If you missed our post from October 19th, we promised to identify some sources of administrative waste highlighted by a The JAMA Network article highlighting the $935 billion that is lost without tangible benefit in our healthcare system annually. The authors, while identifying the scope of the loss, offered no meaningful solutions. We will try to help them with that.

 

Each day Santa Monica Primary Care we handle anywhere from 20 to 30 prescription refill requests. The bulk of these requests come via our E-prescribe system to which I was an early adopter and remain a strict adherent. There are a number of advantages to adopting a fully electronic prescribing system, the most compelling of which is patient safety. (More on this at: https://www.healthit.gov/…/state…/eprescribing-adoption/)

 

An additional consideration for our practice when refilling a medication is state guidelines. Particular states limit renewals to 12 months while others allow a longer time period, for example, a 90-day supply with four refills – a 15-month window. Why does this matter since we are in California? It matters a lot because we may be filling prescriptions in other states for patients who live elsewhere or are traveling. Additionally, many patients are now receiving prescriptions through mail order with fulfillment centers in Missouri, Arizona, Rhode Island among others.

 

What is fascinating (and sadly true) is that “work of prescription renewal has become so ingrained in practice that many physicians no longer recognize it as waste (Family Practice Medicine; Nov-Dec 2012).” This article goes on to point out that “physicians commonly renew scripts for an arbitrary number of refills, thus guaranteeing unnecessary work for themselves and their staff a few months later” (also sadly true).

 

Fortunately there is a solution! The solution is to synchronize prescriptions around the annual visit, providing sufficient refills to last until that time, and to ensure that the next annual visit actually gets scheduled

 

We are often asked our “office policy” (or receive feedback via Yelp/Google) regarding medication refills and the annual visit. Our policy is really a philosophy: 1. Ensure that the medication is working for you and remains appropriate. 2. Evaluate for any potential side effects of the medication that may have developed. 3. Integrate the medication’s use across all of the patient’s conditions. 4. Confirm that there are no drug-drug or drug-disease interactions.

 

As eloquently said in a KevinMD.com blog focused on this issue: “So, when we ask you to stop in for a brief visit, it’s not because we delight in hassling you or are hungry for your co-pay. We’re trying to protect you and to keep you well. Doesn’t this seem like the right prescription?”