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THE CITY REBORN FROM THE ASHES OF AMERICA'S MOST DISASTROUS FOREST FIRE
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DHHS Halts Prescription Pay For Anthony House Clients

Issue Date: July 26, 2017

Controversy over prescription medication has again arisen between Steve Wilke, owner of ValuCare Center Pharmacy in Marinette, and Robin Elsner, administrator of the Marinette County Department of Health and Human Services (DHHS).

Wilke provided the Peshtigo Times with copies of a letter he had received from Elsner, dated Friday, July 21, and his response, dated Tuesday, July 25.

Wilke wondered if his pharmacy is being punished for his opposition to the DHHS decision last year to provide space and support in the Health and Human Services building for Genoa, a private pharmaceutical company, through which DHHS clients can receive prescription medications.

In his annual report to Marinette County Board on Tuesday, July 25, Elsner cited the agreement with Genoa to provide Pharmacy Services for consumers served by his department as an accomplishment for 2016.

He also discussed creation of an After Hours Crisis Program utilizing two full time and one quarter time staff positions to deal with problems that come in outside of regular office hours, and said diversion to Anthony House helps the department minimize use of high priced hospital facilities.

In his discussions with DHHS last year, Wilke had pointed out that Genoa cannot provide emergency medications, while he and other local pharmacies do.

At a meeting of the HHS Committee on Wednesday, Aug. 10, 2016, Wilke had detailed an incident which occurred the previous evening. He had closed his store at 6 p.m., and received a call at 6:15 p.m. from Anthony House, wanting to know if the orders had been received from a new arrival, who was admitted to Anthony House with no medications. Wilke took care of the orders by the end of the night, which took him about an hour. He said there were $83 in copayments alone from her insurance, "which we have to try and collect from this patient...That's the kind of service you're not going to get from an outside provider. They are not going to be able to provide those things, and I don't charge to do that" I might have to rethink that, and don't be surprised if something like this happens down the road and you get a bill for $100 for an after-hours call," he told the committee.

Elsner had assured everyone at the meeting that DHHS clients could chose which pharmacy they preferred.

Since then, Wilke has continued to fill prescriptions for clients of Anthony House, including those of an emergency nature that come in after hours. He has also provided repackaging of other medications if requested by Anthony House. That may now stop.

Elsner's latter to Wilke stated:

"It has come to my attention that the Marinette County Health & Human Services Department has been paying for pharmacy services of clients that receive diversion services at the Anthony House. The pharmacy services include co-payments for medication, medication packaging and over the counter medications. Payments for these services are the responsibility of the clients being served at the Anthony House.

"Effective August 1, 2017, the Marinette County Health and Human Services Department will no longer pay for pharmacy services for clients at the Anthony House. These services are the responsibility of the client residing at the Anthony House. Previously, these services have been paid through county tax levy, and I cannot support utilizing county taxpayer dollars to pay for these services moving forward. It is the responsibility of the client to pay for these services and they should be billed directly for payment.

"I have discussed this issue with the Anthony House management staff and have informed them that this change will occur. Anthony House should be providing ValuCare Center Pharmacy with the billing address for clients, so that you can bill them for these services upon discharge from the Anthony House."

Elsner concluded with an invitation for Wilke to call him if he had any questions.

Copies were sent to Pam Losinski, Group Home Association Administrator; Robert Valentine, Community Services Supervisor-ADAPT Clinic, and Guy Powers, MD, Medical Director.

Wilke wrote in response to Elsner's letter:

"I received your letter of July 21 with today's mail. I must say that I extremely disappointed in receiving such short notice for your change in payment policy and do not feel that the letter accurately reflects the understanding we had been working under with Anthony House for many years.

"ValuCare has made every effort to collect payment directly from the clients. The understanding was that we would attempt collection from them for 90 days and then if no payment was received, HHS would reimburse ValuCare for services rendered. There are several clients still in the 30 to 90 day billing cycle so I trust that the prior agreement will be honored for these people.

"As you should be aware, these clients are not admitted to Anthony House voluntarily. Many are transferred from various mental health facilities for temporary care. While many are Medicaid recipients, a good number are without any insurance and/or homeless. This makes collecting payment from them highly unlikely.

"ValuCare agreed to provide pharmacy services to these clients only after being assured that HHS would pay for their medications if there was no payment received after 90 days. To do otherwise would put ValuCare at substantial financial risk.

"Providing service to these clients requires much extra work compared with our other clients. Obtaining prescription orders from other facilities and pharmacies, reconciling the medication discrepancies and often having to repackage the clients own meds from other pharmacies is very labor intense and costly. These new admissions frequently occur late in the day which often results in having to keep staff after normal business hours and pay overtime to get the orders completed. After hours and weekend emergency pharmacy services are also provided at no additional charge to the client or facility.

"A recent seminar I attended suggested that ultimately, the facility should be held responsible for paying the pharmacy packaging fees when the packaging is mandated by the facility for administration to the clients.

"Please be advised that unless your policy is reconsidered, effective August 1, 2017, ValuCare will not extend credit to clients unless a responsible party makes arrangements and agrees to pay for pharmacy services. Lacking this arrangement, payment will be due at the time the medications are delivered to the facility or picked up at the pharmacy. After hours and weekend emergency services will be offered but will be subject to additional charges to the facility.'

Wilke concluded, "Had I received some advance notice of your policy change, I would have been happy to discuss these issues with you or your staff or committee but as with other actions affecting local businesses, it appears unlikely that the HHS committee was involved in this decision."

At the 2016 HHS meeting with Wilke and representatives of Genoa, Dr. Vickie Marie Cloutier had been the only committee member to vote against the agreement with Genoa. She asked how Genoa would get medications to group homes or facilities quickly after an admittance late at night, referring to Wilke's comment that ValuCare had gotten a patient in Anthony House his or her medications in about an hour the night before.

"What we can do is FedEx it, and get it overnight," the Genoa spokesman stated. He stated that Genoa has a pharmacist on-call at all times that can transfer the medication to the nearest 24-hour pharmacy, who can fill five days of the prescription, though not until the next day. Wilke was quick to point out, however, that there are no 24-hour pharmacies around, just local pharmacists on call. Wilke said that he is even called at home to deliver medications.

The Genoa spokesman had said the Consumer Medication Coordinator's role was to make sure people do not run out of medications. "We're going to let the prescriber know five days before a prescription runs out," he said.

Elsner expressed concern that the coordination by a case manager here related to that discharge (involving the person sent to Anthony House) didn't occur earlier in the day. "Somebody dropped the ball last minute," he said.




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