Northwind Pharmaceuticals

The New Year is here.  With it come the hopes, dreams and resolutions.  Weight loss remains at the top of many lists and 2012 will be no exception.  Many of us are able to adjust eating and exercise to achieve these goals.   Unfortunately, there are many who suffer from chronic obesity and require additional help to address their weight loss challenges.  Some qualify for bariatric surgery but many do not.  For the chronically obese who are not good candidates for surgery, prescription medications remain an important part of an overall program to address this disease.

There are many practices that specialize in physician-directed weight management.  Often, doctors choose to simplify the process by offering prepackaged medications from their office.  This saves patients the inconvenience of going to the pharmacy.  Clinic dispensing is legal in most states and physicians have been dispensing medications to patients for hundreds of years.

The primary dispensed medications for weight management are phentermine, phendimetrazine and diethylpropion.  These appetite suppressants are important parts of the process and can aid in weight reduction.  Physicians offering medication dispensing along with their medical consultations provide significant value to these patients.  Many patients are seeking support from their primary care providers and physicians are playing an increasingly important role in helping patients manage obesity.  Offering the right clinical pharmaceuticals gives the practice an edge in helping patients combat this disease.

Beginning tomorrow, Pfizer's blockbuster treatment for high cholesterol comes off patent paving the way for less expensive generics.  The generic name for Lipitor is Atorvastatin Calcium and it presents another option for dispensing clinics to better serve their patients.  How big a deal is this?  There are currently 8.7 million Americans taking Lipitor.  Lipitor has been on the market since 1997.  Pfizer sold $10.7 billion of this drug last year.

Wholesale pharmaceutical distributors like Northwind Pharmaceuticals will have Atorvastatin Calcium available beginning Wednesday, November 30.  For the first 180 days, rules limiting generic competition will limit price decreases but significant price decreases should hit after that point.  Drug plans as well as Pfizer are offering incentives to stay with Lipitor or switch but it is difficult to say how long those incentives will be offered.  For physicians offering office medication dispensing, it is interesting to note that the average co-pay for Lipitor is $49 and the average co-pay for generic medications is $10.

As prices come down, Northwind will offer prepackaged versions of Atorvastatin Calcium to make it easier to dispense within clinics.  For more information on the change, check out this article in today's Wall Street Journal.

Laura Landro had an interesting article in the Wall Street Journal this morning talking about the growth of alternative clinics: retail, work, urgent care.   She quotes a study by Renee Hsia that shows patients seeking emergency care rose by 43% from 2000-2009 while hospital emergency room visits declined 27% over the same period.

The trend is compelling for clinic operators interested in bringing services closer to patients.  Wal-Mart recently announced plans to re-expand into this space.   Currently, much of the expansion has been into retail locations (pharmacies, department stores) that see a stream of customers for other products.  However, this article also says that about 300 new urgent care clinics are opening each year.

These developments present opportunities and challenges for clinics seeking to compete for patients.  Patient acceptance of the "quick care" model in lieu of scheduled office visits or ER visits opens the potential for more patients in clinics that adopt new models for serving these customers.  As competition increases, pressure on pricing and available services will also increase.  Maintaining a broad suite of services, like medication dispensing, as well as adjustments in hours, scheduling and staffing will help clinics remain competitive.

Though these trends aren't new, they may be accelerating.  The health care law and growing price pressures will continue to push patients and payers to creative solutions to today's complex healthcare challenges.

Pay for Performance - what do you think?

www.ama-assn.org/amednews/2011/10/24/bisf1027.htm

Here it comes...pay-for-performance sounds like a good concept but runs into problems with definitions and ultimately, who sets them. Patient satisfaction is about as vague a measure as possible and creates, like all incentives, unintended consequences when health systems try to comply.  Outcomes?  Is it reasonable to force our health systems to take responsibility for our lifestyle choices?  In other parts of the economy, the market makes the choice - those that provide value are rewarded with survival and those that don't provide value don't last.  Healthcare has many nuances but it it seems counter-productive to try to legislate quality with financial incentives when consumers are more than capable of making the choices themselves.  Government or insurance, the result is nearly the same; someone else is choosing how to motivate or punish our care giver.  Should we be working harder to open up competition or continuing to let payors shrink our options?

