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A movement founded by doctors, for doctors, dedicated to empowering medical professionals to reclaim control over healthcare decisions and advocating for their fair share of the industry's resources.
00:00:04:00 - 00:00:27:01
Justin Nabity
This is the DocNation podcast. We are a movement founded by doctors for doctors dedicated to empowering medical professional to reclaim control over health care decisions and advocating for their fair share of the industry's resources. Please note the views expressed are those of DocNation and not necessarily those of our Guest or Reference Health centers.
00:00:27:03 - 00:00:30:02
Neil Dougherty
Dr. Stout, thanks for being with us..
00:00:30:04 - 00:00:33:00
Dr. Jaron Stout
Thank you very much for inviting me. I'm glad to be here.
00:00:33:02 - 00:00:37:11
Neil Dougherty
Oh, I love it. Have you seen some of our podcasts in the past?
00:00:37:13 - 00:00:45:11
Dr. Jaron Stout
I watched a couple. Not not very many. And only I did. Not all of them all the way through. But I got a feel for it. So.
00:00:45:13 - 00:00:50:05
Neil Dougherty
So we have. We haven't actually had a chance to meet. Can you give me a little bit more of your background?
00:00:50:07 - 00:01:11:22
Dr. Jaron Stout
Yeah. For sure. I'm, I'm Dr. Jaron Stout. I'm a pharmacist. And, I have a very unique practice that's kind of, on the cutting edge, I guess. But I'm. I'm trying. So. I mean, just a very brief background. A consultant pharmacist is a required service in skilled nursing facilities. I don't know if you knew that.
00:01:11:24 - 00:01:14:00
Neil Dougherty
Okay.
00:01:14:02 - 00:01:41:02
Dr. Jaron Stout
It's their job to make sure every resident's medication is reviewed every month. And so, I was hired as a consultant pharmacist early in my career, shortly after I graduated, and I quickly realized that it was, not the service that it needed to be to meet the need of the population. And so I've made it my mission to kind of raise the bar on the standard of practice and how it's handled.
00:01:41:04 - 00:02:00:10
Dr. Jaron Stout
And that includes, you know, very thorough collaboration with medical groups, and using the available billable mechanisms to enhance the services and extend the reach of the physicians. So that's an oversimplified way of explaining it.
00:02:00:12 - 00:02:29:09
Neil Dougherty
I have I have questions here right. Now, any time, obviously, you're kind of exercising your leadership and doing things like this on a podcast and stuff like that. So, but when you mentioned the word mission, I don't want to I want to know, right. What what really is that mission or what's driving that? Like what what's going on there that needed to be kind of revamped.
00:02:29:11 - 00:02:52:18
Dr. Jaron Stout
All right. So just as a background of what typically happens, when I was first hired, I was I was trained to, show up, crank through as many charts as you can as fast as you can. And I worked for a pharmacy, which technically, there's an inherent conflict of interest. There's no incentive to get rid of unnecessary meds because it technically hurts their bottom line.
00:02:52:20 - 00:03:11:19
Dr. Jaron Stout
There's no incentive to do a good job, because no matter how good you are, you're going to lose your job as soon as they hire a new pharmacy. So there there's there's some problems with it. I was trained to show up. And if you find someone's on aspirin and Plavix, then that means you make a recommendation saying, hey, we need to monitor for bleeding.
00:03:11:21 - 00:03:31:05
Dr. Jaron Stout
And, you know, very early in my career, I was I remember seeing a nurse and she was telling me, Jaron why do you tell me to monitor for bleeding? I'm a nurse. I do that every day. Whether or not you recommend it, whether it doesn't matter what drug they're on, I'm already doing that. And that changed my perspective.
00:03:31:05 - 00:03:53:20
Dr. Jaron Stout
And I started to think, oh, well, you're right. What should a pharmacist be doing? Like what kind of recommendation should we be making? And so instead of identifying bleed risk, I had I identified when the meds were present that would increase the risk and identify if they were appropriately used. Because not everyone should be on dual antiplatelet for extended periods.
