Like Walmart expanding into the grocery business, medical practices have begun branching into services that will up their revenue and deem them one-stop medical shops. That includes opening pharmacies inside their offices.
In January, Cullman Internal Medicine, a large practice of 12 physicians and 12 nurse practitioners, opened their pharmacy on the floor housing their internal medicine offices. The idea sprang from wanting to offer another service to their patients. “A lot of them ride the CARTS bus (Cullman Area Rural Transportation System), so they have to pay every time they’re dropped off somewhere, and two dollars is a lot money to some people,” says Debbie Brumbeloe, practice manager.
Now those patients can stroll right into the pharmacy before they even leave the doctor’s office. Though not as extensive as other independent pharmacies, Cullman Internal Medicine’s pharmacy stocks maintenance drugs for conditions like blood pressure, COPD, and cholesterol. “The everyday medications you need on a regular basis,” Brumbeloe says.
The very first customer who used the pharmacy was a CART bus rider. “She came in ecstatic that we had a pharmacy, because she has to pay another $2 and then wait another 30 minutes for pick up when she needs a prescription filled. And with us, her over-the-counter vitamin was less expensive. And she avoided more time in the rain,” Brumbeloe says. “She was absolutely thrilled and let us know. We have had multiple compliments like that.”
Initially, Cullman hired only a pharmacist. Within a few months, they’d hired a tech. Even Brumbeloe sent in her $60 to become a certified pharmacy tech. “Because if you’re not a tech, you can’t go behind the counter and count drugs,” she says. The certification allowed her to accept inventory that first week before the pharmacist arrived and stock the shelves. Now when they get busy, Brumbeloe can run the register or count pills. “I’m accountable if there are questions about the business, and being hands-on for me is how I’m going to know the answer,” she says.
Besides filling basic prescriptions, the tiny pharmacy does compounding for their physicians. “Like pain creams for our sports medicine physician, where he adds certain drugs like lidocaine or steroids,” Brumbeloe says. “Or some elderly patients who don’t like to take pain pills for aching joints, will rub a compounded pain cream on their knee.”
Done in-house, the compounding by their own pharmacist comes out cheaper. “Because we had to order out of Birmingham for compounds, except for some things, like poison oak or the magic mouthwash,” Brumbeloe says. “Most independent pharmacies do those things.”
And that’s where the practice hit opposition. The town has 15 independent pharmacies. “The local pharmacies were upset,” Brumbeloe says. “We’re in a small community, and we’re a large practice. They were scared we would put them out of business. We didn’t want to take business from local pharmacists, but we still felt like with the compliance issue and assistance with formularies and it being a good service to offer patients, it was the right thing to do.”
But Cullman Internal Medicine is not interested in competing with the full-service drug stores. “For one, we’re limited being on the third floor. We don’t have a drive-up window, and people have asked for one,” Brumbeloe says. “And we’re not open weekends, and that has been a deterrent for some.” Though she says they do offer an automatic refill service that can deliver through the mail, as long as it’s not a narcotic.
The tiny, 800-square-foot pharmacy can’t compete much in the over-the-counter arena either. They stocked what physicians would be telling patients they needed, such as ibuprofen and cough syrup. “We thought they could get their prescription, their Kleenex, and a bottle of water and not have to make that extra stop,” Brumbeloe says.
The drink machine and snacks of crackers and cookies have been more popular with the 75 employees than the patients. “They need that afternoon boost of their M&M’s, apparently,” she says. “The only thing we plan to add is durable medical equipment. Things like crutches, canes, boots, and knee braces. We’re not getting into oxygen tanks or beds.”
When the pharmacy first opened, they averaged 10 prescriptions a day. Over the last nine months, they’ve grown to 60 per day. “It doesn’t sound like much, but we kept it low-key, and only let patients know who came into the office,” Brumbeloe says. “Our goal was always to help our patients be more compliant.”
To that end, their physicians also offer to have prescriptions filled and delivered to the room of their patients being discharged from the hospital. With offices right on the hospital’s campus, the service is simple to provide. “It’s a great service they’ve really taken advantage of. No extra stop on the way home,” Brumbeloe says. They started offering the service about two months ago and about 10 to 15 patients a month now use it.
With such ease of use, Cullman Internal Medicine is banking on prescription compliance increasing. Right now, insurance companies are sending the practice regular notifications about unfilled prescriptions. “If we get graded on these, and we keep moving toward the pay-for-performance model, then we need to get our patients more compliant,” Brumbeloe says. “One answer was education, but now we can offer them a pharmacy right inside the practice, so they can step right over and get it filled before they even leave our doors.”