Medications remain an important part of a clinical weight loss solution.  Northwind Pharmaceuticals works with many medically supervised weight loss clinics that offer medications as part of their solution.  Physician dispensing in a bariatric practice is a great fit for several reasons:

1. Many patients are not good candidates for gastric bypass surgery and must therefore look for other alternatives to help them manage the disease called obesity.
   
2. Physicians typically prescribe a narrow range of medications for weight-loss management.  A smaller, targeted formulary is easier to manage from a clinic perspective.
3. Because weight management is an ongoing battle, physician-directed weight management often requires that patients be on medications for extended periods.  This increases the practice's opportunity to dispense medications and provide convenient service to patients.
4. The nature of obesity is complex from a psychological as well as a physiological perspective.  Allowing the patient to receive treatment and products in the safe environment of the clinic avoids extra trips to the pharmacy and long waits for medications.

Depending on the number of patients, medication dispensing in a bariatric clinic can be overwhelming.  Clinics sometimes purchase bulk bottles and count out pills for patient prescriptions.  This is incredibly time consuming and completely unnecessary.  Northwind Pharmaceuticals offers prepackaged medications; this means that we package the bulk medications into smaller, unit-of-use bottles.  For example, some of our clinics will dispense Phentermine 37.5mg in 30 count, 45 count and 60 count bottles.  Prepackaged bottles are labeled according to FDA and state pharmacy board guidelines; the clinic will need to place a label with the patient's name, instructions and clinic name on the bottle to make it a legal prescription.

To help manage the dispensing process, Northwind offers dispensing systems that comprise a manual labeling approach as well as software (RxTracker) to print labels and track inventory.  Our goal is to make it quick and easy to provide the medications to your patients.

There are no easy solutions.  Clinics offering weight management services must utilize every available option to help fight obesity and improve the quality of life for patients.

Continuing consolidation among repackagers is creating opportunities and challenges in the clinic dispensing market.  The challenges fall on medical clinics that are experiencing disruptions in their supply chain, changing personnel, higher prices, new processes, discontinued medications and various other issues.  Northwind Pharmaceuticals has received many calls from unhappy clinics looking for better support, steady access to medications and competitive pricing.  In the spirit of sharing, I wanted to put a few bullets from those conversations into this post.

• Why are companies merging?  Money, competitive positioning, aging owners etc.  The pharmaceutical industry is changing rapidly and pressures continue to mount for business owners.  Regulatory scrutiny continues to increase along with downward pressure on pricing.  Its tough out there.
• Why am I having difficulty getting medications?  When it comes to consolidation, many of the repackagers are ending up on the coasts.  For clinics that are located farther away from their supplier's new location, this means increased shipping times.  In addition, when companies merge, the goal is to reduce costs which often means streamlining formularies or eliminating product offerings.  Finally, you have the normal challenges of recalls, manufacturer shortages and regulatory barriers that tend to choke supply.
• How do I know if I should stay with my current supplier?  Everyone tends to stay on their current path unless something pushes them off of it.  If you need better service, better prices, better technology, better delivery times or any of a host of priorities, then it is probably time to do an evaluation of your options.
• I just don't have time to evaluate options...  Actually, looking around doesn't have to take much time.  You usually figure it out in a couple of interactions.  Is the vendor responsive?  Believe it or not, many are not very timely in responding.  Do they offer the technology or labeling that you need?  Do they offer the medications that you dispense?  Are their prices competitive?  Do they make it easy to order?

We all want to buy from people we know and trust.  When a company is bought, often the people you trust are required to follow new dictates.  They may still be trustworthy but it just might not work for your situation anymore. Your supplier needs to provide the dispensing systems that meet your office medication dispensing requirements.  Pricing, availability and service are all part of that equation.  Things are changing fast; don't be afraid to look at a little change yourself.

I recently came across an interesting Brief from the Center for Healthcare Research and Transformation discussing antibiotics.  The Brief is titled Antibiotic Prescribing and Use.

