Independent Insights, a Health Mart Podcast

Episode 10: Collaborative Care: Shaping the Future of Pharmacy

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Join us for an exciting episode of Independent Insights as Suzanne Feeney sits down with Dr. Elizabeth Skoy from North Dakota State University. They delve into the dynamic transformation of community pharmacists' roles and explore the power of collaborative practice agreements and test-to-treat services. These innovations are opening new doors for pharmacists to make a significant impact in their communities.
 
From empowering pharmacy technicians to embracing a team-based care approach, this episode is brimming with actionable insights and strategies designed to inspire you to lead the charge in pharmacy practice transformation within your state. Whether you're a seasoned pharmacist or just starting your journey, this episode offers valuable guidance on enhancing your pharmacy's influence while keeping patient care at the forefront.
 
Tune in and discover how you can drive positive change and elevate the standard of care in your community pharmacy!

Host
Suzanne Feeney, PharmD
VP, Pharmacy Retail Operations
McKesson / Health Mart

Guest
Elizabeth Skoy, PharmD, FAPhA
Professor and Director of the Center for Collaboration and Advancement in Pharmacy
North Dakota State University

Resources

Health Mart franchise members can access Health Mart University for point-of-care testing, Test-to-Treat, and compliance courses here: Health Mart University


The views and opinions expressed in this podcast are those of the guest and do not necessarily represent the views or positions of Health Mart, McKesson or its affiliates or subsidiaries ("McKesson”). The information provided herein is for informational purposes only and does not constitute the rendering of clinical, legal or other professional advice by McKesson.

[00:00:00] Are you looking for ideas to grow independent pharmacy and make a greater impact in your community? Look no further. Welcome to Independent Insights, the podcast brought to you by Health Mart. Episodes delve into a wide range of topics to provide you with the practical strategies, expert insights, and inspiring stories to help you and your pharmacy excel.  

The views and opinions expressed in this podcast are solely those of the guest and do not necessarily reflect the views or positions of Health Mart, McKesson, or its affiliates and subsidiaries (“McKesson”). The information provided is intended for informational purposes only and does not constitute clinical, legal, or any other type of professional advice from McKesson.

Pharmacists are expected to exercise reasonable care as dictated by legal and professional standards and are ultimately responsible for decisions related to patient care and medication management. It is your responsibility to review and comply with all applicable state and federal laws, rules, and regulations governing your business operations. This includes laws applicable to businesses in general, those pertinent to employers, [00:01:00] and those specifically regulating the practice of pharmacy.

Suzanne: Welcome to Independent Insights, a Health Mart podcast focused on independent pharmacy. My name is Suzanne Feeney. I'm a pharmacist on the McKesson Health Mart team. And today I am absolutely thrilled to introduce all of you to Dr. Elizabeth Skoy, who's on faculty at North Dakota State University. Welcome, Liz 

Elizabeth: Oh, thank you very much. It's good to be here. 

Suzanne: Well, I'm excited to introduce you to our audience. If they haven't had the chance to meet you yet, I know you're at some of our McKesson IdeaShares, or you've done a lot of continuing educations, through Health Mart University over the years, but I'm excited to have you on because, every time I hear you speak, you inspire me as a pharmacist to practice at the top of a license, to really get engaged in practice transformation and doing all of that in a community setting.

 So first just. Thank you truly for how much you do for our profession and for all of us in pharmacy. I really appreciate that. And I know that all of us out there do as well. So thank you. 

Elizabeth: Oh, you're welcome. And thanks for those very kind words. It's great to be around people that [00:02:00] share your passion.

So I'm also very fortunate. 

Suzanne: Thanks a lot of fun. And I know you practice in North Dakota. And for those of you who are listening who aren't in North Dakota, I want to assure you that today's episode is going to be very applicable to all of you out there. We are going to talk a lot about what's happening is an example, to highlight in the state of North Dakota that's available for their pharmacies.

