According to research published this year, quality-linked dispensing could be a performance-based payment model that will improve the patient outcomes and benefits to the health system.
Pharmacist Counselling Fee
The Proposed Model
Dispensing in community pharmacies in Australia is currently remunerated on a fee-for-service basis with little room to create incentives for better performance and quality of care.
Through quality-linked dispensing remuneration, pharmacists could provide enhanced counselling that will improve patient outcomes and bring other benefits to the health care system.
Researchers at the Monash University Faculty of Pharmacy and Pharmaceutical Sciences suggested that instead of fast dispensing, it would be better for patients and the healthcare system if pharmacists were better funded for improving the use of medicines rather than just supplying them.
Thanks to increasing healthcare costs around the world, researchers from the healthcare systems have been experimenting with performance-based payment models that link payments with the quality of care provided. And some countries have started to introduce alternative models that link the level of funding to the quality of services provided by healthcare practitioners.
The United States has experience with performance-based payments to pharmacists, with evidence suggesting lower total costs of care and better medication use from adequately paying pharmacists to proactively address all necessary factors at the time of dispensing a patient’s medication.
In the UK, the government’s Pharmacy Quality Scheme works similarly to the Australian Practice Incentives Program for General Practitioners with the aim to track improved performance in areas such as monitoring drug use and patient safety.
A minor concern about performance-linked payments needs to be considered. Performance targets should not be too onerous and time consuming as this may impact other areas of a pharmacist’s regular job. There is evidence that suggests improved patient outcomes and it should be applied naturally without putting pressure on a pharmacist’s performance.
Under the Pharmaceutical Benefits Scheme (PBS), pharmacies receive a handling fee and mark-up on the cost of the medicine to cover the commercial cost of maintaining the pharmacy.
There is also a dispensing fee for the pharmacist’s professional services. These include reviewing the prescriptions to ensure all necessary factors for the patient have been considered and a record has been created for the dispensing, labelling the medicine, and counselling the patient on the necessary information.
Generally the basic dispensing fee for a pharmacist with Ready-prepared medicine is currently at A$7.39.
Higher dispensing fees are paid for medicines requiring more security (such as controlled substances) and for various medicines a qualified pharmacist has to prepare themselves.
But the dispensing fee to the pharmacy does not currently change in line with the level of counselling given to the patient. This creates the perception that the current funding model does not benefit the pharmacist to spend time with the patient to proactively go over all the factors pertaining to the particular medicine.
If the pharmacist spends more time counselling the patient, the amount of prescriptions they can dispense may be lower and thus also the fees the pharmacy could receive.
The Proposed Model
With the aim of improving patient outcomes, counselling to patients should be an integral part of a pharmacist’s activities. Appropriate remuneration models need to reflect this .
Dispensing fee for a prescription is recommended in the research as a way to encourage the pharmacist to interact with patients and help them with advice on the best use of their medicine.
The proposed changes would require a major restructure to the funding model and dispensing prescriptions. There would also need to be agreements on reliable and valid performance measures and information systems to help with this.
In the end, funding based on a professional services and performance-based model rather than a volume-based model would greatly support pharmacies in Australia with the patient outcomes and improvements to the overall healthcare system.
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