The brief pulls data from a study based on Blue Cross Blue Shield members in Michigan but results are likely reflective of broader US trends.  Northwind clinics that offer medication dispensing will be interested in some of the findings.

Some interesting findings:

• Overall antibiotic prescribing actually decreased from 2007-2009.
• Antibiotic prescribing for children increased in the same period.

Top Ten Antibiotics:

1. Azithromycin
2. Amoxicillin
3. Cephalexin
4. Ciprofloxacin
5. Amoxicillin-Clavulanate
6. SMZ-TMP
7. Doxycycline
8. Levofloxacin
9. Clindamycin
10. Penicillin V

Azithromycin and Amoxicillin were prescribed much more frequently.  The list shifts a little  with children.

The brief also talks about appropriate prescribing habits and the challenges associated with inappropriate antibiotic use.  For clinic dispensing, awareness remains key as practitioners seek to address legitimate health concerns and the sometimes challenging emotional concerns of patients and the parents of patients.

As we head into another school year, antibiotics will again be at the top of the list for many ailments hitting us.  Applying antibiotic prescribing to bacterial infections and avoiding it for viral infections remains the best measure of "appropriate" (at least from the Brief's perspective).  For point-of-care dispensing. the trends remain the same.  Offering the patient convenience while balancing their preferred treatment with the most effective approach remains a challenge.  Pharmaceutical wholesalers like Northwind remain a source of support but the balancing challenge remains with the practitioner.

For more information on this brief and some other interesting topics, check out the CHRT at www.chrt.org.

I am so impressed with the entrepreneurial spirit I see with so many of our clinic customers!  As the pressures mount, the creativity explodes!

A few examples:
During a visit to a dispensing clinic in Chicago this week, we discussed pending changes in Illinois law related to workers compensation reimbursement.  The news?  Not good.  Unflinching, the clinic is already working on other avenues of revenue and exploring joint venture opportunities with health services companies in different fields.  For this clinic, medication dispensing is one part of an overall plan to grow their business and continue serving their customer.

At a student health center, I discovered an RN who returned to school to get her APN.  Returning to her clinic, she lobbied to reduce their dependence on contract medical expertise and expand the clinic's capabilities by leveraging her new capabilities.  The result of her initiative?  Cost savings of hundreds of thousands of dollars a year for the clinic.  In addition, she is working to expand services including clinic dispensing to enhance the value they provide and convenience to their patients.  Lower costs and enhanced services!

At a health system-owned group of clinics, we discussed developing an expanded formulary to help secure a contract with an employer group.  The list of medications needed to match a different set of patients than some of their other clinics.  The pharmaceutical fulfillment solution needed to be timely and relevant to their new customer.  As a trusted partner, we also worked to help them identify new practitioners as they continue to expand into new areas.

Northwind clinics around the country are aggressively meeting changes in law, practice, economy and demographics with incredibly creative and entrepreneurial ideas.  The challenges will not disappear and neither will the opportunities.  As a pharmaceutical wholesaler, we distribute medications.  As a trusted business partner, we work to supplement our customer's efforts and expand their business.  Pharmaceutical logistics are easy when compared to the challenges of running a clinic in today's complex environment and we welcome the chance to help our clinics face those challenges head-on.

Our clinics demonstrate that they are not just great medical practitioners, but smart business people.  I would not bet against them!

Has it seemed like there are more and more products that are getting harder to get?  I just read an article in the Indianapolis Recorder talking about critical drug shortages.  It is interesting that a niche Indianapolis periodical has picked up on what is becoming major issue for health care providers and patients.  For clinics that dispense medications to their patients, it can be very disruptive to practice patterns.  Patients with chronic ailments relay on that periodic visit to review their condition and receive their medication at the point of care.  For acute patients, the inability to get the right product at the right time can slow their recovery.

