University of Colorado Skaggs School of Pharmacy & Pharmaceutical Sciences, Aurora.
Colorado Department of Public Health and Environment, Denver.
J Manag Care Spec Pharm. 2019 Sep;25(9):984-988. doi: 10.18553/jmcp.2019.25.9.984.
This study summarizes the potential financial impact of a 3-year collaboration focused on delivering disease management services through pharmacies in 12 rural Colorado communities.
To (a) identify components within the disease management program that would be billable and generate revenue to each pharmacy and (b) estimate the revenue amount that could be generated based on these services across the 3-year project.
Reimbursable services included diabetes self-management education; medication therapy management services, including the comprehensive medication review; and improvements in Medicare star ratings through pharmacy interventions.
An estimated total of $117,800 could have been generated by services provided to patients across the 12 pharmacy sites. After subtracting the estimated cost of labor for a pharmacist to provide these services, an estimated net profit of $60,023 resulted over 3 years. Star rating impacts were discussed but were not able to be included as specific revenue based on the complex contracting between pharmacies and third-party insurers.
Based on these estimates, delivery of chronic disease management could represent a financially feasible option for community pharmacists. Some credentialing and changes to the mode of delivery would be required to meet billing requirements. Further research is needed to better estimate the cost savings resulting from these services to possibly expand pharmacists' reimbursement opportunities.
This publication was supported by Cooperative Agreement Number DP004796-05, funded by the Centers for Disease Control and Prevention. The contents of this publication are solely the responsibility of the authors and do not necessarily represent the official views of the Centers for Disease Control and Prevention or the Department of Health and Human Services. None of the authors have any conflicts of interest to disclose regarding this work.
本研究总结了一项为期 3 年的合作计划在 12 个科罗拉多州农村社区通过药店提供疾病管理服务的潜在财务影响。
(a) 确定疾病管理计划中哪些部分可以计费，并为每个药店带来收入；(b) 根据这些服务在 3 年项目中的情况，估算可能产生的收入金额。
可报销的服务包括糖尿病自我管理教育；药物治疗管理服务，包括全面药物审查；以及通过药店干预提高医疗保险星级评级。
通过在 12 家药店提供给患者的服务，预计总共可产生 117800 美元的收入。扣除药师提供这些服务的估计劳动力成本后，3 年内预计可产生 60023 美元的净收益。星级评级的影响已进行讨论，但由于药店和第三方保险公司之间复杂的合同关系，无法作为具体收入包括在内。
根据这些估计，慢性病管理的提供可能代表社区药剂师的一种经济可行的选择。为了满足计费要求，需要进行一些认证和交付模式的改变。需要进一步研究以更好地估计这些服务带来的成本节约，从而可能扩大药剂师的报销机会。
本出版物得到了美国疾病控制与预防中心资助的合作协议号 DP004796-05 的支持。本出版物的内容完全是作者的责任，不一定代表美国疾病控制与预防中心或美国卫生与公众服务部的官方观点。作者均无与这项工作相关的利益冲突需要披露。
