Home Forums Discussions General Discussion Forced to have patients come in for refills

It appears there are 3 new things Drs offices are going through re: eRx-

1. PCMH- here in MI, they want the statistics of eRx sent- % with numerator and denominator and we are supposed to reach higher number every day.

2. MU- tied to eRx.

3. Penalty of 1% in 2012 if not eRx per Jon's status update.

With this we have to add G8553 at the TIME OF VISIT to get credit. If we do eRx the day before/day after or anytime but the visit, we do not get the credit and/or we get penalized.

So we are forced to have patients come in for refills. NO REFILLS ON PHONE DUE TO NEW FEDERAL REGULATIONS OF EPRESCRIPTION is what our new office notice and website will say.

So far, we did not have problems of refilling on phone especially if pts were just seen recently. Now we are not at the liberty to avoid above penalties.

Just like those airport warnings: DUE TO NEW FEDERAL REGULATIONS: Please do not leave your baggage unatt.......................

But, if the patient was just seen recently, why do they need refills that quickly?

This happens to me all the time. Patient misses an appointment, dog eats it, had to reschedule. I send in a bridge Rx electronicallly and I guess penalized.

Unless they were in recently, we make them come in anyway. But that is an appropriate sign to post

We might start doing that, clogs up the schedule and the insurance gets billed for an appointment that really isn't necessary clinically. They have to pay the co-pay. Maybe that is behavioral therapy?

Bill,

I agree with you, but I have no sympathy for the insurance getting billed.

It would be a quick visit and might make up revenue that is being cut elsewhere.

Tom

We write for the number of refills we want patient to until next seen, so demanding an appointment is ordinarily no problem. My major bugaboo these days is when patient changes insurance company, and needs all meds rewritten for new mail order pharmacy. As dedicated as I might be, I do not work for free, and unlike a my lawyer (who once billed me 0.1 billable hour for phone calls attempted but not completed due to busy signal), we don't get paid for time not face to face. Time and expertise is what we are selling. I may get soft on the "dog ate my furosemide" excuse, but if it is so the insurance company wants to save money, they can pay me for the privilege of assisting them. I would put this in the same category.

Absolutely agree.

I will refill (most) meds when reasonable, and when the request for a refill comes from the pharmacy.

If I have to re-write (e.g. for "mail-in" pharmacy) or change the prescription, then it is a new prescription, not a refill and the patient has to make a visit.

I almost never respond to patient requests to "call my pharmacy and refill my meds" type calls -- not even if they say "please".

I have often looked longingly at practices with signs that say no refills given after hours, bring your bottles to every appt. I have a sign up to bring the pills, but they usually do not, and have continued with refills. It seems there would be a big objection to not doing phone refills.

First, there is the terminology. I know that you know the proper terminology, but the patients and seemingly the pharmacists don't, so we are specific with it.

A "refill" is listed on the bottle and no new Rx is needed. This is what we tell patients. If the bottle says "# Refills 0" then what you are asking for is a "Renewal" of the prescription. All renewals require an office visit. We do not honor renewal requests directly from the pharmacy. Patient must come in. And yes, sometimes there is some objection on the part of the patient about this, especially if they don't think its a serious issue (or sometimes even when they do.) We tell them, if you need a prescription for it, or if you need a doctor to tell you if/how to use it, it is a potentially serious issue and you must come in. Even for OC renewals. But remember, a certain number or refills were included in the initial Rx, so typically its been 6 months, or possibly 12 for some women taking OC.

We're getting closer!

I actually will allow "renewals" when appropriate, as long as they come from the pharmacy and we don't have to be troubled with calling them in.

For many patients, I don't want to put "Refill #x" on the prescription, because I want to monitor their refill frequency. In those cases, the pharmacy will fax a request for a refill (renewal) and I sign it off.

What I won't do is generate totally new prescriptions or write seemingly endless prescriptions whenever they change pharmacies without a visit.

We used to get ~50 refill requests through our paper fax machine daily. This was causing a huge headache for the staff and wasting tons of paper. Since we have switched to electronic fax, our policy has changed greatly. I see almost 80% of my patients every 3 months (1 month supply with 2 refills). We will only renew a prescription for a 1 week supply for well-known, long-established, compliant patients. They then have to make an appointment to come in when we authorize an extra 1 week supply. Everyone else needs an appointment for RX renewal, unless it is a serious matter (coumadin, insulin, etc).

Pharmacies in our area LOVE to send refill requests for long discontinued medications, so we ignore ALL pharmacy faxed requests now. They also love to tell Hispanic and low-income patients their insurance does not cover a certain med or that they only have the brand-name in stock. I have caught pharmacists in the middle of a lie several times, but that is another story.

This is the difference between pediatrics and FP. Well just one of them anyway.

What is?

Well, let me give four quick scenarios. We have a 24-hour policy on refills. That's still better than most at least from reading on here. It is still difficult when a patient calls to get their next script of Concerta (we usually give two scripts but until lately we couldn't or didn't give three) and some patients are on an every three month med check schedule. So, they have to call for the med. They are supposed to call a day ahead of time so we can process it, but if they call at 9 am, it's kind of hard for me to think, well it will take one second to print it off and another to sign. I know. Piss poor planning...and all that. But a week ago, my newest staff member told a parent at 10 am they would have to wait until the next day (just like she is supposed to). The patient got a little upset. I know. Who needs a patient like that? But, my other staff memeber had been telling them they could get it in the afternoon.

