Hold onto your hats. I am about to enter dangerous territory. I am about to suggest maybe doctors should profit from dispensing medications from their office to offset declining reimbursements and rising expenses by using prescriptions as a source of ancillary revenues.

Why dangerous?  For a number of reasons.

One, physicians still grapple with the perception that it is improper for a physician to make money from the delivery of care from business ventures. Two, profit-making from prescription writing might induce physicians to write unnecessary prescriptions. Three, prescriptions for profit might lead to conflict with pharmacists. Four, Some states prohibit physician office dispensing, and more dispensing might lead to other states prohibiting the practice. Five, there is also a fear that such a physician business venture carry significant risk relative to government regulation.

Then, there’s the other side of the issue. Writing prescriptions and ordering their refills takes a lot of physicians’ time. It also takes knowledge. It carries some malpractice risk, should the patient suffer an adverse reaction. Dispensing from the office would be convenient for patients. Since 30% of patients never fill their prescriptions, office dispensing is more likely to assure compliance. And prescriptions dispensed at the office are generally significantly less expensive than those filled at the local pharmacy.

Besides, physician can work only a finite number of hours and see a finite number of patients. The rational way to increase revenues is to identify revenue streams that do not involve an inordinate amount of incremental time on the part of the physician. Ancillary services can assist the physician in his ultimate goal of providing quality medical care (often in his own office setting) while producing a profit for his efforts.

Add to this fact the reality that physicians across the country are already performing an increasing number of ancillary revenue-producing services – lab tests, x-rays, imaging services, osteoporosis screening, electrocardiograms, physical therapy units, alternative medicine and herbal drug sales, diabetes management programs, and weight management programs.

Are there other ways physicians can increase their compensation without sacrificing lifestyle or running afoul of government regulation?

Yes there are, and profits from prescribing is one of them. But again, consider the negative factors before setting up an office dispensing system.

• Hesitancy to change existing practice patterns
• Fear of being labeled sat “commercial”
• Lack of office space to store drug inventories
• Reluctance to buy inventories.
• Reservations about upsetting local pharmacists

Still, why shouldn’t a physician with an entrepreneurial orientation is allowed to design a plan for ancillary service delivery, execute it and make a profit?

Why not office dispensing? After all, a typical doctor sees 20 patients a day, writes one and half prescriptions and one a half refills per patient, or three for each patient. That amounts to 60 prescriptions per day. And that doesn’t count all those phone calls asking for refills. If these doctors were to have an average profit of $5 per prescription, that would be an extra $300 a day.

The linkage of e-prescribing with EHR systems, the ability of mobile iPads to send e-prescriptions, and concerns about the hazards of illegible doctor handwriting, and the push for more practice efficiencies, electronic prescribing is very much the rage these days.

So why not have the ability to e-prescribe inside the office using targeted software to write and refill prescriptions and to issue a bill?

Richard Reece is the author of Obama, Doctors, and Health Reform and blogs at medinnovationblog.

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