Anywhere and everywhere
Pharmacists fit into the new value- and quality-based landscape anywhere and everywhere that medications are used.
“No one in the healthcare field has more clinical training and expertise in pharmacology than pharmacists,” said Daniel Buffington, PharmD, MBA, Clinical Pharmacology Services, Tampa, Fla. “For every dollar spent on medication therapy management or pharmacists’ clinical services, the healthcare system saves significantly more dollars in return. That is in addition to the clinical improvements in patient outcomes.”
The advent of ACOs and other value-based delivery models has helped health systems, hospitals, and physician practices recognize the role and value that pharmacists can bring in reducing adverse drug events and related readmissions, and in improving medication adherence, thus improving outcomes and reducing overall healthcare costs. Many health systems have increased pharmacist head counts to support their growing ACO programs.
At Barnabas, for example, pharmacy manages an outpatient anticoagulation clinic. Pharmacists are responsible for managing patient regimens, improving outcomes, and helping physicians select the most appropriate anticoagulation agent. Pharmacists play similar hands-on roles in managing diabetes, asthma, lipids, cardiovascular disease, and other chronic complaints.
Bringing pharmacist expertise to patient care routinely improves outcomes along with more appropriate medication use and lower adverse event rates. Declining admission and readmission rates add to an overall drop in the costs of care in these specific patient populations.
New programs, new codes
As part of its move to value-based care, CMS has created new Part B programs and reimbursement codes that fit easily into pharmacy practice.
Transitional care management. Transitional Care Management (TCM), is one of the most clinically and financially valuable services. TCM is designed to reduce 30-day readmission rates by facilitating the transition from hospital to community care and reconciling medication needs between hospital and community settings.
“Our nurse practitioner-led TCM program wanted a pharmacist on every team,” Costello said. “They recognize the difference that medication management can make in reducing the 30-day readmission rate.”
Barnabas uses staff pharmacists for TCM, but other health systems and provider networks contract with independent pharmacists or pharmacy providers. CMS rules call for TCM and similar service reimbursements to be shared with pharmacists and other providers, incident to the services billed by the physician or practice.
Annual wellness visits. Also new are annual wellness visits (AWV) to develop or update a personalized plan to prevent disease and disability. The AWV includes creating or updating a list of providers and medications; evaluating individual risk factors, treatment options, and personalized health advice; detection of any cognitive impairment; medical and family history review; screening schedule for appropriate preventive services; and routine measurements such as height, weight, and blood pressure.
“If you do a thorough job, you have a baseline to make subsequent interventions to keep patients healthy,” said Sandra Leal, PharmD, MPH, vice president for innovation at SinfoniaRx.
The potential impact is enormous. A family medicine practice in Asheville, N.C. and the University of North Carolina Eshelman School of Pharmacy found that reimbursement for wellness visits could cover a $120,000 annual salary in about 40% the pharmacist’s available working time. The wellness visit is in addition to the welcome-to-Medicare visit with a Part B provider.
Chronic care management. Chronic care management (CCM) could have been tailored for pharmacists. Medicare patients with two or more chronic conditions can be seen up to monthly for as little as 20 minutes for care coordination, medication recommendations, medication adherence help, and other interventions intended to prevent their conditions from worsening and leading to hospitalization. A physician must conduct the initial visit, but subsequent CCM can be handled by a pharmacist or other provider, either in person or by phone.
“The idea is that if we are doing CCM right, we will delay progression and reduce overall resource utilization,” Leal said. “At a reimbursement of $42 per patient per month, you can start creating a new sustainability plan pretty quickly.”