Why are we seeing shortages of pharmaceuticals?  Raw materials shortages, reduced production of less profitable products, FDA recalls (many of these) and the occasional medication that is declared unsafe and removed from the market (like propoxyphene) can affect drug supply.  For dispensing clinics, we are seeing shortages of corticosteroid products, ophthalmic ointments and a host of lotions and creams of varying types.  The shortage of these clinical pharmaceuticals challenges practitioners in resolving ailments.  In some cases, we've seen shortages of injectable drugs but the biggest issues in the world of medication dispensing have been common, prepacked pharmaceuticals.

What can you do?  In some cases, we've been able to identify comparable products or substitutes for our clinic customers.  Of course, those usually don't last long if it is a major shortage.  In the case of FDA recalls, manufacturers typically address the issues and get back into production fairly quickly.  Some of the raw materials shortages we're seeing right now are more challenging because the supply chain has little ability to impact availability of many of the raw materials.  Physicians and nurses are evaluating their use of many of these products and searching for alternatives to solve patient issues.  In some cases, it is simply a matter of paying a higher price for the same product.  More often, practitioner and patient must grin and bear it.

The bottom line?  These shortages are simply a part of the world we live in and will continue to challenge pharmaceutical logistics throughout the country.

Distributors that help clinics dispense pharmaceuticals normally offer a dispensing logbook and/or an electronic tracking and labeling system.  These systems enable the clinic to keep track of medications dispensed to their patients.  Medication tracking software can be simple or complex depending on your vendor.  We encourage our clinics to keep their dispensing system as simple as possible.

Practitioners that dispense to their patients typically offer a combination of pills, lotions, ointments and solutions.  Many of our customers focus on treating acute conditions so we see many orders for antibiotics, analgesics, cough & cold products as well as corticosteroids.  Vaccines are also offered as a complement to the dispensing process.  In the case of Northwind Pharmaceuticals, we will also provide medical supplies to our clinics. 

Point-of-care dispensing is not a path to riches.  There are companies that promote practitioner dispensing as a means to generate significant dollars but the simple truth is that it can provide a decent supplemental revenue stream to a healthy clinic.  If dispensing revenues are higher than those from medical treatments, something is very wrong!  A single physician/nurse practitioner can reasonably generate enough to cover one or two office staff members.

Over the last few years, workplace place clinics have become more and more popular.  Rising health costs have created an environment in which employers are aggressively seeking alternatives.  Often, these clinics are operated by third parties that specialize in providing medical care.  Some employers build their own clinic.  Normally staffed by nurse practitioners or physician assistants, these clinics act as highly accessible urgent care operations dedicated to employees.  School systems, manufacturers, health systems, government agencies and a variety of other types of employer groups are implementing these clinics.

Northwind Pharmaceuticals physician dispensing program fits right in with these employee focused clinics.  Offering prepackaged pharmaceuticals that match the urgent care formulary, Northwind enables the employer sponsored clinic to treat acute issues quickly and effectively.  Low cost generic medications serve as the centerpiece of these clinic's formularies and enable the employer to enjoy lower health care costs, healthier employees and more timely service.  As a pharmaceutical wholesaler, Northwind Pharmaceuticals does not operate clinics but partners with the practice to provide medications to employee-patients.

Physician dispensing continues to grow as a mechanism for practices to supplement their revenue and extend their service to patients.  Simply put, physician dispensing is the act of providing medications to patients in lieu of going to a pharmacy.  In most states, prescribers are authorized to dispense pharmaceuticals to their own patients.  Normally, the practitioner provides prepackaged medications in unit-of-use sizes.  This means that the drugs are packaged in the dispensed size so the physician or nurse practitioner doesn't have to count pills.

There are many companies playing in the physician dispensing market.  Most of them are brokers that resell products sitting on a distributors shelves.  There are a handful of companies that maintain state and federal licensure to distribute pharmaceuticals and some of them also have VAWD (Verified Accredited Wholesale Distributor) status.  Typically, clinics purchase generic products for their clinic dispensing programs.  Some clinics purchase programs to accept insurance but this typically creates another level of complexity with minimal profit to the practice.

