Save physician and staff time by renewing prescriptions until the next annual visit.

Synchronized Prescription Renewal

  • Christine Sinsky, MD AMA, Medical Associates Clinic and Health Plans
AMA in partnership with
MOC
CME Credits: 0.5

How will this module help me implement synchronized renewals?

  1. Strategies to simplify implementing the new process
  2. Answers to questions and concerns your staff may have about implementation
  3. Advice on what you may encounter when implementing synchronized prescription renewal

CME accreditation information 

Increasing administrative responsibilities—due to regulatory pressures and evolving payment and care delivery models—reduce the amount of time physicians spend delivering care. By implementing the synchronized, bundled prescription renewal process, physician practices can save valuable resources, increase time spent delivering care and improve patient safety with better medication adherence.

Synchronized Prescription Renewal Process
Release Date: October 2014
End Date: October 2018

Objectives

At the end of this activity, participants will be able to:

  1. Calculate the amount of time spent per year on prescription renewals
  2. Assess the efficiency of the current prescription renewal process
  3. Learn how to effectively implement the synchronized, bundled prescription renewal process
  4. Adopt a synchronized, bundled prescription renewal process that adheres to current state laws
  5. Improve and refine the recommended prescription renewal process

Target Audience

This activity is designed to meet the educational needs of practicing physicians.

Statement of Need

Prescription renewals have become so ingrained in office-based practices that many physicians do not recognize it as an inefficient allocation of resources. In fact, most practices renew prescriptions for an arbitrary number of refills that inevitably generates unnecessary work for physicians and their staff. This synchronized, bundled prescription renewal module is one of several practice transformation strategies aimed at reducing or eliminating onerous administrative tasks associated with prescription renewals that reduce the amount of time physicians spend delivering care.

Statement of Competency

This activity is designed to address the following ABMS/ACGME competencies: practice-based learning and improvement, interpersonal and communications skills, professionalism, systems-based practice, interdisciplinary teamwork, quality improvement and informatics.

Accreditation Statement

The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

Credit Designation Statement

The American Medical Association designates this enduring material for a maximum of 0.5 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Claiming Your CME Credit

In order to claim AMA PRA Category 1 Credit™, you must; 1) view the webinar in its entirety, 2) successfully complete the quiz answering 4 out of 5 questions correctly and 3) complete the module.

Planning Committee

  • Kevin Heffernan, MA – AMA CME Program Committee
  • Ellie Rajcevich, MPA – Practice Development Advisor, Professional Satisfaction and Practice Sustainability, AMA
  • Sam Reynolds, MBA – AMA Director, Professional Satisfaction and Practice Sustainability
  • Christine Sinsky, MD – Vice President, Professional Satisfaction, American Medical Association and Internist, Medical Associates Clinic and Health Plans, Dubuque, IA
  • Rhoby Tio, MPPA – AMA Senior Policy Analyst, Professional Satisfaction and Practice Sustainability

Author(s)

  • Christine Sinsky, MD – Vice President, Professional Satisfaction, American Medical Association and Internist, Medical Associates Clinic and Health Plans, Dubuque, IA

Faculty

  • William Bush, PA-C, MMS – Internal Medicine, Lawndale Christian Health Center
  • James R. Deming, MD – Palliative Care Physician, Mayo Clinic Health System–Northwest Wisconsin Region
  • Blair W. Fosburgh, MD – General Internist, Internal Medicine Associates, Massachusetts General Hospital
  • Michael Glasstetter – AMA, VP Advocacy Operations, Advocacy Planning & Management
  • Amy L. Haupert, MD – Family Medicine–OB, Allina Health–Cambridge Medical Center
  • Thomas Healy, JD – AMA, Vice President and Deputy General Counsel
  • Jeffrey Panzer, MD – Medical Director, Oak Street Health
  • Mary H. Parsons, MD – Medical Director, Redstone Health Center, University of Utah
  • Ramin Poursani, MD – Medical Director, Family Health Center Clinic, University of Texas Health Science Center at San Antonio
  • Ellie Rajcevich, MPA – Practice Development Advisor, Professional Satisfaction and Practice Sustainability, AMA
  • Sam Reynolds, MBA – AMA Director, Professional Satisfaction and Practice Sustainability
  • Christine Sinsky, MD – Vice President, Professional Satisfaction, American Medical Association and Internist, Medical Associates Clinic and Health Plans, Dubuque, IA
  • Rhoby Tio, MPPA – AMA Senior Policy Analyst, Professional Satisfaction and Practice Sustainability
  • Michael M. Wall, MD – Family Physician, Decatur Memorial Hospital Medical Group
  • Rachel Willard-Grace, MPH – Research Manager, Center for Excellence in Primary Care, Department of Family & Community Medicine, University of California–San Francisco

