Adding Ancillaries: Dispensing drugs

In October 2003, after two years in private practice, Snellville, GA, internist Bruce Sabin decided that there had to be a better way-other than urging and warning-to get patients to fill prescriptions and follow medication regimens. That's when he hit on the "bring the mountain to Muhammad" solution of dispensing drugs from his office. He hasn't been sorry.

"Now patients aren't skipping out on meds because they're too busy to fill a script or the drugstore is too crowded," says Sabin, who adds that he's seen improvements in patients' blood pressure, cholesterol, and diabetes numbers. Another number that Sabin likes is his income from this ancillary service: He nets from $5,000 to $6,000 a month.

"Physician dispensing is a convenience for patients and can be a major ancillary profit center," says Jeffrey J. Denning, a practice management consultant in La Jolla, CA. But it's hardly a no-brainer. "Dispensing requires staff to be trained in how to handle transactions and educate patients about their meds. And you have to maintain strong security over the inventory."

You can also order stock bottles of medications from distributors that supply pharmacies, and dispense them on your own. But that's more work, and you'll need to contact a healthcare attorney to make sure you don't run afoul of regulations that govern in-office dispensing. No matter which route you take, here are some guidelines.

Equipment

The basics are a cabinet or two and a computer. Most states require that controlled substances be stored under lock and key. "We suggest that doctors who sell drugs, even if they limit their inventory to noncontrolled substances, store the drugs in lockable cabinets and allow access only to selected people, much as a retail pharmacy would do," says Greg Cull, president of Allscripts' Medication Services Group.

If you use a commercial distributor you'll need to purchase the vendor's software, plus you might have to upgrade your computer and purchase a label printer, a bar-code scanner, and other hardware.

Space

Unless you decide to dispense drugs on a large scale, your existing office space should suffice. FP Azar Korbey, who sells over 250 kinds of meds from his office in Salem, NH, stores them on four shelves along one wall. Some practices set up a "dispensing station"-staffed by a nurse and consisting of cabinets, a desk, and requisite computer equipment-where patients can pick up their meds.

Staff/training

In most cases, a nurse or medical assistant can oversee your drug dispensary. She should have a good knowledge of drug side effects and interactions, so that she can educate patients about these, and about how to take the drug correctly.

Both Allscripts and PTC conduct on-site training sessions that involve setting up the hardware, installing the software, and showing the individuals who'll be doing the dispensing how to use the system. If you're not working with a vendor that will supply the requisite training, you can hire a pharmacy consultant to teach your staff drug-dispensing basics.

Costs

Your current PC will probably suffice, but if you choose to have a dedicated computer specifically for drug dispensing, expect to spend around $2,000 for a PC, label printer, and bar-code scanner. You'll need the printer and the scanner in any event; they'll run you about $425 total. In addition, PTC charges a one-time software licensing fee of $4,995 per site, plus a monthly support fee of $175, says company president Warren Moseley.