00:03:53:20 - 00:04:16:06
Dr. Jaron Stout
So identify if it was for a stroke and if so, that's usually a very short term regimen. So that's one way of putting it. And I would say that the mission is because that kind of started it. And I also had a nurse early in my career said, Jaron, we love having you here, but we know when you come here you're just going to give us a stack of paperwork.
00:04:16:08 - 00:04:36:00
Dr. Jaron Stout
And so I've looked for ways to simplify it so that I'm not adding to their workload, but instead I'm doing a collaborative practice with the physician to where I show up, implement changes on their behalf, and then give the nurse a stack of paperwork that says, here's all the stuff that I did to fix your facility and the medications today.
00:04:36:02 - 00:05:00:07
Dr. Jaron Stout
And so I also I started a collaborative practice. I created my own company. I broke free from the dispensing pharmacies. And I've I've taken over 50% of my market in the state that I live in in Utah. And, I've also created a coalition. I go to DC and I do a lot of advocacy on how, physicians and pharmacists can do and, more collaborative efforts.
00:05:00:09 - 00:05:10:18
Dr. Jaron Stout
And I know CMS has a lot of interest in more team based approaches and practices. So this has been received well all around. So far.
00:05:10:20 - 00:05:11:14
Neil Dougherty
Uh Justin?
00:05:11:14 - 00:05:35:17
Justin Nabity
I’m itching, yeah. So, one of the things that I think people wonder about DocNation is, is DocNation just for doctors, is it for anybody else? And actually, yes, it's it's very much about patients. We want to restore the relationship between doctors and patients because there's been a huge wedge that has come between that relationship and that relationship
00:05:35:17 - 00:06:02:13
Justin Nabity
is so key. And having time with your patient and what you're talking about, actually making sure that the way that they're being treated with their medications and the regimen and what they're doing, that a holistic process for getting the care for your patient the way that they should be taken care of. That's so critical. And you said earlier that the bottom line for these businesses gets in the way.
00:06:02:15 - 00:06:32:02
Justin Nabity
And that's a problem. And we're all about business. We are pro business. We love business. It's our favorite thing is to see business flourish for our clients in whatever way that they're doing their practice. But the business, the corporate side should not get in the way. It should not disrupt the relationship and the quality of the care. That's why it's 2024 and we should have the best outcomes, the best health care ever that has.
00:06:32:04 - 00:06:52:01
Justin Nabity
We have all of these innovations in technology and everything else. And for some reason, health care is actually go in the opposite direction. It's the opposite of what it should be. And why is that? Because the health care provider and the patient don't get to have the relationship that they're supposed to have. So DocNation is not just about doctors.
00:06:52:01 - 00:07:15:03
Justin Nabity
There's always it's way more than that. It's about their relationship that they do have their patients. So I love what you're doing here because you have seen that there's something competing with the quality of care. So can you maybe speak a little bit more because even the patients, the, the non-medical professionals that tune in and listen into this, they need to know that because they think, “Is my doctor
00:07:15:03 - 00:07:30:17
Justin Nabity
the problem? Is an insurance company the problem? What's really the problem here?” Like patients need to know that doctors really want the best for their patient, but there's a constant fight that they have to put up with. So tell us more about that.
00:07:30:19 - 00:07:55:12
Dr. Jaron Stout
Yeah. So I mean, as you know, health care unfortunately has created a system that has become very much volume driven. So you're you're you're compensated well to crank through the patient visits more than you should. And it so, you know, one of the ways to remedy that currently is, well, let's just throw more providers at the problem.
00:07:55:14 - 00:08:15:10
Dr. Jaron Stout
Now keep in mind more providers is great. And we obviously need more providers because we have a giant gap that continues to grow and the number of providers available, especially on the front lines and primary care. And, you know, just to the best part. So,
00:08:15:12 - 00:08:39:16
Dr. Jaron Stout
Rather than throwing more of the same old stuff at it as, like you said, things are kind of going in the wrong way rather than throw more of the same old stuff. If we include a new perspective and a more collaborative approach, I think that's going to enhance the patient care significantly. And the best part about that is you don't need to give provider status to pharmacists.
