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

Abstract

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.

Pharmacy resident third party credentialing and reimbursement in a family medicine clinic

“…An example of this is a recently published article which described the reimbursement potential, physician appointment capacity, and billing levels with the use of a pharmacist-physician co-visit model in a Federally Qualified Health Center (FQHC) in Indianapolis, Indiana. 11 The investigators found that with a pharmacist and physician co-visit model, reimbursement was significantly higher compared to physician visits alone ($850 vs. $558 per half-day in clinic). On the other hand, results from a 2020 article evaluating pharmacist reimbursement for independent visits in two Oregon patient-centered medical homes found an average reimbursement rate of $36 per This study, by contrast, demonstrates that reimbursement rates may be significantly higher in states with payment parity.…”

“…Many studies evaluate the value of a pharmacist from the perspective of quality improvements or study the pharmacist's value only in the context of shared appointments with other healthcare providers. An example of this is a recently published article which described the reimbursement potential, physician appointment capacity, and billing levels with the use of a pharmacist‐physician co‐visit model in a Federally Qualified Health Center (FQHC) in Indianapolis, Indiana 11 . The investigators found that with a pharmacist and physician co‐visit model, reimbursement was significantly higher compared to physician visits alone ($850 vs. $558 per half‐day in clinic).…”

Expanding comprehensive medication management considerations to include responses to the social determinants of health within the BDHelping Build Healthy Communities Program

“…CMM expands upon the medication optimization practices within MTM primarily by standardizing the process for optimizing medications and working with other members of the interdisciplinary team to ensure that each medication has an appropriate indication, is effective for the condition, can help in achieving clinical goals, is safe, and the patient can adhere to the regimen 6 . Because of CMM's documented positive impact in improving patient outcomes, FQHCs have been including CMM services in the care for their patients, especially for diseases which require more complicated medication regimens like diabetes mellitus 7‐11 . Accompanying this transition to patient‐centered CMM, is a growing push to apply the recommendations of the IOM and Healthy People 2030 to integrate SDOH into all aspects of the pharmacy workflow 5 .…”

“…6 Because of CMM's documented positive impact in improving patient outcomes, FQHCs have been including CMM services in the care for their patients, especially for diseases which require more complicated medication regimens like diabetes mellitus. [7][8][9][10][11] Accompanying this transition to patient-centered CMM, is a growing push to apply the recommendations of the IOM and Healthy People 2030 to integrate SDOH into all aspects of the pharmacy workflow. 5 Prominent examples of this integration of responses to SDOH can be found within various pharmacy practice settings.…”

Pharmacist-Physician Split-Shared Visits in a Federally Qualified Health Center: Lessons Learned from a Novel Reimbursement Model using Telehealth

“…Despite the potential benefits of shared visit and split-shared visit models, a review of the literature only found four publications discussing the outcomes of such practice models in the FQHC or Rural Health Center (RHC) setting, which summarized outcomes from seven different health centers. 13 - 16 There are currently 1385 registered FQHCs 17 and 4799 RHCs 18 in the United States.…”