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What Can We Do Without Provider Status? PAIAG Update

By Courtenay Wilson posted 02-20-2014 09:35


Provider Status is a hot topic these days! The New Practitioner Forum's Practice Advancement Initiative Advisory Group (NPF-PAIAG) is helping promote PPMI objective, E4l: Establishment of pharmacist provider status under Medicare. 

While the advocating continues, here are some ways our institution is promoting pharmacist's worth even without provider status:

    - Medicare Annual Wellness Visit (AWV)1,2
           - Introduced as a part of the Affordability Care Act
in 2011
           - Focuses heavily on preventative services
           - May be conducted by any healthcare provider working under the direct supervision of a  
               physician, including pharmacists.
           -  Average reimbursement rate of $160 for initial AWV and $110 for subsequent AWV, 
              this presents a significant opportunity for pharmacists to generate revenue for a physician’s 
    - Transitional Care Management (TCM) Medicare Codes3
           - Goal is to improve care coordination and reduce readmissions
           - Two required components that pharmacists can complete are 1) communication with the patient within 2
              days of hospital discharge and 2) a complete medication reconciliation.
           -  Physician can then use TCM codes for the office visit, which is reimbursed significantly higher than the 
               Level 4 or Level 5 office visit. 
    - Team-based care though Medical Home and Accountable care Organization Models4 
            - Opportunity to focus on pharmacists' abilities to provide comprehensive  
               medication management in order to maximize patient outcomes in settings where payment 
               is driven by performance and quality indicators.

 Look at all the ways we can add value to our healthcare team in the interim to our ultimate goal of provider status. What do you think? What have you done?

1.        Centers for Medicare & Medicaid Services. Quick reference information: The ABCs of providing the Annual Wellness Visit. Accessed February 10, 2014.

2.        Physician fee schedule. Accessed February 10, 2014.

3.        Centers for Medicare & Medicaid Services. Transitional Care Management Services. Accessed February 10, 2014

4.        Patient-Centered Primary Care Collaborative. The Patient Centered Medical Home: Integrating Comprehensive Medication Management to Optimize Patient Outcomes. June 2012. Accessed February 10, 2014


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