But we're also going to touch on what could be available in your state. You may have some of these resources. If not, how can you advocate for that? Or how could you get collaborative practice agreements on your own so everything we're talking about kind of falling into that realm of pharmacy prescribing is really applicable to any state that you're in following the practice laws and working with their state associations, we're just at all different points in that.

So. talking through some of these use case examples in North Dakota, I think will be really helpful for everyone. Um, but to get us started, Liz, can you tell us a little bit about what you're excited about right now in community pharmacy? And, and I know there's a lot out there that we're all advocating for and working towards change.

But share some good news with us today. 

Elizabeth: Yeah. I think the good news is that we're kind of at that, [00:03:00] point of maybe a fork in the road, I would say. I even talk to my students about. It's the boiling pot, right? Or like right there and it's starting to, the pot's like starting to boil or we're going to be boiling really soon and potentially boiling over.

But, I know we've had a lot of struggles in community pharmacy and the struggles are very real and they're still there. But at the same time, I feel like more and more opportunities are opening for the pharmacist to be that accessible healthcare provider beyond what 

the public maybe has perceived a community pharmacy to be, and there again, I feel like all the pieces are being put into play. We have much more favorable state laws that are being placed around the country. Legislative action that is allowing pharmacists to do more and more activities. You have.

Our accreditation standards for pharmacy education are changing. For the first time have the word prescribe in our accreditation standards. What we're teaching in the [00:04:00] schools is different than what we even taught, you know, 15, 20 years ago, keeping on top of that. So the next generation of pharmacists are leaving with this knowledge.

So I think all of those things are really exciting and also I'm not gonna discount the public's perception. Yeah. I think the public perception has changed and if you've ever heard me talk about testing to treat or point of care testing I refer to that Walters Kluwer survey, that national survey of what the public views as pharmacy. The large percentage of them or the majority say that they would go to a pharmacy for primary care, so I just I think that, this is all like the pot starting to boil, right? We're getting all these pieces in play and I really, I think we're going to continue to see some practice transformation taking place in our pharmacies and we already have across the country, but I think the wave is coming and it's going to be hopefully more and more.

Suzanne: And I love that because as people are thinking, okay, well, there's mail order, there's convenience or all these factors that go into shaping our consumer habits on how we shop or how we look at even health care, having the ability to [00:05:00] walk into a pharmacy and have some of these solutions right at your fingertips is really appealing to me as a consumer.

 And something I'm definitely looking for in my community because it's that trusted individual. You know, I've heard you mentioned this before when you talk, it's You have those relationships with parents, with children, with caregivers, with our elderly community, and so you're really embedded in the community as a pharmacist, and how can you be there for them in a way that, technology is a great thing, but having that relationship with a pharmacist in your community, I think is so invaluable which is one of the things that, inspires me as so many things move to online or telepharmacy or telehealth.

I think there's still quite a lot of value in that community pharmacy setting. 

Elizabeth: Yeah, a hundred percent. And our relationships and being one of the most trusted professions in the country and all of those things. Yes, absolutely. 

Suzanne: Yeah, you bring me back to when I was a pharmacy resident and just realizing that as somebody is coming in and picking up their meds, like you can really check their edema, see if they have their swelling, do that blood pressure.

And those are things that are so valuable if they're tracked and communicated to the patient and [00:06:00] communicated to the prescriber. So having that touch point, I think even in today's world still offers a lot of value. 

Elizabeth: Yeah, absolutely. 

Suzanne: Well, before we dig in because I know we want to talk about the different ways that pharmacists can get engaged in prescribing, like you said, point of care testing test to treat some of the standing orders that are out there.

But can we just take a step back first and describe what has happened in the last year or so in North Dakota, where you are all at with a CPA. 

Elizabeth: In North Dakota, pharmacists can execute a variety of CLIA wave tests. 

There's a few states that still have restrictions on what pharmacists can provide for CLIA wave testing or point of care testing but We can first we can do that and that's been around for quite some time and our board of pharmacy is fantastic of hey What's what other tests are out there?