Today, we had a similar situation so we had one of those, "Put the phones on hold, we are having a mini meeting." To be honest I didn't know what I wanted to do. Just wanted a policy. We have signs everywhere. I look at it like maybe 80% of patients honor it. Same way as for every patient who calls at 2 am with a 99 "fever" there are 200 who didn't call and five that had two year olds with fevers of 104 who didn't call. Personally, I have generally joked that we need 24 hours, but if they call in the parking lot on their cell, I will fill it. It's just not worth the hassle.

While we were having this mini meeting, a 16 yo walked in who had fallen off his bike two days ago. He had come from Walk-In Care with a bandage/bandaid on his chin and wanted a script for Tylenol and Motrin. Yes Mainecare will cover that. They cover most OTC meds, even Melatonin, which costs about $2.00 for 5,000 tablets. OK, maybe $3.00.

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But, I digress from the very beginning. I think I am with you on this. Not that there is a right and wrong. Parents are simply different than a 38 year old. A 38 yo will wait a day for a script. A mother will not let her 5 yo go without codeine or whatever for a cough for two hours. It's just different. If we didn't fax, ePrescribe, call, print out prescription refills, we would lose patients left and right. People can say that you don't want those, but we do. We have to have them.

Take a one month old on Zantac. Sure, they have WCC checks every two months. But, if a mother or father calls a week before the four month check asking for a refill of Zantac, am I going to so know; they have to come in. So, I see them and say, "So how is little Susie doing on the Zantac? Great. OK, here is a refill."

Other meds are different.

I talk to Adam (Family Practice) down the street, and his entire practice is different. From his hours to the number of calls to the fact that he could just put a "Gone fishin'" sign out and maybe one patient would be upset. Patients are just different than parents.

Sorry, rambled on a bit.

Well, it was a nice ramble. I just got an evening email from a patient who I have not seen in 6 months. He HAS to have a refill by tomorrow. He is upset that he has to call to get a refill after 6 mo and I didn't just right him for a year of sleeping medicine. He also thinks I charged Medicare too much for a home visit 6 months ago for his dad. I haven't heard from him in 6 mo, but says he is 'very upset.'

I think that fax is just automated and goes out after enough time for refills. We get these all the time where the patient has moved and no longer goes to that pharmacy. Or the med has been discontinued.

I did have a patient attempt to get snarky with me the other day, asking why she had to come in since she was just in in January (6 months) and I wasn't exactly syurpy sweet when I replied that its the rules, its our policy, you must come in for all renewals of prescriptions. If you have run out, Dr C will write you a 2 week supply. Of course, all patients receive a sign a copy of our policies which state that you must come in for all renewals.

@Bert--yeah, each business and patient population is different. And I am sure there are things we can do that as you said you cannot when dealing with concerned parents. Yep, you would be wise to not even try (and you don't).

Oh, yes it annoys me that Medicaid pays for OTC meds. Commerical Ins will too for certain doeses...like 600mg of ibuprofen. We have had patients who really didnt need that high a dose call and request it so the insurance would pay for it. The pharmacist told them to.

Great post, Wayne.

@Boondoc The upset was needs a "letter." The kicker is that this happened on a page.

On a similar subject, another issue that comes up that doesn't need to is the fact that the office needs drama. We are all human, and all of us (definitely me) sometimes get a little upset with the first person they talk to on the phone. Just an initial reaction or vent. I don't mean being rude. So, instead of just sending me a quick note, my staff feels obliged to go into to detail as to what they said and how they were upset, etc. That, of course, changes the way I look at the whole subject. Instead of saying Ms. Smith called and wants you to call her back about X. She did seem a bit frustrated, they will say the first part, with and she was very upset she had to do whatever. Something like that.

Because, as you know, sweet as pie in the room. Not saying my staff should be abused. Hopefully you get the idea. And, there are times you do need a heads up prior to seeing a patient.

Now I take a somewhat different position to Bert. I will NOT refill routine meds after hours. I had a patient call me yesterday about a tylenol refill 30 minutes after the office closed (medicaid) and she was told it might have happened if she had called an hour earlier. Now she would have to buy it.

If they have an appointment coming up, I will give add refills. I am generally liberal for 1 year after the last visit, at that point SORRY. Some of this also depends on the medicine. I have a different policy for asthma meds vs a meds for enuresis.

Good policy. I don't prescribe after hours either. Sorry if I gave that impression.

But, I did have to change my policy with the answering service. It was...NO refills after hours EXCEPT asthma meds. But, then, they would hear any medication, like "Dr. Adams usually calls in Prednisone for asthma/croup/poison ivy or Tylenol w/codeine for severe cough and they take that as a "refill." And, I can't blame them. It's too much for them to discern.

So, now they page them out, and I decide.

But, you know, when the patient washes the kid's jeans and the Klonopin gets wet, and they go to dry them and they fall down the sink, and they retrieve them, but then they are stolen, I just believe them and write for more.

Why can't we see them and refill, but if over the phone, there is a X amount of dollars tabbed on. Probably not doable.