00:08:39:16 - 00:09:00:08
Dr. Jaron Stout
And I'm not advocating for provider status because we can make a difference right now with the billable mechanisms that are already in place. As long as we work for a medical group under a medical group, we can extend the reach of those physicians under their supervision. We and whatever. It's not like, you're just handing over the keys.
00:09:00:08 - 00:09:38:03
Dr. Jaron Stout
Although some physicians would like to do that. You literally only delegate what you're comfortable delegating. And in the case of a pharmacist, you have to realize that we we're not diagnostician, we're not trying to be diagnostician, but we have been very thoroughly trained on how to manage chronic disease states and treat them pharmacologically. And, you know, ironic. It's a kind of ironic that more and more pharmacists are becoming more functional medicine based, because we see that we tend we're right now over medicating a lot of people and polypharmacy.
00:09:38:05 - 00:10:06:19
Dr. Jaron Stout
And the most common intervention in health care right now is adding a medication. Well, when you start a medication, you're never, ever, ever, ever, ever fixing a problem. You're trading it in for a new one. And so if you have a pharmacist on your team who has that perspective, then we're able to reverse engineer what medications are creating new problems that we weren't identifying that resulted in more medications being added on board.
00:10:06:21 - 00:10:08:10
Justin Nabity
So I love that Hold on one second if I can interrupt.
00:10:08:11 - 00:10:10:05
Dr. Jaron Stout
Yeah, yeah.
00:10:10:07 - 00:10:12:13
Justin Nabity
Are you getting in trouble because you just said that?
00:10:12:13 - 00:10:15:11
Justin Nabity
Like like just go to like you
00:10:15:13 - 00:10:32:01
Justin Nabity
just said the thing that like the drug companies don't want to be heard. Like for patients that are tuning in like, absolutely. This is exactly the kind of Intel that should be shared. Like, who are you to get in trouble with? Why would you talk like that?
00:10:32:03 - 00:10:36:21
Neil Dougherty
That's, Justin, that's who we are. It's like DocNation. We say the quiet part out loud.
00:10:37:01 - 00:11:02:09
Dr. Jaron Stout
Yeah, right. That enhances good care. Right? You know, and and yeah, I mean I've it it's funny you would say that I tend to, perhaps. Not I wouldn't say offend. That's too strong of a word, but rub some people the wrong way in how I approach that, especially since I no longer work for a pharmacy.
00:11:02:15 - 00:11:28:06
Dr. Jaron Stout
It's it's so hard for me to be defined in my practice now, because technically, when a pharmacist steps out of the pharmacy, they have, they're not defined in how they practice at all. We're literally confined to a box where we can practice. And I am an out of the box thinker. And so, it's it's made it so that it's some people don't like.
00:11:28:08 - 00:11:55:06
Dr. Jaron Stout
Not very many. I would say the vast majority like what I do, and they agree with what I do. And like you said, it's just the quiet part out loud that we need to find non-pharm... And that's another aspect I'll, I'll get into you ask.. So if right now providers are incentivized to have an intervention in their during their visit because that allows them to bill for a higher complexity.
00:11:55:08 - 00:12:19:15
Dr. Jaron Stout
What we need to do is identify more interventions that are not drug based. And if we have more ways of intervening and providing care plans that don't include adding a new medication, then we can still bill for those higher complexities and perhaps even have better outcomes, because a lot of drugs, like I said, are just a trade off and we're creating new problems down the road.
00:12:19:17 - 00:12:28:16
Justin Nabity
And so here's why the consulting for these these patients is key. Because who is advocating in this way like
00:12:28:18 - 00:12:52:10
Dr. Jaron Stout
Right, yeah. And you know, like I said, it's a new perspective. So when a physician sees a patient they make a diagnosis. They will they see the patient make a diagnosis and move down to medications. A pharmacist does the exact opposite. And it's really synergistic and very complementary. We start with the meds and then work our way up to their conditions and then talk to the patient about what what our findings are.
00:12:52:10 - 00:13:00:17
Dr. Jaron Stout
I mean, you'd be surprised at how well that works together. I have tons of examples I can give.