About the Professional Satisfaction, Practice Sustainability Group

The AMA Professional Satisfaction and Practice Sustainability group has been tasked with developing and promoting innovative strategies that create sustainable practices. Leveraging findings from the 2013 AMA/RAND Health study, “Factors affecting physician professional satisfaction and their implications for patient care, health systems and health policy,” and other research sources, the group developed a series of practice transformation strategies. Each has the potential to reduce or eliminate inefficiency in broader office-based physician practices and improve health outcomes, increase operational productivity and reduce health care costs.

Disclosure Statement

The content of this activity does not relate to any product of a commercial interest as defined by the ACGME; therefore, neither the planners nor the faculty have relevant financial relationships to disclose.

Hardware/software Requirements

Adobe Flash 9.0.115 or above
Audio speakers or headphones
Screen resolution of 800X600 or higher
MS Internet Explorer 8.0 or higher, Firefox, Opera, Safari, etc.
Adobe Reader 5.0 or higher

References

  1. Baron R. What is keeping us busy in primary care? A snapshot from one practice. N Engl J Med. 2010;363:495-496. nejm.org/doi/full/10.1056/NEJMon0910793. Accessed April 2, 2014.
  2. Choundry NK, Fischer MA, Avorn J, et al. The implications of therapeutic complexity on adherence to cardiovascular medications. Arch Intern Med. 2011;171(9): 814-822. http://archinte.jamanetwork.com/article.aspx?articleid=227251. Accessed April 2, 2014.
  3. Devine EB, Hollingworth W, Hansen RN, et al. Electronic prescribing at the point of care: a time–motion study in the primary care setting. Health Serv Res. 2010;45(1):152-171. ncbi.nlm.nih.gov/pmc/articles/PMC2813442/. Accessed April 2, 2014.
  4. Foster DG, Hulett D, Bradsberry M, Darney P, Policar M. Number of oral contraceptive pill packages dispensed and subsequent unintended pregnancies. Obstet Gynec. 2011;117(3):566-572.http://journals.lww.com/greenjournal/Abstract/2011/03000/Number_of_Oral_Contraceptive_Pill_Packages.8.aspx. Accessed April 2, 2014.
  5. Sinsky CA, Sinsky TA. Bundling prescription refills. Fam Pract Manag. 2013;20(1):9-10.
  6. Friedberg M, Chen P, Van Busum KR, Aunon FM, Pham C, et al. Factors affecting physician professional satisfaction and their implications for patient care, health systems, and health policy. Washington, D.C: RAND Corporation; 2013. http://www.rand.org/content/dam/rand/pubs/research_reports/RR400/RR439/RAND_RR439.pdf. Accessed April 2, 2014.
  7. Murphy DR, Reis B, Kadiyala H, et al. Electronic health record-based messages to primary care providers: valuable information or just noise? Arch Intern Med. 2012;172(3):283-285. http://archinte.jamanetwork.com/article.aspx?articleid=1108701. Accessed April 2, 2014.
  8. Sinsky TA, Sinsky CA. A streamlined approach to prescription management. Fam Pract Manag. 2012;(6):11-15. http://www.aafp.org/fpm/2012/1100/p11.html. Accessed April 2, 2014.
  9. Wieczner J. The doctor won't take your call. Marketwatch. July 16, 2013. http://www.marketwatch.com/story/the-doctor-wont-take-your-call-2013-07-16. Accessed April 2, 2014.
  10. Jalpa A. Doshi, Raymond Lim, Pengxiang Li, Peinie P. Young, Victor F. Lawnicki, Joseph J. State, Andrea B. Troxel and Kevin G. Volpp. A Synchronized Prescription Refill Program Improved Medication Adherence Health Affairs 35, no. 8 (2016): 1504 - 1512 doi: 10.1377/hlthaff.2015.1456

Introduction

What is synchronized prescription renewal?

Synchronized prescription renewal is the process of renewing all of a patient's stable medications for the typical maximum duration of 12 to 15 months.

Synchronized prescription renewal introduction

How much time and money per year will a synchronized prescription renewal process save my practice?

Consider a hypothetical scenario of an internal medicine practice that has not implemented a synchronized prescription renewal process. This practice has 1,000 patients with chronic illness with an average of five medications per patient. Every year, each patient makes an average of two calls per prescription. Each call lasts about two minutes. These factors result in more than 300 hours of physician and staff time spent on prescription renewals per year.

