R. Jordan Hinkle is director of Patient Services and Implementation for Curant Health.
Adding pharmacists to the care team will result in better patient outcomes, lower payer costs, relief for physicians, and better use of pharmacists' skills and experience. It's a no-brainer.
Despite advances in technology, physicians spend less time with patients than ever before. On average, physician interaction with a patient lasts only eight minutes, which amounts to about 12% of his or her time on the job, according to a study published in The Journal of General Internal Medicine. Instead of focusing most of the consultation time on the patient, physicians are consumed with electronic medical record documentation, prior authorizations, and other tasks.
Owing to the Affordable Care Act, the physician time crunch is unlikely to improve anytime soon. This is where the clinical pharmacist can make a difference.
While often overlooked, clinical pharmacists are healthcare providers and members of the patient’s care team, an especially critical factor for people with multiple chronic conditions. These patients need help to improve adherence to multiple medications in order to achieve the best possible outcomes.
Internal research conducted by Vickie Andros, PharmD, director of Clinical Services for Curant Health, revealed that clinical pharmacists spend 21 minutes with patients per interaction. This is more than double the average time physicians spend with their patients.
According to Andros, “Our clinical pharmacists have completed more than 600 enhanced medication therapy management calls of complex primary assessments with complicated, chronically ill patients over the last 18 months. It is in these calls with patients where our clinical pharmacists identify barriers to adherence.”
There are two reasons to make this investment in the patient. First, pharmacists are educated and trained to be experts in medication therapy management (MTM). Second, pharmacists can devote patient-focused time to address medication-related issues and optimize medication therapy.
Pharmacists involved in MTM can often offer “clinical pearls” for improved medication adherence. These interventions include recommendations of certain foods that mitigate irritation and adjustments to scheduled times of medication administration that can result in maximal medication effect with minimal side effects. The goal is always to increase adherence to ensure effective medication regimens for improved patient outcomes.
Multiple studies have shown that pharmacist involvement within the patient care model has positive effects on outcomes and cost. In theory, the involvement of therapists enables physicians to spend more time recruiting new patients into their practices.
Pharmacists can help improve the hospital’s overall performance and reduce Medicare readmissions penalties. As the U.S. Department of Health and Human Services (HHS) and other entities in Washington continue to advance the move from fee-for-service to value-based care, decision-makers in a position to put to use the value provided by clinical pharmacists should do so.
Pharmacists and pharmacy leaders within health systems need to take advantage of current opportunities that have an impact on these value-based measures, as well as to look for other innovative approaches to advance patient care.
As part of the integrated healthcare team, clinical pharmacists are able to make an impact on patient outcomes and hospital readmission rates. Hospital pharmacists involved in the patient discharge process can minimize medication discrepancies.
This is especially important because studies have shown that 42% to 82% of patients have at least one medication discrepancy at discharge; one study emphasized that 10% of those discrepancies were serious.1-6
Although medication counseling at discharge by hospital pharmacists is an important patient-care service, it has become difficult for many pharmacy departments to justify the costs of hiring additional pharmacists dedicated to the discharge process.
In light of the tightening of budgets throughout the country, it might be prudent for healthcare systems to consider partnerships with organizations that focus on medication management for patients with chronic conditions. These types of organizations allow for the inclusion of additional pharmacy FTEs without the added burden to the hospital or health-system’s bottom line.
Once a patient transitions out of the controlled environment of the hospital, medication adherence becomes an issue. An IMS Health study indicated that $105 billion of $213 billion in avoidable U.S. medical expenses annually is attributed to medication nonadherence.7
Medication adherence is the longest lever available in reducing waste in the U.S. healthcare system. Effective medication management with a highly engaged pharmacist is capable of improving adherence by 69%.8 Furthermore, pharmacists’ services have demonstrated a reduction in hospital readmissions by 86% in one-quartile of a Medicare population.9
Although many stakeholders recognize the value of pharmacists as essential members of a robust healthcare team, provider status still remains a significant barrier. While other professions, such as physician assistants and nurse practitioners, have won recognition as primary healthcare providers under Medicare Part B, pharmacists have yet to achieve parity.
After years of battling the system to break this barrier, national pharmacy organizations are taking on the campaign, with the twofold goal of giving pharmacists the accreditation they deserve and giving physicians an additional healthcare partner to function as an extender of services, thus giving patients increased access to the care they desperately need.
Provider status would enable pharmacist-provided services to be covered under Medicare Part B. The campaigns by APhA and ASHP support the amendment to Section 1861(s)(2) of the Social Security Act, which would make patients in medically underserved areas eligible for services provided by pharmacists under Medicare Part B.
At the webpage for APhA’s Pharmacists Provide Care campaign (www.pharmacistsprovidecare.com), an interactive map displays the crucial need for H.R. 4190 on a state-by-state basis. Curant Health’s main office is in Atlanta, so we decided to look at how this federal ruling would impact the state of Georgia.
Of the 159 counties in the state, an astounding 143 include areas that are considered “medically underserved.” Approximately 90% of Georgia’s counties are identified as needing healthcare services. Within these areas, Georgia’s Medicare population could benefit from pharmacy services such as MTM, chronic care management, and preventive screenings that include blood pressure and cholesterol monitoring. An estimated 10,200 pharmacists in Georgia can help fill this gap in care.
There are numerous issues to be tackled in today’s healthcare system. While we cannot solve them all, allowing pharmacists to use their expertise and accessibility to alleviate some of the burden is a huge step in the right direction.
1. Moore C, Wisnivesky J, Williams S et al. Medical errors related to discontinuity of care from an inpatient to an outpatient setting. J Gen Intern Med. 2003;18:646–651.
2. Schnipper JL, Kirwin JL, Cotugno MC et al. Role of pharmacist counseling in preventing adverse drug events after hospitalization. Arch Intern Med. 2006;166:565–571.
3. Duggan C, Feldman R, Hough J et al. Reducing adverse prescribing discrepancies following hospital discharge. Int J Pharm Pract. 1998;6:77–82.
4. Dickerson A, MacKinnon NJ, Roberts N et al. Drug-therapy problems, inconsistencies and omissions identified during a medication reconciliation and seamless care service. Healthc Q. 2005;8(Spec No):65–72.
5. Foss S, Schmidt JR, Andersen T et al. Congruence on medication between patients and physicians involved in patient course. Eur J Clin Pharmacol. 2004;59:841–847.
6. Paquette-Lamontagne N, McLean WM, Besse L et al. Evaluation of a new integrated discharge prescription form. Ann Pharmacother. 2001; 35:953–958.
7. Aitken M, Valkova S. Avoidable costs in U.S. healthcare, IMS Institute for Healthcare Informatics, June 2013. http://bit.ly/responsmeduse. Accessed April 3, 2015.
8. Dunham PJ, Karkula JM. Effects of a pharmacy-care program on adherence and outcomes. American Journal of Pharmacy Benefits. January/February 2012;e8-e14. http://bit.ly/pharmcareprog. Accessed April 3, 2015.
9. Zillich AJ, Synder, ME, Frail CK, et al. A randomized, controlled pragmatic trial of telephonic medication therapy management to reduce hospitalization in home health patients. Health Services Research. 2014;49(5):1537–1544.
R. Jordan Hinkleis director of Patient Services and Implementation for Curant Health.