Reimbursement
Sonya Collins
Pharmacists improve patient outcomes in chronic care management while easing the workload of primary care physicians, who are already in short supply. This is borne out in an increasingly large body of research. But keeping a full-time pharmacist on staff in a private medical practice is often cost prohibitive.
University faculty, pharmacy residents, and student pharmacists may provide a cost-effective solution for patient care, according to a recent study by Keri Mack, PharmD, in the American Journal of Health-System Pharmacists.
“It is financially beneficial for primary care practices to partner with schools of pharmacy to either start or enhance reimbursable pharmacist-led services,” said Mack, a clinical pharmacist practitioner at West Palm Beach VA Medical Center in Florida. “Overall, it is less overhead for the practice to incorporate faculty pharmacists and/or trainees to expand patient reach and improve management of chronic conditions.”
High ROI with pharmacy faculty and residents
In a retrospective study that aimed to calculate return on investment (ROI), Mack analyzed the reimbursement over a 12-month period of a pharmacist-led chronic care management (CCM) program that utilized pharmacy residents and student pharmacists at a privately owned family medicine practice in Florida.
The private practice employed an academic pharmacist for 20 hours over 3 full clinic days per week and paid a portion of the pharmacist’s salary. Three of the pharmacist’s weekly hours were dedicated to CCM. Twelve fourth-year student pharmacists and two pharmacy residents served as pharmacist extenders.
“The co-funded faculty member alone is a cost-savings for the practice when compared to what it would cost the clinic to employ a full- or part-time clinical pharmacist,” Mack said. “When you consider the additional work of pharmacy trainees assisting with CCM services, provided at no cost to the practice, it would have been much more expensive for the practice to employ a full-time fully trained pharmacist to provide CCM services, and the overall ROI would have been lower than that found in our study.”
During the 12-month study period, 203 patients were enrolled in the program, yielding 19 to 121 billable patients per month. Pharmacists and pharmacist extenders spent 463 hours on CCM during this time.
The practice grossed $55,104.64 for CCM and incurred expenses totaling $9,482.64. Reimbursement for CCM codes totaled $44,042.31 (80% of gross revenue). Total ROI was 481% and 364.5% on CCM codes alone. Of 1,046 CCM claims filed, 957 (or 92%) were reimbursed.
Patients reap benefits with pharmacists on board
Through the pharmacist-led program, patients received more frequent check-ins, faster prior authorization for their care, improved coordination of care, and better overall control of their chronic conditions.
“Because pharmacists complete the medication-related administrative tasks as a part of CCM, it gives providers more time to spend with patients and provide higher quality care,” Mack said.
A previous study that Mack coauthored on pharmacist-led care in the same medical practice found that the number of CCM encounters and annual wellness visits increased after the pharmacist was brought on. Healthcare Effectiveness Data and Information Set measures and star ratings also increased, which Mack said, “demonstrated that overall quality of care and outcomes were improved.”
Pharmacists extend the reach of primary care
Employing pharmacists in primary care practices may ease the burden on an already overtaxed primary care physician workforce. “Pharmacists can improve medication and chronic disease state management and complete administrative tasks related to medications, such as prior authorizations, appeals and refills, which allows other providers to focus on the patient care and clinical tasks that require their expertise.”
Critical education
With or without trainees in the picture, patients and physicians reap benefits from pharmacist-led care. Add trainees to the equation and ROI increases while residents and student pharmacists receive increasingly critical hands-on education. As the population of older adults balloons in the United States and demand for chronic care grows along with it, Mack said, “incorporating trainees into these practice models is important to prepare the next generation of pharmacists for these types of roles.” ■