ASHP Section Advisory Group on Compensation and Practice Sustainability (CPS SAG) Networking Session at the 2018 ASHP Summer Meeting
The ASHP Section Advisory Group on Compensation and Practice Sustainability (CPS SAG) hosted an engaging Networking Session at the 2018 ASHP Summer Meeting. Here, we hope to share a summary of the discussion, stimulate further discussion using ASHP Connect, and encourage you to come to our upcoming ASHP Midyear Networking Session on Tuesday, December 4th at 12:30 pm at ASHP Midyear. Let us know what you think. And we will see you in Anaheim!
The summer session had three topics. All participants were given time to comment on each of the topics and then spent the later portion of the session engaged in a deeper dive of their topic of choice. Here are the key points:
Topic 1: Direct revenue generation through billing for services
To date, all pharmacists have yet to be collectively recognized as healthcare providers able to bill payers in federal and state programs. However, pharmacists do have the opportunity to work as auxiliary personnel under an eligible provider who may bill for a pharmacist’s services. With this “incident-to” ability pharmacists can generate revenue. The process is complex and requires a clear understanding of the rules/regulations and the complicated codes across the states and regions.
Pharmacists across the country are generating revenue through the delivery of services through the physician’s bill or through health systems for the pharmacist's services through billing rules for: chronic care management (CCM), transitional care management (TCM) services and annual wellness visits (AWV), which also are reimbursed by Medicare. Community pharmacists may bill through a physician or health system relationship or may bill directly provided they have a contract with a prescription drug plan (PDP) for Medicare Part D MTM services and for diabetes self-management education/training (DSME/T) as an accredited site with the American Association Diabetes Educators (AADE’s DEAP) or the American Diabetes Association (ADA).
Understanding of the billing processes and access to the Electronic Medical Records (EMR) and documentation interoperability were the unified barriers.
Topic 2: Cost avoidance through indirect return on investment models such as value-based care
Justifying pharmacy services through cost avoidance is a difficult task, but has been completed successfully in the past. Institutions have used a variety of cost-savings measures to support these services and demonstrate the impact of pharmacists. Methods that were noted during our Networking Session included providing shared visits with providers, associating outcome improvements with monetary savings, optimizing medication therapy, associating pharmacy interventions with improving quality metrics, reducing readmissions, and focusing population health initiatives on those patients at highest risk.
To support these opportunities for indirect cost savings measures for pharmacy services, attendees at the Networking Session provided key advice for promoting success. Key features that have allowed programs to be successful include aligning system efforts with quality metrics, decreasing burden for physicians and other providers, receiving support from leadership and/or physician champions, focusing on medication optimization, and working in a closed healthcare system (i.e. interventions made in an outpatient setting can lead to reduced hospitalizations, medication costs, or ED admissions). In addition to this advice, the key barrier that must be overcome is identify a structure to connect back cost savings initiatives back to the pharmacy service to promote continuation, and/or expansion of this service.
Topic 3: Utilizing electronic health records to support and measure clinical services
The electronic health record (EHR) can be a valuable tool for pharmacists needing to track and measure clinical services. During our Networking Session, attendees shared the tools they use to track activities and evaluate impact. While many use external tools such as Excel to track clinical services, utilization of the EHR and available tools within it (e.g., dashboards) and information extracted from it (e.g., codes) is very common and growing.
While the value of the EHR is clear, several challenges and barriers exist for pharmacists to take full advantage of the tool. EHRs can be difficult to use. Limited time and resources on several levels presents a particular challenge, especially the difficulty obtaining IT and data analyst support to build tools and extract data.
Attendees spent time discussing different ideas and strategies to address these challenges. Key advice shared by participants included EHR-specific tools, working with managers and directors to advocate for needs, dedicating time from a clinical pharmacist to work directly with EHR developers and involving residents and students in data collection and reporting efforts. Attendees spent time with those that used the same EHR and were able to share different tools and capabilities with one another. Leveraging the EHR to support existing clinical activities and promoting the expansion of services was recognized as a critical tool for ambulatory care pharmacists.