Aug 10, 2016
Delivering clinical services in physician partnerships may be the most profitable use of pharmacists’ time — and don’t wait for CMS to grant pharmacists provider status to start. That’s the advice that Nicolette Mathey, PharmD, RPh, gave to listeners at McKesson’s ideaShare 2016 in Chicago.
Providing clinical services that boost patient outcomes and cut total costs also positions pharmacists for bigger roles and bigger rewards under pay-for-performance and accountable care payment models, said Mathey, who is a consultant with Pharmacy Development Services, Palm Springs, Fla.
Start with wellness visits
Annual wellness visits (AWV) are a good place to start, Mathey said. She works with several independent pharmacists who provide AWVs in physician offices under collaborative practice agreements. Physicians bill AWVs as an adjunct service using their provider numbers, and pharmacists bill the physicians according to the practice agreement.
Medicare pays about $170 for an AWV, and pharmacists can perform 10 per day, Mathey said. Two days’ work each week nets $3,400 — that’s $170,000 annually.
“That covers a full-time clinical pharmacist’s salary, plus more,” Mathey said. It also leaves three days a week for pursuing other opportunities — such as performing clinical work in other physician offices. There are more than 115 Medicare billing codes for clinical services that pharmacists can provide, she added.
Forging physician partnerships is challenging, Mathey acknowledged. But it’s also an opportunity for independent pharmacists to build physician partnerships before national chains step in, as they already havedone in hospitals.
“We’re ahead of the chains on this, and we have to stay there,” Mathey said.
Breaking the ice
Independent physicians in smaller practices are prime partner candidates, Mathey said. They make decisions without asking multiple management layers, which can indefinitely delay agreements with hospital-owned or larger groups.
The first meeting is always the hardest, Mathey said. It helps if you know how you can help doctors meet the challenges they face. “You have to speak their language,” she said.
Just as pharmacists have CMS Five Star measures, physicians have Meaningful Use (MU) measures pertaining to use of electronic health records, as well as specialty-specific Physician Quality Reporting System (PQRS) measures. “They pay a penalty if they don’t do well on them,” Mathey said. So any help you can offer gets their attention.
Talking about other mutual pain points can further build rapport, Mathey said. You’re both doing more work for less money. You both want to get into preferred networks. You both love your profession — and your independence.
Above all, you both love your patients, and you put their needs first.
Still, physicians are often skeptical about whether pharmacists can add value, Mathey said. Citing successful clinical partnerships helps. “You have to convey that this is being done elsewhere and that it can be done successfully.”
Mathey suggests researching how specific measures may affect a prospective physician partner’s specialty and how you can help.
For example, many physicians have trouble providing AWVs, which is an MU measure. One reason for this is that physician AWVs often morph into higher-paying office visits, and they can’t bill both the same day. So when physicians delegate AWVs to you, they come out ahead, because it frees their time for higher-paid services.
Pharmacists are ideal providers of AWVs, Mathey added. They mostly consist of medications, treatment adherence, and lifestyle reviews; counseling and education; and development of Personalized Prevention Plans — in other words, what you’re already doing in med sync.
Cementing the partnership
Begin by suggesting a nonthreatening pilot arrangement, Mathey advised. The results often make the sale. “Once physicians see a pharmacist’s med rec versus a medical assistant’s med rec, they don’t want to let you go.”
Once you’re in, there’s plenty of opportunity. Managing care transitions and long-term care arrangements is especially valuable, because this can reduce hospital readmissions, another critical performance measure.
Practicing med sync in your pharmacy tees it all up, Mathey said. That’s what gets you off the dispensing treadmill and onto investing your time in higher value patient care.