Home Forums Discussions General Discussion Prescription screen needs pharmacy info

There was a thread discussing this before. I fax prescriptions from my wireless tablet as I see patients. If I am doing a phoned in refill request, which I despise, I would like to have the preferred pharmacy on the prescription writer page. Until that happens, I've started adding the patients preferred pharmacy as the first prescription on the screen. I use a leading period to put it at the top of the MED LIST.

In Medication & Dose: ".Pharmacy Name" in the Sig: I put the Zip code. You could place the phone number, etc...


My related ranting:

I always write prescriptions at office visits that will cover the patients until their next visit. It is amazing how many people ignore their recommended follow ups and think I am simply the phone in medication refill service. I now will do seven days of medication, sorry you have to pay your full monthly copay, for those patients who decide that my medical recommendation on appropriate follow up for medical issues that involve prescriptions that I write is optional. If their cardiologist wants to give them eleven refills, and they skip follow up for a year, that's on them.

I expect that this will cut down on the unreasonable amount of time my staff and I spend every day (non billable) to address the concerns of this minority of patients.

Of course, we never put a patient at risk by withholding medications, but they don't have to know that.

Billl,

You're on a roll today. Do you have the day off?

Anyway, I jumped for joy for two reasons:

1. I more than despise calling in scripts. Always fax. Which is one of the reasons I caught my MA calling in Vicodin for a month under my name (but let's not turn this into another thread on narcotic abuse).

2. Your workaround. Very nice. I love them, but they ALWAYS indicate there is a need to have something changed and done correctly.

While we are venting, I also love it when a patient calls me at home when I am on call asking for a refill; but they don't have the pharmacy number. Then I call it in only to find out there were four more refills.

Hey gang,

Our policies are for our DOCTOR's sanity, not the patients. If a patient calls on a weekend or after hours, they're told to CALL ME BACK with their request when they have the pharmacy phone number in front of them. So sorry, NO, I'M NOT GOING TO LOOK IT UP. I'm on call, but not on duty. They're YOUR meds, YOU do the legwork. I also point out to them that they open that bottle at least once a day - the time to call is Monday through Friday during business hours, BEFORE the bottle is empty. I yell at them. I'm not above this. Sorry, acting professional does not necessarily mean rewarding laziness or stupidity on the patient's part. They've known now for a week they're almost out, but waited until Saturday at 8:00 AM - so as to "catch me early before I'm busy", never mind that I'm sleeping, to call for their refill.

You're out of refills? Means you're due for a follow up. I'm VERY liberal with refills - if you're on something that you're going to be on forever, you either get a month with 11 refills, or a quarter with 3 refills. When your year is up, is time to come in.

Things that can't be written that way, you come in and pick up the computer printed script. Again, don't like it? go elsewhere. My girls are NOT here to spend the day on the phone or fax for you, not for the $40 your insurance company paid me for half an hour of my time for your office visit. The exception is if you're 90 years old and shut in.. those we fax.

Out of pain pills? You're S.O.L., baby. NO phoned in "emergency" narcotic refills. None. Never. Yeah, I'm mean. Don't like it? Go somewhere else where they'll put up with your b*lls*it. Oh, it's an EARLY NARCOTIC REFILL on a weekend??? You're risking being dismissed from the practice for violating our narcotic policy for taking controlled substances other than as directed. We enforce this. We also drug test.

I find that most of the time when we say NO to unreasonable requests, the patients say "OK", and they start holding up their end of the bargain. We've only had ONE patient leave because we wouldn't phone in their kid's Rx. The father lives less than a mile from the office, and always sent the kids in with their grandmother because he was too lazy to bring in his own kids. We were sorry to see the kids go - they were nice kids - but the dad was a pain in the behind, and wasn't missed.

<sigh>

Putting that aside, having the patient's preferred pharmacy on the Rx screen should be a relatively easy hack, as the patient record set is already in memory, and I believe that the patient's pharmacy is part of the demographics record. Having a fax server as a printer, with the pharmacies listed so you can just pick off the one on the screen would be cool.

I've cut my patch-writing down to almost zero, as I've been too busy with running the practice and projects at home to do much, but I'll look at this, or if Jon reads the board, maybe he'll consider having one of his programmers add this.

Regards,

V.

