.

During those years, we went to DC with two of national associations that we belonged to… when they had multi day legislative meetings and we would meet with our elected members of the House and the Senate to lobby them on some legislative changes that was up for discussion and changes to regulation that affected our business and the pts that we cared for.

What was pretty common is that – especially large – proposed changes would not be addressed or final posting would not happen until after Labor Day on years when there was a Federal Election.  They would finalize the proposed rules then because all 435 members of the House and 33-34 members of the Senate would be out on the CAMPAIGN TRAIL…  When the election was over the first week of Nov… Congress would come back to DC…  those that did not get re-elected would start packing their office up… those who gained seniority because of the election would start jockeying for new/better office based on their new seniority.

Before you know it… it is time for Congress’ Christmas break…  before the new Congressional session starts the first of Jan.. Then there is orientation for the new ‘freshman” members of Congress. So the bureaucrats have several months to implement their proposed regulation changes to implement… because no one in Congress is around to try to get them to intervene.

If history repeats itself, the CDC will finalize the 2022 proposed opiate dosing guidelines around Labor Day and the DEA will latch on to them and start their indoctrination of various entities that have DEA licenses to prescriber or dispense controlled meds and most likely, they will have been working on their “new standard of care and best practices” to start their intimidation of many as possible within the healthcare system… that 50 MME/day is – IN THEIR OPINION – is where a prescriber prescribing greater than 50 MME/day will constitute providing opiates outside of “valid medical need” – per the DEA’s medical expertise

Filed under: General Problems