What's new and coming? What are patients needing and making sure that that list is up to date? So we have that and then also North Dakota we have a few protocols [00:07:00] throughout the state and For those of you that kind of need , the refresher a protocol is usually set by neither an institution like might be a hospital, but also can be or a state initiated protocol.

Like in our cases, our North Dakota Board of Pharmacy. And we have a variety of protocols that allows the. Prescriber of record to be the pharmacist through that statewide protocol through a board. Those are for tobacco cessation immunizations, like all, ACIP approved vaccines as well as. Naloxone. But right now, in order to provide the test to treat services in our state, we requires a collaborative practice agreement with a provider in the state of North Dakota. A pharmacist can enter into a collaborative practice agreement with a nurse practitioner or a M. D. or D. O. Okay, so it gives us also that ability to enter into a CPA with a nurse practitioner.

So that's some of that background there. Now, there are a number of states that have like [00:08:00] statewide protocols are standing orders for test to treat for, influenza, U. T. I, Strep ,and then there's a couple of states like Iowa more recently and Idaho that have really that standard of care, which gives them kind of a blanket to do a lot of other options, which is It's probably a whole separate podcast, so it depends, of course, where you're state, but that's where we are in North Dakota.

So in order for a pharmacist to prescribe a medication to treat a disease that has been confirmed by a positive CLIA waved point of care test, the pharmacist needs to enter into a collaborative practice agreement 

with a provider. 

Suzanne: I really like that quick overview of where people may be depending on their state.

So you talked about standing orders at the state level, which we might see through like a public health department, the protocols, which I think so many of us are familiar with at the state level from an immunization perspective. And that's actually a question that I get quite a lot in the nine states that I support I think Michigan was a [00:09:00] state that about a year ago came out with immunization.

And state protocol. And so the pharmacist is like, who is the prescriber? It's like, you're the prescriber. It's your name, which is such a cool feeling, but it's like, oh, I have to retrain my brain that, I'm not necessarily going off of a standing order anymore, that it really is pharmacist prescribing.

So, we take a minute and look back at how far we've come. That's really exciting to see so much happening in the States. And I know I'm interested to learn a lot more about standard of care. I keep seeing the emails coming in from Iowa. And I know Idaho has done that. So that's also exciting.

A lot of change happening. A lot of progress happening. And what I want to talk a little bit more with you about is the collaborative practice agreement that you have available for correct me if I'm wrong, but all pharmacists in the state of North Dakota who are either a member or not a member of the state association are able to purchase a collaborative practice agreement that not only has test to treat, but also pharmacist initiation of some important medications.

Did I sum it up okay? 

Elizabeth: Yep. 

Absolutely. And a little background of this is that, [00:10:00] in general from the pharmacists I've worked with, they're hesitant to, and say not everyone, but the majority of pharmacists that I've worked with are hesitant to initiate a collaborative practice agreement.

 How do you start that conversation? How do you get that moving? And I will say it's a lot easier than you think it is. And, funny story, we've had some fourth year pharmacy students who are on their APPE, you know, their rotations who have gotten collaborative practice agreements for the pharmacies that they're on rotation.

They've said I'll go talk to Dr. So and so and then sure enough, we have metformin initiation of, high glucose. So it's really interesting to see that. So, goes to show that it's not always as hard as you think, but one of the roadblocks that for some of our pharmacies in our state that we're running into was that for, especially in our larger metropolitan areas, sometimes the clinics and Hospitals are run by larger entities on DSO.

When our pharmacists would go to maybe a provider that worked for a larger, like a [00:11:00] larger entity or larger health system to enter into collaborative practice agreement, the provider themselves were very open and they were willing. But when it got down to the document, they all of a sudden couldn't because they're the contract they had with their current health system prevented them as a conflict of interest.

And that isn't for everyone, so I would say, don't let that stop you from getting a CPA, but don't be surprised if that, might happen. So there was this appetite, There was a lot of pharmacists like, I want to do this.

My patients want this. 

