Two studies in the July/August 2014 issue of JAPhA highlighted good news for pharmacists when it comes to establishing clinical services directly located in physicians’ offices. The experience studies explored potential roles for pharmacists in Medicare Annual Wellness Visits (AWV). The studies showed that pharmacists “can use the AWV to create the infrastructure of pharmacy services in primary care practices that will be needed to care for patients once provider status is achieved,” said Courtenay Gilmore Wilson, PharmD, CDE, BCPS, CPP, Associate Director of Pharmacotherapy at Mountain Area Health Education Center and lead author of one of the studies.
AWVs comprise services that can keep patients healthy by preventing diseases or detecting them early when they occur. One of the required elements is a complete medication review, a service pharmacists are ideally suited to provide.
The first experience article described pharmacist-delivered AWVs for Medicare beneficiaries developed within a family practice office in a cost-justified manner. “Patients asked for this service, but physicians did not have time to provide it,” said study coauthor Michelle Herbert Thomas, PharmD, CDE, BCACP, Clinical Pharmacist, Chickahominy Family Physicians. “I previously provided patient care services 1 day per week, and I added an additional day per week for AWVs.”
Thomas provided health risk assessments and medication therapy management as well as screened for depression and immunization status. From September 2012 to February 2013, 174 patients participated in the pharmacist- delivered AWV. Each visit was reimbursed at a rate of $163.51. The annual practice income from AWVs was $27,880.
In a second experience article, the authors assessed the financial feasibility of pharmacist-conducted AWVs in a physician’s office. The authors calculated what proportion of Medicare-eligible patients had to receive an AWV to support a pharmacist salary in a small, medium, and large physician practice. “Especially in practices with five or more physicians, it is relatively easy to achieve the number of visits needed to cover a pharmacist’s salary of $120,000 per year,” said Wilson. “Only 18% of eligible patients need to have an AWV in practices with five doctors.” The study found that a total of 1,070 AWVs per year are required to support a pharmacist’s salary, regardless of practice size.
CMS language states that a health professional—meaning a physician (a doctor of medicine or osteopathy), a qualified nonphysician practitioner (a physician assistant, nurse practitioner, or certified clinical nurse specialist), or a medical professional (including a health educator, registered dietitian, nutrition professional, or other licensed practitioner), or a team of such medical professionals who are working under the direct supervision of a physician—must furnish the AWV.
“Because pharmacists are not included in the list of providers in key sections of the Medicare law or Social Security Act, a pharmacist cannot directly bill for the AWV, [so] the supervising physician bills for the AWV using a HCPCS code,” said Jean-Venable “Kelly” R. Goode, PharmD, BCPS, FAPhA, FCCP, Professor and Director of the Community Residency Program at Virginia Commonwealth University School of Pharmacy. Goode is a pharmacist for a federally qualified health center (FQHC) and is the coauthor of the JAPhA study about establishing AWVs in a family medicine clinic. “Pharmacists in settings where there is no direct supervision by a physician do not have a mechanism to bill for the AWV.” Goode recently was elected the 2015–2016 APhA President- elect.
There are many types of settings in which pharmacists are well positioned to provide AWVs, such as FQHCs. Unfortunately, because pharmacists are not listed in the Social Security Act, they are not considered “core” FQHC providers. Under current FQHC regulations, only core providers can bill for FQHC visits.
Teresita Lawson, BSPharm, CDE, is a clinical pharmacist at Zufall Health Center, an FQHC in northwestern New Jersey. She believes that gaining provider status will help all pharmacists, regardless of practice setting. We need “to unite as a profession and do all we can to achieve provider status under the Social Security Act, which is what H.R. 4190 aims to do,” she said.