00:13:00:19 - 00:13:10:17
Neil Dougherty
That's really encouraging. That type of collaboration. How much of this message, has reached DC?
00:13:10:19 - 00:13:13:03
Neil Dougherty
You mentioned something earlier...
00:13:13:05 - 00:13:37:12
Dr. Jaron Stout
so I created it a coalition. And it was mostly because we wanted to bring a case to CMS and let them know, here's, here's what the incident two laws or regulations state here is how vastly different they are being interpreted from one provider to the next. Here is all of the misunderstandings that we have identified.
00:13:37:14 - 00:14:05:03
Dr. Jaron Stout
We need a public clarification. Yes, pharmacists can be auxiliary personnel. Yes, they can do incident into in nursing facilities. Because there is a ton of medical groups and MAC providers that are all interpreting it differently. And even though I personally have received confirmation from CMS in an email that yes, I interpreted it correctly, because I kept going up and up and up the chain.
00:14:05:03 - 00:14:25:03
Dr. Jaron Stout
Everyone didn't know how to answer my questions. So finally they afforded me to a rep at the CMS office in Denver. And so we wanted to get a public clarification. When I created the coalition, that was kind of the goal. However, with the flexibilities in place with Covid, it wasn't like a high priority. So we kind of put that on the backburner.
00:14:25:05 - 00:14:55:22
Dr. Jaron Stout
And now it's been mostly just, spreading the word with occasional visits to my senators and a few other senators. Depending on who's with me when I go to Capitol Hill. So it's still, not widely known because we're, a pretty small niche that I'm hoping a change that I would say if what I do works and what I'm trying to do works, it could quadruple the number of consultant pharmacists that provide care in nursing homes.
00:14:55:22 - 00:15:00:13
Dr. Jaron Stout
And significantly enhance what they're doing to begin with.
00:15:00:15 - 00:15:09:00
Neil Dougherty
Okay, so let's get the word out right now. All the other pharmacists or consultants out there, they need to do what,
00:15:09:02 - 00:15:11:00
Dr. Jaron Stout
well.
00:15:11:02 - 00:15:12:08
Dr. Jaron Stout
The unpopular...
00:15:12:11 - 00:15:14:17
Justin Nabity
Contact you and get a game plan.
00:15:14:19 - 00:15:50:20
Dr. Jaron Stout
Yeah, yeah, yeah, I think the unpopular opinion, many people would disagree with me, but we we're I love the fact that we've provided products for ages and ages, but we we can't be a one trick pony. I would say break free from the pharmacy. Do this on your own. Pharmacies are great at what they do, but they're not great at understanding how to bill for time because that's the biggest obstacle we've had.
00:15:50:22 - 00:16:17:13
Dr. Jaron Stout
We've only been able to bill for products for ages and ages and ages. So when we have the opportunity to bill for our time, it turns into what product can we base this on? So let's do lipid screening so we can hand out more statins, let's do, Covid tests so we can hand out more, more, Covid treatments, little things like that.
00:16:17:15 - 00:16:44:23
Dr. Jaron Stout
I would say create your own thing. And like you said, reach out to me. Go. And if you if you're a consultant pharmacist, you should already have good relationships with several providers. Team up with providers, start offering enhanced care through incident to, through CCMs, through BHI, and annual wellness visits to extend the reach of those physicians and use those billable mechanisms to extend the reach and enhance the care.
00:16:45:00 - 00:16:54:22
Justin Nabity
There's already a provision for this. There's a requirement that, as you mentioned at the very beginning, as you get your background, that this is a requirement to be available, it's not being filled.
00:16:54:24 - 00:16:55:20
Dr. Jaron Stout
Right.
00:16:55:22 - 00:17:04:08
Justin Nabity
And the reason why they don't pharmacists don't know this or unaware or they're not pursuing it is what? What's stopping them from fulfilling
00:17:04:10 - 00:17:04:19
Dr. Jaron Stout
Several things.
00:17:04:19 - 00:17:15:13
Justin Nabity
What's already required to be in place that should be there for their own benefit of the the patients that are living in these facilities?