This is the new thing. And so we worked closely with the North Dakota Pharmacy Association. And I really commend them for taking this on. They kind of literally took the bull by the horns and they were like, we're going to fix this. And so they approached, nurse practitioner that was really very supportive of pharmacy involvement and it was in a real area and really saw the value of what a pharmacy could do for some of these potential [00:12:00] CPAs.

And so our. North Dakota Pharmacy Association really worked on the contracting and getting the CPAs up and running kind of similar to what maybe some states have done with protocols, but our Pharmacy Association actually took that on and sometimes when you enter into CPAs on the provider side, they require an additional writer for malpractice insurance.

And so this writer was going to cost some money. And there was a fee that the pharmacy associations membership agreed. Can there was a vote to put some money towards that? And then in addition there would be a fee to participate in the CPA. So in order to participate in and get the CPAs and be a participating pharmacy there was a fee.

That was outlined which is not astronomical by any means. It's a very reasonable fee. 

So that's kind of where we are right now. And then the greatest thing is there are some tests to treat options the CPAs. So we have COVID-19, influenza Strep and uti. I. So those are things that after a positive test, [00:13:00] would then allow the pharmacist to prescribe a treatment, upon that positive test.

And then there's also a lot of others that, as pharmacists we've had needs for in the past or maybe had patients or we've been, had those, like I call 'em the pickles, right? Where a patient needs something and you can't. Give it to them because you just need a prescription. You're like, this is so silly.

I wish I could just give that to them. And one of those is, albuterol inhaler um, and glucagon uh, are two of those. and so we have CPAs for those, tobacco cessation, semi glutide. hormonal contraceptives, the epinephrine auto injector so those that don't have any refills of the EpiPen and they need the EpiPen because their kid's going to be going to camp and they don't have any refills, that kind of a thing, as well as cold sore treatment.

And of course it's not for everyone. There's standards, right? We've worked with the provider of who can be treated and who can't and we follow clinical guidelines and it's pretty straightforward. So not everyone can get an albuterol inhaler if you walk off the street, right?

You have to have some previous history and diagnoses and prescriptions or whatever. But anyway [00:14:00] lots of really great opportunities for pharmacists to serve their patients and meet their patients where they are and what they need. 

You're listening to Independent Insights, a McKesson Health Mart podcast with host Suzanne Feeney, VP Pharmacy Retail Operations for McKesson/Health Mart. And guest Dr. Elizabeth Skoy, faculty member of North Dakota State University. 

Let's continue. 

Suzanne: You talked about a couple of things that I highlighted that I just wanted to hit on.

One, I love that the student pharmacist was able to secure a CPA. I think that's just, I just have to give kudos for that. And, so many of the Health Mart pharmacies out there, precepts, Students and I just think, this is something that you can talk to them about. They're learning this in school.

Like you mentioned, it's in the accreditation standards. This is a project that they could take on to help you. And as we're coming into the summer months, I know I worked at independent pharmacy forever in college as a student intern. So what a great project to take on. Definitely wanted to call that out.

I also heard you say that members of the state association took a vote on how to move forward with this. And I just love that. I'm always talking with Health Mart pharmacies [00:15:00] about engaging with your state association and moving things forward that fit what the needs of your states and your patients are.

And that just really highlights such a great way to see that work getting done that is supporting practice in the state of North Dakota. That's really exciting. And you described that prescribers were open to this. The providers wanted it, but here was a roadblock.

And so working together to overcome that and having it be in place is just fantastic. I just had to call out those two things because they were exciting to listen to. one of the things that actually came up in conversation today, as we were looking at what's available in North Dakota for CPAs.

I think most pharmacists are really comfortable with obviously COVID, we've been doing that for a few years now, influenza and strep, but with UTI, can you talk a little bit about the need to have that test in a community setting, and how you see the public being comfortable, giving a urine sample in a pharmacy and really the benefit that pharmacy could have to engaging and care for UTIs?