The calculators below will automatically generate the amount of time saved per year and the annual savings that could be gained by implementing a synchronized prescription renewal process. Use the dropdown menu in each calculator to select the numbers that reflect your practice.

Calculate time saved per year:

Estimate savings

Patients with
chronic illness

x

Medications
per patient

x

Calls per prescription
per year

x

Minutes per call

=

Time

250h 0m
/YEAR

Time saved

Calculate money saved per year:

Your practice

$
/min

Cost of physician's time

$
/min

Cost of staff time

days/year

Clinic days per year

Estimate savings

min/day

Rx time for Physician More info

+
min/day

Rx time for Staff More info

=

Time

1h 0m
/day

Time saved

=

Money

$26,400

Annual savings with
Synchronized Prescription
Management

Source: AMA. Practice transformation series: synchronized prescription renewal.. 2014.

Three steps to synchronized prescription renewals

  1. At a dedicated annual comprehensive care visit, renew all medications for chronic illness for the maximum duration allowed by state law.
  2. Include instructions for the pharmacy on all prescription modifications and renewals as applicable (e.g., “Do not fill until patient calls” or “Place on hold”).
  3. Take the opportunity to renew all of the patient's prescriptions for chronic conditions when you receive a prescription renewal request.
  1. 1

    At a dedicated annual comprehensive care visit, renew all medications for chronic illness for the maximum duration allowed by state law

    The annual comprehensive care visit is a good time to renew all medications for chronic illness because during this visit the patient's medical history is thoroughly reviewed, including past and present conditions and medications. During this visit all medications for chronic illness should be renewed for the maximum duration (12 to 15 months in most states). When a patient has received prescriptions for their chronic conditions for the upcoming year, they will not need to call the office for refills, and they will not have any unanticipated gaps in medication adherence.

  2. Minimize refill re-work. Prescribe for the whole year. #STEPSforward

  3. 2

    Include instructions for the pharmacy on all prescription modifications and renewals as applicable (e.g., “Do not fill until patient calls” or “Place on hold”)

    A standard notification indicating that a medication is being discontinued or a new dose replaces a previous one can accompany the electronic prescription submitted to the pharmacy. This allows the pharmacy to update their list of the patient's current prescribed medications. This will also lessen the chances that the patient continues to fill both the old and the new prescriptions.

    As a courtesy, we recommend alerting the pharmacy that the patient may not need to fill the renewed prescription right away. This way, the pharmacy does not dispense medication before the patient needs it.

  4. Include Instructions
  5. 3

    Take the opportunity to renew all of the patient's prescriptions for chronic conditions when you receive a prescription renewal request

    During the hustle and bustle of a busy workday it may be tempting to renew only the requested medication. However, renewing all prescriptions at the time of one medication request will reduce the subsequent number of calls for prescription refills, especially during the first year.

    There is no need to calculate the number of refills necessary to last the patient until the next annual visit. This is unnecessarily complex. It is easier to renew prescriptions for the maximum duration (i.e., 90 days and 4 refills). You should then synchronize all of the prescriptions at the next annual comprehensive care visit, by renewing all for the maximum duration, whether or not there are refills remaining on the old prescription.

Conclusion

Synchronized prescription renewal can save your practice time and help it function more efficiently. Your practice can put this approach into action using the step-by-step guide provided in this module and the corresponding implementation checklist.

Synchronized prescription renewal conclusion

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Downloadable tools

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The tools and resources here can offer implementation support for your practice. You can download and modify them to fit your specific needs.

Complete synchronized prescription renewal protocols toolkit

Access all tools and resources for this module.

Download

(ZIP, 35 MB)

Module Completion

Individual tools

  • Synchronized prescription renewal module

    Download a printable PDF version of this module.

    Download

    PDF, 546 KB

    Preview
  • Synchronized prescription renewal PowerPoint

    Use this PowerPoint presentation to review this module with your team.

    Download

    PPT, 35 MB

    Preview
  • Synchronized prescription renewal implementation checklist

    A checklist to help assess, improve and reassess the implementation process of synchronized prescription renewal in your practice.

    Download

    MS WORD, 50 KB

    Preview
  • Synchronized prescription renewal metrics

    Measure the impact of synchronized prescription renewal.

    Download

    MS WORD, 95 KB

    Preview
  • AMA Wire - Synchronized Prescription Renewal

    Article adapted from the AMA Wire® that summarizes the STEPS Forward module on Sychronized Prescription Renewal.