00:17:15:15 - 00:17:22:19
Dr. Jaron Stout
I'm not sure I understand the question. So, you're so what are you asking? I'm not sure I understand.
00:17:22:19 - 00:17:40:13
Justin Nabity
There's a that they're supposed to have a consultant. Do you set it right for. Yeah. For every however many patients that live in this facility, they need to have somebody that's helping provide leadership in this way. And there's there's a a hole or a gap that this rule is not being fulfilled by people. That could do it.
00:17:40:18 - 00:17:49:09
Justin Nabity
Doctors like you. So is there a reason why they don't know about it or they're not pursuing it? What's what's the hold up there?
00:17:49:14 - 00:18:19:03
Dr. Jaron Stout
Okay. Yeah. Sorry. So I think part of it is just. You're taught how to do a task, and you and typically pharmacists like to stay in their little box. So as soon as you're trained on. Hey, show up, if you see doctors say try to get rid of it or recommend getting rid of it. If you see, if you see it basically comes down to education and training.
00:18:19:03 - 00:18:45:01
Dr. Jaron Stout
Most of them don't even know that these opportunities are available. And it's funny because CMS publicly stated or answered the American Academy of Family Physicians in 2014. Yes, pharmacists can work in a clinic and they can operate as incident to an in a clinic. But despite that, none of the pharmacy organizations have really promoted that. None of the pharmacy schools have really promoted that.
00:18:45:02 - 00:19:04:23
Dr. Jaron Stout
No, there's no not a lot of education or understanding on how you can collaborate with physicians. I'm trying to make it so that we I've collaborate with where I went to pharmacy school, trying to get them on board with providing a course, because the problem is, when you graduate from pharmacy school, you're six figures in debt, and then you find out that these opportunities are available.
00:19:05:01 - 00:19:22:21
Dr. Jaron Stout
So now you have to pay other pharmacists, that are out there teaching other pharmacists how to do this. And then you go another, 4 or 5 figures in debt trying to figure that out, because there's a lot to understand and how to bill for your time, that pharmacists are not trained on, that physicians are routinely trained on it.
00:19:22:23 - 00:19:45:07
Dr. Jaron Stout
So a big, big, big aspect of that is A) education and B) how it's regulated. Because right now, if the flexibilities go away, there's going to be a lot of restrictions that are coming back that complicate it. And just one last thing on that general versus direct supervision, I assume you know what that is in incident to regulations.
00:19:45:09 - 00:20:06:15
Dr. Jaron Stout
But direct supervision that works great in a clinic, but in a nursing home, it actually complicates things. In fact, if you are a physician in a medical group, you have a physician and a nurse practitioner. You schedule your visits to stagger so you're not in the building at the same time or on the same day. Otherwise your visits might overlap.
00:20:06:15 - 00:20:27:17
Dr. Jaron Stout
And that creates problems because you can't bill for both those visits. Now under direct supervision. If you have a pharmacist working for the physician, you would have to be in the building at the same time at the same day. Then you have to do a lot of heavy coordination. Okay, you're going to see them? Okay. I'll put my visit with them off till another day.
00:20:27:19 - 00:20:46:12
Dr. Jaron Stout
And if you're there once a week, sometimes you're waiting one or 2 or 3 weeks to see the patient that you found a problem with. And so technically, direct supervision in nursing facilities is a very bad way to go about providing this care.
00:20:46:14 - 00:20:48:17
Neil Dougherty
That’s interesting. Let’s think about that part.
00:20:48:19 - 00:20:51:08
Justin Nabity
Yeah.
00:20:51:10 - 00:20:52:19
Dr. Jaron Stout
Well, yeah.
00:20:52:21 - 00:21:11:00
Neil Dougherty
So even hearing this as a patient or Yeah. Me I got to excuse my ignorance a little bit. I didn't know a lot of this stuff coming in here. I would but what can we do. What what are, what do we need to look out for.