Elizabeth: Yeah. So most of the protocols and it's, not only the North Dakota CPA, but even just the statewide protocols that are out there for UTI, the [00:16:00] pharmacist is not doing a dipstick in the pharmacy. So there's over the counter, UTI tests, right? And same thing we saw with COVID, you could, a patient could bring in a positive test and say, Hey, I just took, UTI test and it's positive, and it can be a picture of the test.

 So it depends on the attestation, things like you can do different things with it, but like the pharmacist, showing that. Yes, they're a positive test for that. And then of course they have to meet certain criteria, like they have to be a certain age, female versus male so , it's not for everybody, but it's for the more common cases.

So a need for that is just the. The amount of that ease for the patient, right? Of again, like they can take the OTC test at home, they can take that and then they can call their provider or they can make an appointment. Sometimes the provider will not give them a antibiotic.

They qualify over the phone, so they have to make an appointment so by that time the patient's how many hours in and dollars in this allows the straightforward cases, this is not a really complicated cases, your [00:17:00] straightforward cases of, yes, this is an easy treatment, the straightforward treatment for somebody, that our protocols, our CPAs allow for that.

Suzanne: And when you offered the training and went through the example CPAs strep, was one of the examples. And I know we're just talking about UTI, but that these CPAs are truly really prescriptive. So it's like, here's who you can treat.

Here's who you can't treat. And I know you talked, through that. I'm just kind of looking here at the document with, strep and what happens if you have positive? What happens if they have negative? It's all really spelled out. And the nice thing is it also offers the opportunity for when to refer.

So when patients come into the pharmacy, yes, they may get treatment or they may get a negative test. But then there's also that triage of Okay, this is a more complex patient, so I need to make sure that they are seen in the office or in the ER. And I think that's an important piece of care that oftentimes can fall through the cracks and then the patient may end up hospitalized when we can help prevent that.

Elizabeth: Yeah, absolutely. We're kind of that gatekeeper. We're determining how sick they are, by doing some of our [00:18:00] CPAs, like for strep influenza require, some basic physical assessment, right? So those are things that maybe a patient isn't taking their blood pressure at home or, there again, it's a good check for the pharmacy to be able to do those things for our patients. 

Suzanne: For people out there who aren't sure about stepping into this space, like when I look at the CPA for strep and I see the inclusion criteria, exclusion criteria, I mean, it is very prescriptive on who you can help and who you can't help support and then what the prescribing regimen looks like.

 Going through that made me feel a lot more comfortable and speaking of training what sort of training is required for pharmacists to engage in this space? 

Elizabeth: It really depends on your states so some states will require certain training or a certain number of hours of training or a specific training.

North Dakota just says that the pharmacist has to have training, and so not incredibly prescriptive, which I love, but continuing education is so incredibly important and I'm a pharmacist and I do a lot of continuing education and I take a lot of continuing education, but at the same time, I don't think we need to say like a training needs to be 20 hours or 30 hours [00:19:00] for you to be able to do something right.

So for the pharmacist, that's only doing strep and influenza, then they get trained on strep and influenza they learn how to do the sample collection. They learn how to use the CLIA wave tests that they're actually utilizing in their pharmacy. And they do a refresher on the guidelines for treatment and prevention and okay, great you have your training documented now. You're good. That's in your CE monitor and you're good to go. So, North Dakota is a little different in that. I would say overall, if you're doing test to treat or, point of care testing in your pharmacy. You want to know the basics of what point of care testing is, you know, so there's some great continuing education programs out there for that.

The requirements of like, what's quality control and you need to have OSHA standards and those types of things. So I think that's a good idea. And then of course, just knowing exactly what it is you're testing for. So you can answer questions and counsel our patients and make the right decisions on behalf of your patients is important.

Suzanne: And I will give a [00:20:00] plug to the Health Mart pharmacies that are listening in. We do have available for you on Health Mart University, a course for you or your pharmacy technicians to take all about getting a CLIA waiver. So that's something, don't be intimidated by that. 

