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2018 SAG on Compensation and Practice Sustainability Midyear Networking Session Recap

By Jeffery Olson posted 04-04-2019 11:37

  

The ASHP Ambulatory Care Section Advisory Group on Compensation and Practice Sustainability (CPS SAG) held an engaging networking session during the 2018 ASHP Midyear Clinical Meeting. While a few months have passed since the Midyear Clinical Meeting, the information shared is still valuable. Discussions and networking centered around four main themes: Credentialing and privileging, telehealth, measuring the value of ambulatory care services, and establishing new ambulatory care services. Each participant was given time to comment on each topic before spending the latter portion of the session engaged in a deeper dive on their topic of choice. Here we wanted to provide a brief summary of key learnings from the networking session in an effort to share valuable learnings and foster ongoing discussion.

 

Credentialing and Privileging

 

Attendees in this session opened with discussion on defining credentialing and privileging and describing successful implementation steps at different organizations. The common themes included collaboration, education, perseverance and support from key leadership. Some members shared it took them years of being persistent to be granted a scope of practice. Specific ideas included having a physician champion and cultivating collaborative relationships to help team members understand the scope of practice of the pharmacist. Utilizing credentialing and privileging pathways developed for other allied health professionals and existing medical staff support for implementation and execution were other suggestions.

Challenges to implementation of credentialing and privileging were also discussed. Specific items included a lack of understanding of the pharmacist scope of practice by providers and administrators, along with a lack of provider status. Questions about what training and certifications should be required for specific practice areas, in particular specialty areas where board certification does not exist. Variation in scope of practice laws also can create hurdles when developing and implementing credentialing and privileging pathways.

Finally, one point of discussion was related to trying to connect with organizations that have had successful implementation of pharmacist credentialing and privileging services and using other available resources. ASHP has a resource center on Credentialing and Privileging that may be valuable to organizations on this journey. Members can access this resource at https://www.ashp.org/Pharmacy-Practice/Resource-Centers/Credentialing-and-Privileging.  

 

Telehealth

 

Telehealth is a rapidly expanding area for care delivery as technology continues to expand and become more mainstream. Attendees in this session highlighted the telehealth efforts used to date in their practices. These include virtual visits for anticoagulation and diabetes management. Call centers to efficiently deliver medication therapy management services are being used. Telehealth solutions are being used to support care transitions as patients leave the hospital.

Several barriers to implementing telehealth services exist. Money (cost and reimbursement), time, patient-specific barriers (literacy, technology ability, engagement, etc.), technology limitations, and late adopters were all mentioned. Some attendees highlighted places where they have successfully overcome these barriers. For example, using support personnel to help with the more administrative tasks has helped offset some of the cost concerns. Support from providers and population health groups are also valuable to successfully implementing telehealth services. Educating around telehealth services and promoting these services to patients has also helped overcome barriers.

The Center for Connected Health Policy (CcHP) provides excellent tools that can provide insight on laws surrounding telehealth at the state and federal level. CCHP defines and explains telehealth at https://www.cchpca.org/about/about-telehealth. A look at state and federal telehealth policy can be found at https://www.cchpca.org/telehealth-policy/current-state-laws-and-reimbursement-policies. An interactive map showing telehealth legislation can be found at https://www.cchpca.org/telehealth-policy/legislation-and-regulation-tracking.

 

Measuring the Value of Ambulatory Care Services

 

Great participation was contributed by attendees in regards to how to define success and measuring the value of ambulatory care services. The importance of identifying what the medical offices, providers, and health system values in terms of clinical pharmacy services and making sure pharmacists are aligning to these interests when thinking about measuring value was highlighted. Using the Resource Center on ASHP.org to find information on advocacy and billing documents was also mentioned. Many members shared their experiences of measuring their value through keeping track of quality metrics (i.e. A1c, statin use, blood pressure goals), direct and indirect revenue (pharmacists directly billing for services or incident-to via E&M codes, CCM, and TCM), and indirect cost savings (i.e., freeing up physician time to see more acute patients, improving ACO and PCMH measures, and reducing readmissions).

Some barriers discussed were that pharmacists are currently considered providers in only a handful of states, preventing direct billing, finding good IT support to help optimize the EMR to keep track of certain metrics, and knowing how to “sell” services to health system administration. Some of the successes have led to the expansion and generation of new positions and clinical services, along with the creation of new residency positions.

Establishing New Ambulatory Care Services


Discussions among attendees on this topic centered on the following three main points. First, the importance of provider and leadership buy-in for pharmacy services was emphasized. Also, having the knowledge of who to go to for what if/when you hit any roadblocks is important. Additionally, success often comes from determining the specific needs of your clinic and the importance of continually working to address these specific needs.

Second, financial sustainability was discussed in-depth, primarily the struggles that many pharmacists face in justifying new positions or billing/receiving reimbursement for services. Understanding the laws of your state and the billing rules for your practice setting were deemed important. The difficulties associated with different payers providing different reimbursements (if any reimbursement at all) for pharmacist services was addressed as attendees shared experiences with identifying patients based upon insurance coverage vs. providing the same services to all patients despite the payer. Value-based reimbursement vs. fee-for-service was also discussed, and the group agreed that healthcare is moving more toward value-based care at this time.

Lastly, the opportunity to utilize pharmacy residents to help justify new services and positions was discussed. Attendees shared their experiences with pharmacy resident research projects or clinical rotations helping to justify additional services through clinic need or outcome tracking/analysis.

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