Evaluation of a pharmacist–physician covisit model in a family medicine practice

Ulrich, Irene Park; Patel, Savannah; Gilmer, Benjamin

doi:10.1016/j.japh.2018.09.010

Cited by 14 publications

(13 citation statements)

References 33 publications

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“…This is a successful model for funding a pharmacist position solely through increased revenue. 27 Interestingly, this barrier was noted by all four of the pharmacists even though only two pharmacists rely on clinical revenue for funding, underscoring the importance of aligning funding with responsibilities. Due to the nature of this study, there were some inherent limitations.…”

Section: Resultsmentioning

confidence: 99%

“…Pharmacists, as the medication experts, have demonstrated clinical and financial benefit in providing comprehensive medication management for chronic disease states. [25][26][27] While diseases such as diabetes and hypertension generally garnish the attention of pharmacy services, these skills are translatable to all medical conditions. Pharmacists are uniquely positioned to maneuver medication affordability barriers, provide in-depth patient education, and ensure safe and effective use of medications; all of which are particularly important for the treatment of OUD as noted in a prospective study that followed 20 patients for up to 1 year.…”

Section: Resultsmentioning

confidence: 99%

“…Pharmacists play a crucial role in expanding access to OUD treatment via OBOT services not only in North Carolina, but nationwide. Pharmacists, as the medication experts, have demonstrated clinical and financial benefit in providing comprehensive medication management for chronic disease states 25‐27 . While diseases such as diabetes and hypertension generally garnish the attention of pharmacy services, these skills are translatable to all medical conditions.…”

Section: Discussionmentioning

confidence: 99%

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Four models of pharmacist‐integrated office‐based opioid treatment

Caron

Fay²,

Pressley

et al. 2022

J Am Coll Clin Pharm

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Purpose: In 2019, one point six million Americans had opioid use disorder (OUD), yet only 18% of those patients received treatment with evidence-based medications. Office-based opioid treatment (OBOT) is the provision of care for OUD with buprenorphine, in various formulations including combination with naloxone, and naltrexone. Currently, there are few reports of physician-pharmacist collaborative practice models for OBOT. The purpose of this study was to identify common roles, clinical backgrounds, and barriers of pharmacists within four pharmacist-integrated OBOT services in one community. Methods: Four pharmacists implemented OBOT services in a family medicine (FM) residency, obstetrics-gynecology residency, a physician-owned FM practice, and a Federally Qualified Health Center. Each pharmacist detailed the evolution of OBOT models at their respective sites. Using a 21-item questionnaire comprised of closed and open-ended questions, the four pharmacists describe: the setting's OBOT; the pharmacist's OUD-related training; pharmacist-related OBOT activities; and barriers to implementation.Results: One pharmacist spends 10 to 20 h/wk on OBOT, while the others spend less than 10 h. In terms of patient care, two pharmacists conducted intake, group visits, collected vitals, and ensured naloxone access. All pharmacists counseled patients and conducted follow-up visits. For nonpatient care activities, three pharmacists developed OBOT policies/procedures, and four coordinated care and consulted on OBOT cases. To prepare for this, two pharmacists learned about OUD in

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Four models of pharmacist‐integrated office‐based opioid treatment

Caron

Fay²,

Pressley

et al. 2022

J Am Coll Clin Pharm

View full text Add to dashboard Cite

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“…This study complements the existing supporting evidence for the effective implementation of a pharmacist-physician co-visit model in other healthcare settings. [17][18][19] Limitations of this study include evaluation of a single clinic site for one pharmacist with two collaborating physicians. This study occurred in a setting with sufficient language concordance between the Spanish-speaking patients and the pharmacist and physicians.…”

Section: Discussionmentioning

confidence: 99%

Reimbursement outcomes of a pharmacist‐physician co‐visit model in a Federally Qualified Health Center