Billl and Vinny,

I run my clinic almost identically. I don't consider myself mean-spirited, but my sanity runs thin when I'm on call 50% of the time providing liability coverage for everyone else in the medical industrial complex. I have washed my hand off of all nursing home patients (can't handle their stupid phone calls "just to let you know the patient fell and bumped his head, but the patient doesn't need to go to the hospital" and the insubordination after ordering a patient to be evaluated "the other doctor calls in Vitamin K for her vaginal bleeding and I want an order for Vitamin K", the lies and misrepresentation of events when I am on call). I have not recieved one call for refills over the past two years from my patients. I never call in or FAX antibiotics, controlled medications or pain meds. If one ever is called in or FAXed, I know I did not authorize them. In fact there has been one arrest for fraudulent use of prescription by FAX.

If the insurance company requests/demands information that takes up my time for preauthorization or appeals, you better believe that I'm going to be reimbursed for the time spent. Patients need to see what I need to go through to get their ARBs approved. If it costs them inconvenience for the stupid barriers that insurers put into place , that is not my fault.

We need to stop being everyone's doormat if this profession is to survive.

Hi, folks,

The patch to put the pharmacy on to the meds form consists of adding a box for the preferred pharmacy, and then adding ONE LINE of code to load it. If I get a chance I'll prepare a patch for Jon. Took about 3 minutes to code up. Would be nice if the pharmacy phone number was part of the database. Can't display a field I don't have.

I've taken to telling patients that the "MD" after my name does NOT mean "Masochistic Doormat". Some of them even get it.

V.

Thanks for letting me see I'm not the only one with some of these frustrations. It's been a hard week!


Barbara

Roy,
Question: You mention getting paid for the prior auth work. Just what are you doing? Requiring an extra office visit for the prior auth or have you found a loophole that allows us to charge for these managed care pains in the bootie busy work??? Love to know what you know.

The ones I hate the most are the prior auth referals that the patients, usually mom's asking for kids, want to get without a real office visit or having our doc in the loop. I had this one mom threatening to leave the practice (I wish she did with her attitude) because she wanted to send her daughter to derm and need a prior auth. Didn't you all know; you went to med school to be a monkey with a rubber stamp. Cha Ching! Have a great weekend all...
Paul

Hi folks,

Sent an instant message to Jon about putting the pharmacy on the med for banging out prescriptions - added a single field to the form and a one line patch. If he wants to he can either add it in about 2 minutes - was all it took me - or I'll mail him the patch.

I bring people in for follow up visits if they require regular refills on narcotics or other controlled substances, or are on medications that require prior authorizations, since just about everything that requires a prior auth requires that they FAIL on formulary meds before the auth will be approved, and to either get enough history to document the failure on the other meds or to try them on it requires doctor time and prescriptions.

Enjoy what's left of your weekends.. I'm going back to my charting backlog :-(

V.

My answer would be "buh bye.. and don't let the door hit you in the butt on your way out" WE treat acne.. they get a derm referral if I can't fix their acne. I use the same Rx products that the local derm uses, and unlike my local derms, I don't try to sell them private label overpriced meds with my own name on them. Zit goop ain't brain surgery.

The ones that REALLY make me nuts is "Hi! We already went to the specialist we didn't tell you about, and THEY say that YOU need to do a prior auth for the visit we already had, and see if they'll back date it." If I don't think they should have gone, they get to pay for the visit.

Yep, I'm mean. Get over it. The contract is between them and their insurance company, and usually when we start asking them, they fess up and admit that they KNEW the rules, they just figured because we're all friendly folks, we'd just give 'em what they want. Nope, sorry.

In the words of the immortal Mick Jagger - "Yooooo Can't Always Get What Chu Waah-ant"

Grumpilly,

V.

Paul,
Getting a prior auth takes more brain power than prescribing ZIT GOOP. My patients are told that additional information is needed to fill the stupid forms the insurance company expects us to perform. I just don't have the time to do this over the phone (and I do need to document stuff the patient has tried OTC in the chart). The additional cognitive workload for a prior authorization usually is a 99213. It's not my fault that the insurance company requires me to get superflurous information to fill their forms. Patients need to come in for me to collect this information (and possibly needs a physical evaluation to make sure their information is accurate). By golly, the last thing I want to do is commit FRAUD by documenting stuff on a prior authorization form that is not accurate.

Hope that helps.

Roy

While you are at it, Vinny, can we get a line for a comment on the script? Or maybe it could be the same line?