 There's a process to it. So easy. But it's not that hard. No. It's just, you have to follow the rules and you can get that done. And we have training to help walk you through how to do that and links to all the forms you need. So don't let. Getting a CLIA waiver be a barrier. I think once you all go through that, you'll definitely recognize that.

 And then we also have trainings to help with any compliance needs like bloodborne pathogens. There's trainings on that. We have trainings available on strep and influenza, through giving those point of care tests. So all that is on health for university. So definitely take a look there if you're listening in.

 Just a couple other things, Liz, that I wanted you to talk about. I think you do such a nice job with this is, why pharmacy? We have people out there who are looking to diversify, but, I've had people say, I feel like maybe I'm stepping out of my lane a little bit.

And I think for me personally, as a consumer, again, I have just wish I could go into my local pharmacy and get these done. [00:21:00] You touched on a lot of things that I hadn't even thought of. Antibiotic stewardship was the one that I was like, Oh my gosh, this makes a ton of sense. 

Elizabeth: This is my favorite thing to talk about.

Um, and if anyone's ever probably heard me talk about point of care testing or does it treat some of this will sound familiar, but yeah it's. Proven. There's been studies that have shown that antimicrobial stewardship, is improved when you have more of a collaborative practice agreement or test to treat for strep going on in a pharmacy because, there's a lot of pressure on providers out there to give a antibiotic when there's not a positive test or it doesn't warrant antibiotic, it looks viral.

And when you're doing point test a treat in a pharmacy and you're following a CPA or protocol, I can't give an antibiotic to somebody who had a negative test. I can't do that. It's illegal, right? But the thing the pharmacist can do that usually you don't see this or experience a provider talking to you in detail about like over the counter, but the pharmacy, guess what?

We can say, you know what, you tested negative, which [00:22:00] is a good thing, but I can tell you're still not feeling well, let's go out to this aisle. And I'm going to show you the things that are going to directly treat your symptoms. And I'm going to give you a treatment plan, but it can be all over the counter.

And then this is when you should get followup care at a provider. We can provide that level of care to them. 

 So anyway, that's antimicrobial stewardship. Uh, another really big thing for pharmacy is, pharmacy is the most accessible health care provider. We all know that you all know that, but guess what? It is real. That is the truth. And we are located in places where even in urban areas, even in like metropolitan areas, we're serving people that don't have transportation that can't get to the clinic during clinic hours because they don't have vacation and so our accessibility is such a big part of helping our patients. And then also I think of that, just that relationship with our patients and one of the things I've heard from pharmacists who have talked about, well, I'm afraid of having the providers push back because that's their patients.

And I'm like, here's the [00:23:00] deal. Okay. I have a few little kids at home and there is no way in the world that I am getting into my primary care provider or their pediatrician the day they're sick. I mean, I can call with symptoms of strep throat and they'll say, great, I can see you next Wednesday.

And again, I mentioned we're in a little bit of an influenza outbreak here in my community as I think a lot are, and, our wait time for our pediatric walk in clinic is like two plus hours right now. So, think of that, think of those patients.

I would much rather, like you had mentioned, I'd want my pharmacy, I'd much rather go. To my health Mart pharmacy down the street that I visited, that's our pharmacy and I'd much rather go to them and say, Hey, I think so and so might have this and have them tested because guess what, my kids know her, my kids know their pharmacy staff, like they recommend, they give them their flu shots, like they know them.

So my kids feel. really comfortable with the pharmacist, but I take him to someone else and it's a, I know, I don't know [00:24:00] who's walking through that door. I have no idea who's going to walk into the waiting room to see my kids or myself, but I know the pharmacist and they know their history. I could go on about rural access or even clinic hours.

 Especially in our rural communities, we have. Clinics that aren't open five days a week. Even they're only open a few days a week. There's a lot of reasons why the pharmacy, if you haven't been in the space should consider and also why nationally we're seeing this map grow and grow and grow of pharmacies that are doing this.

Because it's kind of the new wave . 

