by Del Meyer

Almost all physicians are getting into the habit of giving adequate prescription refills and eliminating the need for patients to call in for prescription refills or having special lines reserved for patients to call in. They are learning that phone refills are not only hazardous, but poor business practice.

This is accomplished by the physician at the time of appointment, who, with all the information at hand, determines a safe period for the patient to take the medicine without further evaluation. Then the number of refills to that evaluation is given when another prescription will be written. Thus, if the patient should be evaluated in six months, then the total refills would equal six and the patient knows to make an appointment when the sixth refill is filled. The same for a 12-month refill.

At a recent meeting of an insurance company, a pharmacy service company was expounding on their ability to automatically send faxes to the doctor when the last prescription is picked up, which will always be one month before the required appointment. They even bragged that they could send out daily faxes until the doctor responded. We recommend that a doctor should not respond to these requests in view of the hazards involved and the costs of this practice.

They are hazardous because pharmacists assume that all that is required is a simple yes or no answer after which they can proceed with refilling a prescription that hasn’t been authorized by the doctor with the patient and his/her chart in front of him/her. This will assure the pharmacist of return business without the possibility of patients having a new prescription in their hand, which could be taken to another pharmacist. But the physician had made a determination that the patient needed further evaluation when the refills are completed and thus appropriate health care is subverted. We recommend that a doctor should not respond to these requests in view of the hazards involved. Faxes can now be programmed to block such calls from repeat offenders.

Phone refills are an excessive cost to a medical practice. To refill a prescription, doctors know the risks involved if the chart is not pulled and reviewed and a new determination is made. Phone refills are basically an office visit without an exam. Therefore, the actual cost of this phone request is about half that of an office call. However, there is no payment for this half-office evaluation. If a doctor sees three patients an hour, and three refills come in during the same hour, the professional income is cut in half.

Attorneys have long known that phone calls are expensive. But they have the mechanism to charge for their time on the phone to their clients. Most law firms have a minimum time per phone call, such as one-sixth or one-fourth hour. Thus, if you have a junior attorney in a firm charging $300 an hour, the phone call is automatically billed at $75 for one to 15 minutes of time, and $150 for 16 to 30 minutes of time. The cost of a senior attorney at $400 an hour would be $100 for each quarter hour or less. Attorneys cannot take the risk of possibly giving out legal recommendations without all the facts in front of them. The same thing applies to physicians who should not take the risk of giving out information, recommendations or refills without all the facts in front of them. Physicians need to establish a fee structure to take care of this practice much as attorneys do. If they don’t, liability increases and malpractice premiums will rise to cover this liability. Meanwhile, physicians must ignore all pharmacy requests for new prescriptions or refills beyond those initially authorized.