By: Randy McDonough, B.S., Pharm.D., M.S., CGP, BCPS, FAPhA
The other day I shared my thoughts with CMS about the impact that retroactive DIR fees are having on patient care and the viability/sustainability of pharmacy practice. When making my points, I try to tie it back to patient care in hopes that it emphasizes the criticality and urgency of the situation. These were my comments:
“When COVID 19 hit we made several large investments in equipment to ensure that we could be a solution for our community including the purchase of an ultra-cold freezer, a trailer unit, and equipment to ensure the safety of our patients and employees. We have provided approximately 20,000 COVID 19 vaccinations in the past 2 years and work closely with our county public health department, social services, and the emergency management agency to ensure we are providing vaccinations and other services to our most vulnerable patient populations. We are stressed, burned out, and challenged—but we never stop, we never close, and we continue to a solution for our community. Then we get our financials for the past year and there is nothing to show for our efforts. It is defeating, it is depressing, and IT IS JUST WRONG!!
Much like other community pharmacy practices, our cash flows are being hit hard. Now we also have to worry about the retroactive DIR fees that will hit us in the first quarter of 2022—further negatively impacting our financial viability. I have seen a large number of community pharmacies close in Iowa, a rural state, leaving communities without a pharmacy or health care provider. At one time our state could boast that we had a community pharmacy in each of our 99 counties—sadly we are far from that statement today. I have communities approach me regularly begging for us to open a pharmacy and my response to them is the financial model is just too unsustainable. This is not just happening in Iowa—this is happening nationally.
The negative impact on pharmacies and patients cannot be emphasized enough. I went into pharmacy because I wanted to help others. I became an owner of a pharmacy practice because I wanted to be part of the health care team for my community. Now I wonder how long we can sustain our practice due to the negative financial impact of retroactive DIR fees. Our patients and our community count on us to be there for them—I hope that I can!”
I have no idea how my comments were received. All I know is I can no longer wait for a system to change that doesn’t appear to want to change. The current system is rigged and I no longer trust it. For me, it’s creating a new business model because the system we’re in is unrepairable. These new models include direct contracting, cost-plus cash basis dispensing, cash only services, concierge practices, and other strategies that bypass the traditional payment methods. It’s time for something new!
“It is difficult to say what is impossible, for the dream of yesterday is the hope of today and the reality of tomorrow.” Robert H Goddard
