Changing the model

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It’s time to move Australian community pharmacy to a new payment model that rewards time spent with patients, but how would it work?

Current pharmacy dispensing-based payment models disincentivise patient counselling, and Australia is falling behind in not moving to change this, says John Jackson, Director of Project Pharmacist at the Centre for Medicine Use and Safety, Monash University, Vic. 

Mr Jackson wrote earlier in the year that “rather than fast dispensing, it would be better for patients and the health-care system if the funding model paid pharmacists for improving the use of medicines, not just for supplying them”.

Now Mr Jackson, a former PSA Pharmacist of the Year, has elaborated his views in a case study, published in the Australian Health Review

In it, he says: “the only financial incentive for a pharmacist funded for dispensing on a fee-for-service basis is to dispense as many prescriptions as they can, as quickly as possible.

The pharmacist is financially disadvantaged if he/she increases the time spent counselling a patient or advising them to delay having a prescription dispensed when it appears that they should still have an
adequate amount of medication”.

Mr Jackson says that while historic funding models have rewarded volume over quality, a number of other developed health systems had already moved to implement performance-based funding models.

“It is unlikely that pharmacy in Australia can continue to rely on an episodic, fee-for-service model of remuneration for dispensing and enhanced service delivery while healthcare funding agencies globally consider performance-based remuneration,” he said.

“In recognition of variations in the level of the pharmacists’ input and to deliver greater value, prescriptions could be funded using a blended model that combines a basic fee-for-service payment with a performance-based adjustment linked to quality-related inputs, or preferably improvement in outcomes,” he suggests.

Mr Jackson, and his co-author, US pharmacy academic Ben Urick, said that in the US, performance-based pharmacy payment models usually assign a score to pharmacies and use this score to
determine upwards or downwards adjustment to payments, such as for prescriptions. The score is normally a composite of several component measures, but there has not been a published study on
the validity of composite pharmacy performance measures.

“Given the pharmacy profession’s minimal experience in performance measures in Australia, it would be wise to begin with a simple set of input and outcome measures,” they said.

“Drawing on international experience, a first step towards a new remuneration model for dispensing could be to link adjustments to payments with a performance measure such as patients’ adherence to prescribed medicines,” they recommend.

“The combination of two principals, namely that counselling improves adherence, which improves outcomes, forms the basis of the model,” they conclude. “To be successful, the measure would have to be
developed and validated specifically within an Australian context.”

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  1. Paul Sapardanis

    Easiest way to do it would be for funding to be based on pharmacist workload. More you do the less you get. Private prescriptions would also be included in the workload.

  2. patrick Mahony

    I am unsure of the latest information, but in Canada in 1998, the Canadian Pharmacies which had a fixed fee for every Rx dispensed (irrespective of cost) would receive 2x fixed fee if for any reason they did not dispense an item at that time. An online report would confirm reason (too early, Rx invalid/wrong, changed/new meds, too late, etc). We could be rich if we were paid for this ervice

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