Physician Assistant Jacqi Kernaghan always knew she wanted to be in the medical field. Straight out of high school, she entered a graduate-bachelor’s combination program and completed her master’s degree at 23.
After time in internal medicine and primary care, she was recruited to a physician doing just osteoporosis and has been in that role for the last seven years. Her supervising physician is a gynecologist who also started an osteoporosis center.
“We have a fracture liaison service where we see patients in the hospital at the time of their fracture to emphasize secondary fracture prevention,” Kernaghan said. “80% of patients that break their hip were never told why they break their hip, which is osteoporosis and none of them were ever put on any medication. So our goal is to reduce the number of fractures in our health system.”
Care for osteoporosis was really revolutionized in the late nineties with the advent of the DEXA scan, a computer-generated image that looks at a patient’s bone, and the first oral biphosphonate. “We used to think that back in the nineties, eighties, even earlier, that when you broke your hip that was the end and there was nothing we could do about it,” Kernaghan said. “That was just the end of life for the most part.”
According to Kernaghan, 86% of patients who suffer a hip fracture will go on to have a further fracture, “which can really inhibit their quality of life and their independence.” On top of that, about 25% of patients with a hip fracture will die in that first year due to the blood supply of the fracture from things like heart attacks, strokes, and blood clots that are preventable if you’re able to remain active.
“The biggest thing we come up with is side effects,” said Kernaghan.
“People are so terrified of side effects, but if you have an educated discussion, which is usually about 45 minutes to 60 minutes with a new patient, you can explain what the side effect rate is, which is incredibly low compared to other medications.”
In fact, Kernaghan explained, the chance of side effects are one in 20,000, while the chance of breaking a bone is one in two for a woman in her life, and for men it's about one in four. Using the Fracture Risk Assessment Tool developed by the World Health Organization, Kernaghan is able to assess whether or not a patient needs to be on osteoporosis medicine in the first place. “Medicines do have side effects and the side effect isn't always worth the low benefit of a treatment,” she said.
During the pandemic, “a lot of patients were terrified to come to the office, but because of our disease state, I actually don't touch people,” said Kernaghan. “There's no physical examination that tells me what your bones look like.”
Instead, Kernaghan looks at test results: x-rays, CAT scans, MRI results, and DEXA scans. Risk factor assessment also plays into these consultations. “It's completely non physical and that's why it wasn't a hard transition to make as an osteoporosis specialist because I don't need to touch people anyway,” said Kernaghan.
Kernaghan’s biggest COVID-19 challenge came when her partner took on medical leave while staff was furloughed, leaving Kernaghan alone to deal with the deluge of patients, getting patients onto their telehealth visits, and more. In addition, some of the osteoporosis treatments are timely and require a certain schedule to be adhered to in order to maximize their efficiency.
“When our County went green again we decided we could have them back in the office again safely, but patients literally just pulled up in their car and my nurse or myself would go to their car and give their injection through the car window so that they could stay on track with their therapy,” Kernaghan explained.
“In terms of my patient advocacy it didn't change. I was still on the phone fighting for prior authorizations, or writing appeal letters or dealing with patient concerns on a regular basis.”
Prior authorizations used to take Kernaghan two hours a day. Now, she said, “I never had a fantastic specialty pharmacy before and I came across Medly in July of 2019 and they changed my life in many ways… Now I give them all the information and they use the information I give them and then complete the form, which is always the more time-consuming part.”
In many ways, Kernaghan said, “The numbers are much less than what I used to do, just because I've got a pretty good system in place now to make it a smooth process.”
The key distinction between life before Medly and life after Medly is the support that Medly offers Kernaghan as a physician’s assistant caught between patients and paperwork. “I have this fantastic pharmacy support that really makes it a lot easier for me as a provider to focus on my patients and not focus on the paperwork,” Kernaghan said.
Kernaghan first encountered Medly when she served as a pharmaceutical speaker. At a particular program, she spoke on her needs as a specialty provider who writes a high quantity of special drugs and the advocacy she supplies as a provider in order to make sure her patients can afford those expensive specialty medications. She and the Medly representative there realized they could pursue “a very symbiotic relationship in terms of provider and pharmacy.”
Some of the issues Kernaghan has encountered with big-box pharmacies include the lack of ability to speak to a live person when dealing with an issue, as well as the lack of support for coupon and patient assistance programs. That’s why “when I have a choice, Medly is the only pharmacy I go to at this point,” Kernaghan said. “It's been really a wonderful, wonderful service that Medly offers to make sure patients get what they need when they need it.”
Patients are big fans of Medly as well. Kernaghan said,
“Every patient that had the choice has stuck with Medly because of the very unique customer service that they offer.”
Kernaghan recommends the following continuing education resources:
To other providers, Kernaghan recommends working hard to understand how insurance works, especially Medicare. “I'm very happy with my knowledge base, but I wish I had known a lot of that earlier, especially in primary care. And I'd write a script for a patient and not think about what the cost was,” said Kernaghan.
Stay tuned to the Medly blog to read more in-depth provider deep dives like this one!