Suzanne: And , I sat in a CE of yours years ago, and you also said something that really resonated with me, besides all the things you just talked about, was the reality of it is, is that patients can also take these tests at home. So if they're doing them at home versus going in their physician, it is nice to be able to talk them over with healthcare provider to help them with their results.

And I always made that connection too which we see some of those at home tests. so the reality of it is, it is happening and it's just, how can you have that conversation with the [00:25:00] prescriber to best service your community and your patients? 

Elizabeth: Yeah. 100%. And, finding those CPAs.

 Like helping your provider in your community, if you don't have something like North Dakota has these blanket CPAs, or you don't have a protocol in your state, maybe talking to your providers and finding out what their needs are. there was a pharmacy that I worked with that the provider was open to it, but they were in a rural community and the clinic was only open Tuesday, Wednesday, Thursday. So guess what? Their CPA was Friday through Monday. So the CPA was executed and allowed. Friday through Monday. So when the clinic was not open, the pharmacist could do this, serve their patients, or after hours or whatever it is.

So you, it doesn't have to be cookie cutter. The greatest thing about these CPAs and things like that is that you really can work with your community and your providers as to what they need. 

Suzanne: Well, the last barrier I wanted to cover with you because I hear this quite a bit is Suzanne.

 I'm set up to bill [00:26:00] for prescriptions. I can't bill for services. So what do you talk to pharmacies about in that case? 

Elizabeth: So, bring me back in five years and we'll talk about medical billing because I really think, I think that is where we're going to be. I have faith. So let's just say that we might be there one day, but we're not there right now.

 But the thing is, that shouldn't be a barrier because this is so beneficial to patients and not every patient. Again, it depends on your patient population, but for cash pay. So I kind of give myself as the example, we were in a situation, a few years ago with my Children who were sick and we wanted to see if they had influenza and same thing like it is now, two hour wait time to go which we didn't really want to do and then also if your copay is like 35 or maybe you have a high deductible plan, or maybe you have to use your health savings for the office visit or even like my plan is labs aren't covered.[00:27:00] 

So you think of those bills, it goes towards your deductible well, then all of a sudden I'm walking out of that provider's visit with probably 200 to 250 that's like ballpark, maybe even low end, right? By the time I pay for the co pay and then I have my labs and then I have my prescription, all of that.

Yep. So would I pay, and I don't want to like price, you know, like don't want to set a price or anything, because there's a lot of pharmacists may be listening to this, but would I pay at a cash price, a reasonable cash price that will be probably lower than that 250 to do this? A hundred percent.

Yes. And I think you'd be surprised at how many of your patients would too for that convenience and for not having to sit in a waiting room for two hours just to know, do I have influenza? Do I not have influenza? Do I have strep? Do I not have strep? 

Suzanne: Cause if my kid doesn't have strep, they're going to school tomorrow.

As long as they feel good. I mean, I'm just saying, as long as they feel good. Yeah, 

Elizabeth: exactly. And like, that's kind of it, right? My kids have always gotten their flu shots and all of [00:28:00] that, but sometimes when it's circulating, then they're feeling crummy, hey, you know, wild to mild, at least they weren't, no one was ever hospitalized, but you just want to know, you don't want to be spreading that to anyone.

So do not let the I can't bill for medical stop you right now. Maybe one day we'll be doing CEs on that and in different podcast on that. But right now, this is something that patients are paying cash for .

So 

Suzanne: yeah, I think the price point plus the convenience factor and then the ability to use HSA dollars for those of us who are on high deductible plans. It makes a ton of sense. Underinsured, uninsured populations, there's a lot of different, populations that could benefit from this.

So I think that's definitely something. To I agree with you, like, don't want the fact that maybe you can't bill for this. And I know some people are, and we're having steps towards medical billing. Even if it were me, I would start with the cash based business first, and then feel like you can grow into medical billing.

Um, right. So I know. 

Elizabeth: Yep. 

