LEESBURG PHARMACY: WHERE CUSTOMER SERVICE BECOMES PATIENT CARE

Cheri Garvin counseling a patient

Providing top-notch customerservice is something that independentpharmacies have always been good at,according to Cheri Garvin, executivevice president and chief executive officerof Leesburg Pharmacy Inc in Leesburg,Virginia. What's changed a bit iswhy this element of doing business isso important.

"We operate by the golden rule: wetreat our customers the way wewould want to be treated when we gointo any retail establishment," Garvinsaid. "We try to greet them by namewhenever we can, and just makethem feel like a person instead of justa number coming through the door."

Garvin has worked in pharmacysince high school. She was recruitedby the founder of Leesburg Pharmacy,Bruce Roberts, RPh, who is nowexecutive vice president and chief executiveofficer of the National CommunityPharmacists Association(NCPA), and she worked as a pharmacytechnician, then a staff pharmacist.When Roberts decided to leavethe pharmacy to head the NCPA, heasked Garvin to take the helm. She hasbeen in her current post for 7 years.

Garvin believes that excellent customerservice is, in many cases, theonly way that independent pharmaciescan compete, largely because ofreimbursement challenges, increasingdifficulties in collecting claimspayments, and more competition as aresult of mail order. "Typically, whenyou think of retail, one of the thingsthat sets you apart are your prices,"she said. "That's a bit fixed in pharmacybecause no matter where yougo, your copay is the same. Then peopleare going to want to shop whereit's convenient and where they getgood customer service."

At Leesburg Pharmacy, customerservice extends to offering servicessuch as compounding and specializedproducts and medical equipmentsuch as walkers, wheelchairs, nebulizers,and breast pumps. Leesburg alsohas an assisted living department, aswell as a wellness center that handlesimmunizations and screenings forcholesterol and bone density. A physicianand lactation consultant areavailable for consultation.

Douglas Hoey, RPh, chief operatingofficer of the NCPA, notes that anumber of the organization's membersare using this strategy. "They arebroadening their revenue streamsfrom prescription-only. They are stillmaintaining their prescriptions, butthey recognize that it is a tremendousattraction to bring patients throughthe door, and those patients needmore than prescription medications,"he said. "They are looking at themselvesas more of a health care centerthan as a pharmacy only."

As a result, pharmacy retailing haswitnessed a wave of diversification."Traditional dispensing is still the...core function. Making sure thatpatients are taking their medicineproperly is what pharmacists do,"Hoey said. "At the same time, medicationsexpand into other areas, suchas compounding, specialty medications,the combination of medicationswith the use of durable or homemedical equipment, servicing assistedliving centers, servicing long-termcare centers, institutional settings.Any place where people use medication,the pharmacists have broadenedtheir role to be a part of those environments."

"It would be hard to survive as anindependent pharmacy if all we didwas stand here and fill regular prescriptions,"Garvin said. "There isn'tenough money to sustain a businessbased on that model anymore. Wehave to offer these other productsand services to make it work." This isnot to say that Leesburg, which bearsthe name Leesburg Pharmacy, afterall, is out of the business of fillingprescriptions. "But it's not where weadvertise; it's not where we market.We are trying to stay focused onthose products and services thatmake us different from mail orderand from the other stores in ourarea," she said.

Jay Gill, Lisa Strucko, Cheri Garvin, Adle Joseph, and Lee Allison Boris

Medication therapy management(MTM) for senior citizens is one suchservice that Leesburg Pharmacyadvertises. "We would rather promoteany clinical services that we canoffer than just fill someone's prescription,"Garvin said. "We focus onour compounding center and whatwe can do for patients with compoundedmedication. The same goesfor our medical department or ourassisted living department. That'swhat we are trying to do to stay viableas a business—to focus on those areasthat set us apart from the other pharmaciesthat are around."

The key in benefiting from this liesin devising a way to be compensatedfor the expertise that pharmacists canprovide, according to Hoey. "Forsome of the core dispensing that wedo, we are having to reverse the tide abit. We have done counseling for solong, and 30 or 40 years ago thecounseling was supposed to be compensatedin the dispensing fee," hesaid. "Now, the dispensing fee doesnot even begin to cover the cost ofcounseling the patient."

MTM is playing a part in chippingaway at this, Hoey notes, and opportunitiesexist related to complianceand persistence. "That seems to be alow-hanging fruit for the pharmacists,"he said. Certain health careplans, namely those that are responsiblefor the entire health care bill,want assurance that their patients aretaking their medications properly;pharmacists can serve as the vitallink in the chain. "Who better to helppatients take their medication on aregular basis? It benefits everyone.Everyone wins when patients taketheir medicine like they are supposedto, and who better than thepharmacist to help them do that?Those managed care plans that lookat the whole benefit have a greaterincentive to make sure that thepatients are taking their medicationlike they are supposed to, and therehas been some interest in payingpharmacists to help do that," saidHoey.

Hoey points to what he callsMTM-like services as another sourceof revenue for today's pharmacies."MTM is just one facet of it. Thereare payers out there willing to paypharmacists for managing the patient'scompliance and persistence,or providing de-identified dataabout the use of the medication tohelp in identifying patients for clinicalresearch," he said. This is a tremendousopportunity for pharmacistsbecause they have the competitiveadvantage of having soliddata as well as daily contact withhundreds of patients that are demandingface time with the pharmaciston duty, according to Hoey."That is the competitive advantagethat we need to use to grow our businesses."

Garvin admits that independentpharmacy is facing its fair share ofchallenges that at times may seeminsurmountable. "The margins arealready so slim, and to think that theyare going to get even tighter makes itdifficult. There will be some harddecisions for a lot of pharmacies as towhether they can continue to providecare to their Medicaid population,"she said. Garvin also said that theindependent pharmacies that are ableto focus on the positive stand to surviveand prosper. "On the positiveside, with MTM being very successfulits first year out, it opens up a lot ofopportunities for pharmacy to showthat we are an integral part of thehealth care team. We have a positivebenefit if we are kept in the loop ofpatient care."