00:21:11:02 - 00:21:35:04
Dr. Jaron Stout
I would say, you know, if you look at the AMA's website, they actually offer a course on how to hire a pharmacist and implement a pharmacist in your services. And it's nobody knows about it. But basically what it says is, is you can just do a pilot, a small pilot, bring them in, give them some of your most complicated cases.
00:21:35:06 - 00:22:09:08
Dr. Jaron Stout
And from there you can identify where their strengths are and kind of build on it. From there. I would say. That's a very effective way to go about it. And also look at where pharmacists have been proven the most valuable. They've been proven valuable in diabetes management. Anticoagulation management, COPD, a lot of the big heavy hitters and chronic disease states that are problems in our country are areas where pharmacists thrive.
00:22:09:10 - 00:22:38:16
Dr. Jaron Stout
And that frees up the the providers to start, identifying and diagnosing new problems with patients. They're freed up to to the day to day management of chronic disease states to kind of delegate that to a pharmacist. So those are very effective ways to to start with. And just on that anticoagulation, topic, I literally just published an article on October 1st, a study that I did with a group over eight states.
00:22:38:18 - 00:23:06:12
Dr. Jaron Stout
We were able to show that, anti doacs direct oral anticoagulation dosing is vastly misunderstood. And we found that consultant pharmacists can and should be making a huge impact to make sure they're dosed appropriately. In fact, I think the numbers inflated. But we found 85% of oral anticoagulation was inappropriate. And so it's really hard to stay on top of that while managing.
00:23:06:12 - 00:23:16:20
Dr. Jaron Stout
And all of your patients from day to day. So having a pharmacist on board just helps improve that care. Yeah, health care's getting more complicated. As you said
00:23:16:22 - 00:23:17:03
Justin Nabity
okay.
00:23:17:03 - 00:23:39:13
Dr. Jaron Stout
I hope that answered your question. Yeah it does. And, Neil, I think we should make sure that we get that link to that course so we can have that with this. So after listening go jump on our web page and go pull that down. Yeah. You talked about the pipeline, but the education process government and these health care institutions, what do they want?
00:23:39:14 - 00:24:01:08
Justin Nabity
They want workers. They want you to be a worker, not a thinker. They want you to be a doer, a taker of orders, being told what to do, not to think for yourself. So I really appreciate you stepping out, being courageous, being bold, stepping into bravery to say, you know, actually there might be a better way to do this.
00:24:01:08 - 00:24:21:24
Justin Nabity
And I it's going to be good for me to think a little bit for myself, because as you think for yourself, you are giving others the opportunity to say for themself as well. So thank you for for taking the step and, and and being bold to go against the grain a little bit like, yeah, some people.
00:24:21:24 - 00:24:28:03
Neil Dougherty
And to get it out there and share with others. Yeah I mean this is thank you for bringing this to DocNation.
00:24:28:05 - 00:24:52:08
Justin Nabity
We look forward to watching you as you continue to champion this, for the sake of the community. And the community benefits because you're as you said, it's never solving a problem, truly. And there needs to be other things that get brought in. So I appreciate your holistic perspective and not just being that one trick pony, which the industry is, is just so plagued with.
00:24:52:08 - 00:24:58:01
Justin Nabity
So we look forward to watching you as you continue to fight this fight.
00:24:58:03 - 00:25:03:20
Dr. Jaron Stout
Well thank you. I'm just honored with the invite and happy to come here any time. So thank you.
00:25:03:22 - 00:25:05:15
Neil Dougherty
Don't be don't be a stranger.
00:25:05:17 - 00:25:08:17
Dr. Jaron Stout
Yeah. Yeah. You as well.
00:25:08:19 - 00:25:25:15
Justin Nabity
This has been the DocNation podcast. If you like what you heard, be sure to subscribe, rate and leave us a review on Apple Podcasts, Spotify, or wherever you are listening to us. Your feedback really helps us reach more listeners like you. We'd also love to hear your thoughts and any topics you'd like us to cover in future episodes.
00:25:25:21 - 00:25:33:05
Justin Nabity
Don't forget to follow us on Facebook, Instagram, and LinkedIn for updates, behind the scenes content, and to join the conversation. Thanks for listening.