Suzanne: Liz, one of the questions I get a lot is how to layer on a service like this when I'm short staffed, I don't maybe have enough pharmacists. And there's a [00:29:00] lot that I think we can talk about within workflow, to help with automation, to help free up pharmacist times. But I think one of the things related to test to treat and some of the services we've talked about is really using the pharmacy technician to their maximum ability.

And I think we've seen a lot of success with that. So can you share a little bit about what you've 

Elizabeth: Yeah, so we all know how well the pharmacy technicians for providing immunizations is going, right? I think that is, that has really been a game changer for pharmacy. Um, and also for pharmacy technicians. I just, I love the pharmacy technicians that are passionate about vaccine and providing immunizations.

So depending upon your state, pharmacy technicians can often do the sample collection and actually deliver the point of care test. So again, check with your own state, but there's an advanced technician, program, training program on this for CLIA waived.

So that's one of the modules you can take for the advanced tech training is about Providing, clear way of testing. So this is not in some of our, technician programs are starting to [00:30:00] touch more and more on this. As well as there's a lot of continuing education out there.

So again, think of this as the pharmacist is really the one that's interpreting the test. They're interpreting the patient intake form as to whether or not they can be tested or they can't be tested. And then they're providing their consults. That's really where the pharmacist is coming in here. You were using that clinical.

Acknowledgement judgment from the pharmacist. So the technician is really doing everything else. Can do everything else. In our pharmacies in North Dakota, for instance, providing the forms to the patient to fill out about their health history and their symptoms, obtaining consent and collecting payment from the patients before they actually get the point of care test.

Also, as I mentioned, depending upon the point of care test or a CPA that you're even executing, you might need physical assessment taken. Well, they can take blood pressure, they can take a temperature, they can utilize the machines to get a pulse respiration, oxygen saturation.

They can get a weight if you have a pediatric [00:31:00] patient in order to dose that antibiotic for potential treatment. So they can collect, they can do the physical assessment and they can document that, they can again, depending on your state, you can do a specimen collection. They can do the quality control that you might need with your equipment.

They can reorder the supplies. So really there again, we're seeing this, the roles of the pharmacy technician. So for workflow, some of the studies that have been done on this in pharmacy is it really takes the pharmacist about the same amount of time as you would a vaccine.

So it's about that same amount of time as the pharmacist involvement in immunization delivery and probably even a little bit less now, the front, the technicians themselves are being able to collect the sample. Really big opportunity for pharmacy technicians, and that can help with staffing shortages for pharmacy, which workflow. 

I always say, maximize the abilities of your workforce to the maximum. That's from pharmacist from doing these types of things to our technicians. 

Suzanne: [00:32:00] Yeah, and the pharmacist is able to step in, like you said, interpret the results, follow the protocol, and have that prescription dispensed or not, depending on results.

But like you said, it really just takes, you Asking the prescriber even if your state doesn't have something that you can leverage and making sure you're following your state practice rules. 

Well, this has been so informative. I really appreciate your time and just all the work that you're doing. And for those who are in North Dakota, it's super exciting. I know a lot of the other states out there are doing similar things, but, I'm really glad we could bring this to all of our health Mart pharmacies, because I think everybody can, dip their toe in the water in some sense, just, following your state practice rules, getting engaged with your state association, and training up your staff.

Elizabeth: Yeah, absolutely. Thanks so much for having me Suzanne

Suzanne: Well, I really appreciate your time, with us today. So thank you so much for sharing and with independent insights that we try to with this podcast, bring together independent pharmacy owners and other community pharmacy experts like yourself to just inspire pharmacy practice, to transform pharmacy practice.

And I invite all of our listeners to plug in, to hear more [00:33:00] innovative ways to strengthen your health of your pharmacy business and take care of your patients in your communities. We do have these business type focused episodes once a month. So we hope you'll listen in wherever you listen to podcasts. 

I'm Suzanne Feeney, Health Mart Pharmacist, signing off. Stay tuned, stay inspired, and keep making a difference in your communities.

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