    Download

    PDF, 141 KB

    Preview

References

  1. Baron R. What is keeping us busy in primary care? A snapshot from one practice. N Engl J Med. 2010;363:495-496. nejm.org/doi/full/10.1056/NEJMon0910793. Accessed April 2, 2014.
  2. Choundry NK, Fischer MA, Avorn J, et al. The implications of therapeutic complexity on adherence to cardiovascular medications. Arch Intern Med. 2011;171(9): 814-822. http://archinte.jamanetwork.com/article.aspx?articleid=227251. Accessed April 2, 2014.
  3. Devine EB, Hollingworth W, Hansen RN, et al. Electronic prescribing at the point of care: a time–motion study in the primary care setting. Health Serv Res. 2010;45(1):152-171. ncbi.nlm.nih.gov/pmc/articles/PMC2813442/. Accessed April 2, 2014.
  4. Foster DG, Hulett D, Bradsberry M, Darney P, Policar M. Number of oral contraceptive pill packages dispensed and subsequent unintended pregnancies. Obstet Gynec. 2011;117(3):566-572.http://journals.lww.com/greenjournal/Abstract/2011/03000/Number_of_Oral_Contraceptive_Pill_Packages.8.aspx. Accessed April 2, 2014.
  5. Sinsky CA, Sinsky TA. Bundling prescription refills. Fam Pract Manag. 2013;20(1):9-10.
  6. Friedberg M, Chen P, Van Busum KR, Aunon FM, Pham C, et al. Factors affecting physician professional satisfaction and their implications for patient care, health systems, and health policy. Washington, D.C: RAND Corporation; 2013. http://www.rand.org/content/dam/rand/pubs/research_reports/RR400/RR439/RAND_RR439.pdf. Accessed April 2, 2014.
  7. Murphy DR, Reis B, Kadiyala H, et al. Electronic health record-based messages to primary care providers: valuable information or just noise? Arch Intern Med. 2012;172(3):283-285. http://archinte.jamanetwork.com/article.aspx?articleid=1108701. Accessed April 2, 2014.
  8. Sinsky TA, Sinsky CA. A streamlined approach to prescription management. Fam Pract Manag. 2012;(6):11-15. http://www.aafp.org/fpm/2012/1100/p11.html. Accessed April 2, 2014.
  9. Wieczner J. The doctor won't take your call. Marketwatch. July 16, 2013. http://www.marketwatch.com/story/the-doctor-wont-take-your-call-2013-07-16. Accessed April 2, 2014.
  10. Jalpa A. Doshi, Raymond Lim, Pengxiang Li, Peinie P. Young, Victor F. Lawnicki, Joseph J. State, Andrea B. Troxel and Kevin G. Volpp. A Synchronized Prescription Refill Program Improved Medication Adherence Health Affairs 35, no. 8 (2016): 1504 - 1512 doi: 10.1377/hlthaff.2015.1456

Downloadable tools

Go to Resource Library

The tools and resources here can offer implementation support for your practice. You can download and modify them to fit your specific needs.

Complete synchronized prescription renewal protocols toolkit

Access all tools and resources for this module.

Download

(ZIP, 35 MB)

Module Completion

Individual tools

  • Synchronized prescription renewal module

    Download a printable PDF version of this module.

    Download

    PDF, 546 KB

    Preview
  • Synchronized prescription renewal PowerPoint

    Use this PowerPoint presentation to review this module with your team.

    Download

    PPT, 35 MB

    Preview
  • Synchronized prescription renewal implementation checklist

    A checklist to help assess, improve and reassess the implementation process of synchronized prescription renewal in your practice.

    Download

    MS WORD, 50 KB

    Preview
  • Synchronized prescription renewal metrics

    Measure the impact of synchronized prescription renewal.

    Download

    MS WORD, 95 KB

    Preview
  • AMA Wire - Synchronized Prescription Renewal

    Article adapted from the AMA Wire® that summarizes the STEPS Forward module on Sychronized Prescription Renewal.

    Download

    PDF, 141 KB

    Preview

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The AMA is committed to helping you implement the solutions presented in this module.

If you would like to learn about available resources for implementing the strategies presented in this module, please call us at (800) 987‑1106 or send us a message.

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AMA PRA Category 1 Credit™ will be available for the activity. Physicians should claim only the credit commensurate with the extent of their participation in the activity. In order to claim AMA PRA Category 1 Credit™, you must: 1) view the module in its entirety, 2) successfully complete the quiz by answering 4 out of 5 questions correctly and 3) complete the evaluation.

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