Northwind Pharmaceuticals is proud to support student health centers.  The student health center is a unique environment.  Serving a very large population within a very narrow geography, student health professionals have to be flexible in their approach to care and get to know their patients in very short order.  Some student health centers focus on treating very general conditions at the most basic level; the school nurse model.  Other student health centers are mini-hospitals offering a variety of outpatient procedures to their large patient population.  The student health center is managed by nurses operating under the direction of a Medical Director.  Smaller centers may be staffed by one nurse and an assistant; larger centers may have a dozen or more nurses, multiple physicians and a support staff.

Our student health center customers are mid-sized clinics that want to provide the convenience of on site medications to their patients without the cost of opening a full-blown pharmacy.  We support clinics that offer six medications as well as clinics offering 40 or 50 medications.  Many student health centers charge their students a co-pay for services while others include health services as part of a "student services" fee paid with tuition.  From dispensing birth control to antibiotics, these clinics become a life support center for their student patients. 

Many student health centers are members of the American College Health Association.  The ACHA supports Student Health Centers with professional development opportunities, information resources, a magazine and an annual meeting.  The ACHA also bridges Federal health initiatives and college health by facilitating communication of trends and data to student health centers.  Almost all of our student health center customers belong to the ACHA.  This year's ACHA Conference will be held May 31 - June 4 in Phoenix.  We will be exhibiting on June 2nd & 3rd - look for Booth 305.

Northwind Pharmaceuticals supports student health centers by enabling pharmaceutical dispensing and providing medical supplies.  We provision these clinics with prepackaged pharmaceuticals, lotions/creams/ointments, injectables, liquid medications, medical supplies, drug information, specialty packaging options and labeling.  Some of our clinic customers work with third party payers for reimbursement while many others focus on cash pay or no-charge services to the patients.  We work to support their efforts by making ordering easy, sharing information and delivering within expected time frames.

The valuable service provided by student health centers ensures quality care for our student population.  Student health centers offer a wonderful extension of hometown primary care as these students transition to full independence.

One major benefit of clinic dispensing is that it helps address the problem of patient medication compliance.  An article in the Journal of Applied Research shares the following facts:

• Approximately 125,000 people with treatable ailments die each year in the USA because they do not take their medication properly.
• 14% to 21% of patients never fill their original prescriptions.
• 60% of all patients cannot identify their own medications.
• 30% to 50% of all patients ignore or otherwise compromise instructions concerning their medication.
• Approximately 25% of all nursing home admissions are related to improper self-administration of medicine.
• 12% to 20% of patients take other people's medicines.
• Hospital costs due to patient noncompliance are estimated at $8.5 billion annually.

A study published in The Journal of Rural Health, "The Effect of Physician Dispensing on Visit Compliance and Blood Pressure Control in a Rural Family Practice Clinic", found that 79% of patients in the dispensed group met criteria for visit compliance versus 49% of patients in the prescribed group.  This only serves to support the potential influence of in-office dispensing on patient behavior.

Physicians offering medications from their office are in a unique position to help address the problem of non-compliance.  Pharmaceutical dispensing at the point-of-care allows the drug conversation to happen in real-time.  Not only can the practitioner describe the purpose and use of the medication, the patient can literally have the product in hand during the conversation.

Northwind Pharmaceuticals provides prepackaged medications and manufacturer labeled pharmaceuticals for physician dispensing within the clinic. Northwind also provides medical supplies to clinics. We ship nationwide and specialize in working with student health centers, community health centers and independent medical clinics.

Northwind's dispensing system encompasses labeling and tracking tools to make the medication dispensing process as easy as possible for the clinic.  Pre-labeled bottles display all required pharmaceutical information and provide four peel-off labels for use on patient medical records, receipts or insurance documentation.  Our dispensing log enables the clinic to write the patient's name and medication instructions on a label that is placed on the bottle.  The labels are on a carbon sheet that retains an image of the label so the clinic has a record of all dispenses.

Northwind also offers software (RxTracker) that automates the pharmaceutical dispensing process.  RxTracker allows clinics to capture dispensing information electronically and print the prescription label from any office printer.  RxTracker will also track drug inventory and automate reordering.  Northwind offers both of these dispensing solutions at no additional charge.