Gonzalvo

Kenneally

Pence

et al. 2021

J Am Coll Clin Pharm

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BackgroundPharmacists have demonstrated a positive impact in providing patient care in ambulatory settings. Pharmacists have faced multiple barriers to reimbursement, especially in a Federally Qualified Health Center (FQHC) setting. A commonly cited barrier is lack of recognition as providers under Medicare.ObjectivesThe objective of this study was to describe the reimbursement potential, physician appointment capacity, and billing levels with the use of a pharmacist‐physician co‐visit model in an urban FQHC.MethodsThis was a retrospective, observational cohort study. Patient visits were included in the co‐visit model cohort if they were completed with the pharmacist and/or collaborating physician on the same clinic half‐day from May‐September 2019. Comparator group patient visits were included in the physician‐only cohort if they were with one of five physicians practicing at the FQHC on a day without the pharmacist. Patient visits were excluded if the visit was nonbillable.ResultsRealized reimbursement per half‐day in clinic [mean (SD)], was significantly less with the physician‐only visits compared to the co‐visit billing model [$558 (242) vs $850 (410), P = .001]. The addition of a pharmacist through the co‐visit billing model increased the median (IQR) billing per half‐day in clinic from $1613 (1173, 1788) to $2108 (1832,2620) (P < .001), and the median (IQR) number of patients seen per half‐day from 9 (7, 10) to 12 (10, 14) (P < .001). Unpaid patient bills ($39 599) were excluded from reimbursement analysis in both groups.ConclusionsThe pharmacist‐physician co‐visit model in an FQHC increased revenue to justify the addition of one full‐time equivalent position within our facility, increased the number of patients seen by the physician, allowed for higher‐complexity billing, and provided physicians with variety in responsibilities. The benefits of team‐based care extend beyond the financial implications of a co‐visit model. Without direct pharmacist‐billing mechanisms, this model justifies the expansion of pharmacist‐managed services.

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“…Two real-world examples of this include incorporating Annual Wellness Visits into the CMM process 29 and MD/PharmD co-appointments that allow for physicians to see more patients daily and bill at a higher complexity. 41 Practices can also achieve direct revenue through quality bonus incentive payments with commercial and government payers through the Merit-Based Incentive Payment System (MIPS) and pay-for-performance (P4P) models. 42,43 Due to the recent Medicare physician reimbursement overhaul known as the Medicare Access and CHIP Reauthorization Act of 2015, primary care physicians will be engaged in upside-downside risk adjustments that can affect up to 9% of their Medicare reimbursement.…”

Section: Cmm From a Primary Care Practice Perspectivementioning

confidence: 99%

Making the economic value proposition for pharmacist comprehensive medication management (CMM) in primary care: A conceptual framework

Tripicchio

Urick

Easter

et al. 2020

Research in Social and Administrative Pharmacy

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Introduction: Comprehensive medication management (CMM) is a patient care process provided by clinical pharmacists in primary care settings that ensures optimal use of medications with timely followup. Despite widespread evidence that shows CMM improves clinical and medication-related outcomes, pharmacist CMM services often fail to be adopted into U.S. primary care settings. Objective: This study presents a conceptual framework linking outcomes of pharmacist-delivered CMM services in primary care settings to financial benefits for both primary care practices investing and implementing CMM and health plans providing coverage of CMM services. Methods: A narrative literature review was performed in PubMed and the gray literature to identify financing opportunities that justify the coverage of CMM by third party health plan administrators or the implementation of CMM by primary care practices. Financing elements that could be impacted by pharmacist-led CMM outcomes, namely higher achievement of medication-related quality measures and reduction of total costs of care, were recorded and utilized to develop the conceptual framework. Results: The framework suggests that CMM may provide economic benefits to health plans and care practices by (1) increasing market competitiveness through higher quality ratings, accreditation recognition, lower premiums and plan bids, and increased patient satisfaction; and (2) increasing revenue through quality bonus payments, shared savings agreements, and fee-for-service reimbursement. Conclusions: The alignment of economic benefits that can be realized through CMM advances a strong value proposition for greater adoption of CMM in the United States' primary care system. Future application of this study's conceptual framework could include use as an advocacy tool amongst pharmacy associations or as a tool for individuals seeking buy-in for CMM services.

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Evaluation of a pharmacist–physician covisit model in a family medicine practice

Cited by 14 publications

References 33 publications

Four models of pharmacist‐integrated office‐based opioid treatment

Four models of pharmacist‐integrated office‐based opioid treatment

Reimbursement outcomes of a pharmacist‐physician co‐visit model in a Federally Qualified Health Center

Making the economic value proposition for pharmacist comprehensive medication management (CMM) in primary care: A conceptual framework

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