South Florida Hospital News
Saturday October 31, 2020

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May 2006 - Volume 2 - Issue 11


Business Muse … Reflections on the Business of Healthcare Delivery

For years the pie that is made up of spendable healthcare dollars has been cut up in ways which keep shrinking the portion that is available to the practitioner.

Money is going instead to ancillary services and corporate profits. The subject of corporate profits for healthcare insurers and whether or not they should be stock or mutual companies is and will be the subject of a future column.

In particular, at the present, I’d like to focus on the inroads sought by ancillary services. There is a continuing desire on the part of many to be practitioners without ever making the scholastic and time commitment necessary for the degree. The desire to order testing whether or not trained in the interpretation of, and what to do with, the results has been sought for a long time by many other healthcare fields. Many fields are as well pushing legislatures to allow them to perform procedures and prescribe medicinals that until now have been the exclusive right of fully trained and licensed providers of medicine.

Currently, in Florida, there is a push on for a bill that has now left committee and is in front of the state senate. This bill will allow pharmacists to inoculate people with the vaccine for influenza. The wisdom of such a move is debatable. Whether another profession is able to handle the potential for complications seems to be a matter no one cares about. Presumably if a physician or a licensed nurse practitioner of someone under their supervision inoculates someone, they inherently accept the responsibility to treat complications. I am sure some remember the swine flu scare, the mass inoculation and the resulting cases of neurologic complications. How does the pharmacist handle this situation? Particularly in this environment of liability who wants to assume the care for someone else’s issue, particularly if he is not a practitioner. Not being a practitioner a pharmacist cannot make a true referral especially under current insurance policies. Although he may make a recommendation to a practitioner, it is obviously not the same. Are all people to go to the ER if a problem arises? Can the pharmacist examine someone to make sure there is no underlying problem that precludes giving the vaccine at the moment? Does he perform a medical history, or note the presence of allergies? Is he required to keep a medical record of all these findings? Is the legislature answering these questions, or merely trying to find a way to deliver vaccine on the cheap? Do they really care about the population’s health or the issue of the appearance of caring? Regardless of where you stand on this issue, it is clear that it is an attempt to further chip away at the rights that come with the ability to be a licensed practitioner. Maybe you should fight fire with fire. Florida allows for licensed practitioners, who prescribe, to obtain an additional license. That is a license to dispense. This allows the in office dispensing of medications that you routinely write Rx’s for. There is some additional record keeping required, but it is simple and readily performed by existing staff with virtually no increase in their task time. As for responsibility, the in office dispensing by you is not different then what you already do, i.e.: inoculating a patient with any medicinal. You purchase these from a vendor, your office supplier. The manufacturer, whether it be of B12, cortisone, or prepackaged Rx drugs is ultimately responsible for producing the product in compliance with governmental regulations.

The ability to dispense in your office can not only result in some increase in practice income, but also in goodwill marketing from patient appreciation. Obviously it is always the patient’s decision to purchase at your office or go to a pharmacy, and that is as it should be. However, the ability to obtain their medicines without traveling to and waiting at another location is a big plus to many.

It makes sense that in the current environment one way to aid your business is to follow the old adage: if they are going to play in your sandbox you should find ways to play in theirs. Call PHC at 561-799-1633 or contact me directly at to find out more about in office dispensing, or to discuss any other business issue on your mind.

PHC solicits and appreciates questions of a business nature relating to Practice Development, Managerial Solutions, and the Integration of Technology in healthcare services and delivery to address in future columns. Please address your questions to PHC at

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