Clinics seeking to learn more about in-office pharmaceutical dispensing are encouraged to visit the Northwind Pharmaceuticals website or call us at 800.722.0772.

Reimbursements continue to shrink.  Pressure is on to see more patients. Pharmacies begin to offer "quick clinic" services.  The government passes far-reaching health care legislation creating a  host of new certainties and uncertainties.  As an independent practitioner, how do you survive in this crazy environment?

Keep the faith!  Demand for the services of good physicians continue to grow.  The growing aging population is creating the need for more and more care.  New technologies and techniques continue to evolve and present new opportunities for services to patients.  A health system in flux also means new opportunities as niches are created and patients find it more difficult to navigate the landscape.

As financial pressures continue to mount, we see more and more physicians turning to clinic dispensing as a means to supplement practice revenue.  Dispensing pharmaceuticals from your office provides convenience for your patients, revenue for your clinic and another point of differentiation for your practice.  Competitive pricing is possible with access to wholesale medications and using prepackaged medications streamlines the dispensing process.  Simple-to-use dispensing software is readily available as are the tried and true dispensing logbooks.  It is easy to implement, easy to administer and easy to maintain.  A single doctor can easily generate $20-$30k of additional profit; focused efforts can reap much more.

As frustrating as many things are for physicians these days, there are still many opportunities.  A little creativity and a willingness to focus on the business elements of your practice can reap unexpected benefits.  Blending medication dispensing, quality care and new services will continue to set your practice apart and keep your patients, and you, healthy.

Medically-directed weight loss has become a necessity for many people.  One element of a physician-directed program is medication.  Bariatric practices that offer medication dispensing are able to bring another tool to the battle against obesity.  Northwind Pharmaceuticals helps bariatric clinics implement pharmaceutical dispensing by providing prepackaged pharmaceuticals, labeling and tracking systems as well as guidance through the process.   

One mistake clinics often make is feeling that they need to count pills and package them within the clinic.  Our service takes the pill counting risk off of the physician and staff by providing options for medications and packaging.  Some commonly dispensed medications within clinics offering medically-directed weight loss services include: 

• Phentermine
• Phendimetrazine
• Metformin
• Fluoxetine
• Furosemide
• Metoprolol

Northwind Pharmaceuticals offers clinics different packaging options for these products.  For example, some clinics will dispense Phentermine 37.5mg in a 30 count bottle and schedule patient follow ups on a monthly basis while other physician's will extend the count to accommodate a longer interval between visits.  Our clinics view themselves as providing weight management solutions and medications are simply another element of the overall solution.

Clinic business models will vary and we try to be flexible to our client's requirements.  As a wholesale pharmaceutical distributor, Northwind provides a wide variety of medications.  As  dispensing consultants, we help you figure out how best to use them in your practice.  Call us today at 800.722.0772 to learn more about dispensing in your practice.

Here we are again, the end of another year!  We've seen a lot happen in 2010 and 2011 promises to be equally intense.  Tired of hearing about Obamacare?  Well, get used to it! The battle for and against this monster legislation will rage throughout 2011 and all of us will have to be savvy in managing in and around whatever form it ultimately takes.  My suggestion?  Focus on what you can control; your practice, your operation.  As you assess 2010 and look forward to 2011, here are some things to consider that sit within your span of control:

1) What are your plans for growing revenue in 2010?  Downward pressure on reimbursements continues.  Now, more than ever, physicians are being forced to look beyond typical medical services to expand their base of revenue.  Are you evaluating pharmaceuticals, nutri-ceuticals or other products as practice enhancers?  New or existing dispensing systems may enable you to easily add products to your mix.

2) What are the biggest threats to your practice?  Are your medical supplies prices increasing? Are your referrals decreasing?  Many hospitals and physicians are reporting a decrease in procedures.  Physicians need to actively track these trends and look for ways to address them proactively.  Trends may be avoidable but you are not helpless; there are always options.

3) Who's on your team?  Does your staff mix bring additional value to patients through enhanced services or extended hours?  Clinics carrying non-value added resources need to carefully consider their options.  Many clinics are leveraging physician time with nurse practitioners and physician assistants.  Reimbursement rates may affect the viability of these resources but they should still be considered. 

4) What are you doing to be different or enhance your practice? Are you doing anything with nutrition, anti-aging, disease management or weight management?  Procedures may be down but there are people looking for specific treatments. Do you continually evaluate new options and procedures for your practice?  No time? Can you afford not to?

5) Who are your competitors? Quick clinics in pharmacies?  Practice buy-outs by hospitals?  Government funded clinics? Evaluate their value-propositions and determine if there are elements of their offer that could work in your practice.  Are there expansion risks you could take that would enhance your business?

6) If you offer medications, what is the mix of products?  Do you evaluate products on an ongoing basis?  What is moving, what isn't?  What products are moving to generics that will be viable for clinic-dispensing?  Are you carrying items that are losers for the practice?  Are you charging enough?  What worked last year might not work this year.  Don't be afraid to change it up.

Though I remain biased towards physician dispensing as a low-cost, low-risk way of enhancing your practice.  There are many alternatives.  The winners in 2010 will find ways to extend their services, add extra value to existing patients and attract new ones.  Will that be you?

I read an interesting article in the Wall Street Journal today entitled "When the Doctor has a Boss".  The article discusses the trend toward more physicians going to work for hospitals as opposed to opening/running their own practice.  The article states that the percentage of hospital-owned clinics hit 55% last year; up from 50% in 2008 and 30% five years ago.  Why?  Hospitals have become more aggressive in consolidating practices to ensure their own revenue and many physicians are opting out of the business-side of owning a practice in favor of simply taking a pay-check.  I contend that part of what's driving is this trend is the difficulty independent physicians are having with generating an acceptable income.  Some docs are simply better at building a business.

In our world, about 65% of our clinics fall under the category of physician-owned.   Our clinic clients are medical entrepreneurs; dedicated to serving patients while building their practice/business.  In addition to offering pharmaceutical dispensing services, these practices provide an array of ancillary services that provide additional value to patients and revenue for the clinic.  Services and products mix to support the patient and the clinic.  Physicians that struggle with the notion of providing additional products and services to their patients will find it increasingly difficult to stay independent. 

I'm very encouraged by our clinics as they find new and creative ways to serve their patients, differentiate their practices and grow in spite of government interference, a tough economy and a host of other challenges that face these medical entrepreneurs.  Medication dispensing is not for everyone; but neither is owning your own business.  I salute all of our practitioners who continue to defy these trends and set their own path in these turbulent times.  Keep up the great work!

The days are growing shorter, temperatures are slowly coming down and the kids are back in school - can it really be September?  With school season comes the inevitable sicknesses caused by piling groups of students together into small areas.  Flu, coughs, colds, allergies, rashes etc. will be coming your way in droves.  Hopefully you've pre-ordered your flu vaccines and have a healthy stock of remedies on hand to deal with all of the acute ailments that announce the changing of the seasons.

As you prepare for the season, the CDC always has some good suggestions:  http://www.cdc.gov/flu/about/qa/1011season.htm Clinics providing medication dispensing services have an opportunity to treat many of these seasonal ailments conveniently within the office environment. 

For an interesting perspective on flu trends, check out Google's Flue Trend page.  This page tracks the trends based on the use of search terms that Google has identified as being indicators of flu activity in a geographic area.  Right now, Google says intensity is low but past trends indicate a burst of activity in October and then again towards February.

In addition to the usual suspects, this year also presents the issue of bed bugs.  Though we don't offer services for treating bed bugs, we do support the clinics that may see patients due to discomfort or lesions from bed bug bites.  Treatment is normally focused on reducing allergic reactions and inflammation from repeated bed bug bites.  Click on http://identify.us.com/bed-bugs/frequently-asked-questions-/do-bed-bugs-cause-harm-or-s.html to learn more about these pests.  Concerned student health centers should make sure they have antihistamines and corticosteroids on hand to address allergic reactions.

It's crazy out there!  Good luck to all of our clinics on the front line!