Texas Health Harris Methodist Fort Worth Hospital, Fort Worth, TX.
Texas Christian University, Fort Worth, TX.
Am J Health Syst Pharm. 2020 Nov 16;77(23):1973-1979. doi: 10.1093/ajhp/zxaa300.
The purpose of this study was to evaluate the financial performance and reimbursement of chronic care management (CCM) provided by clinical pharmacists in a primary care setting using Current Procedural Terminology codes that were added to the Medicare Physician Fee Schedule in 2017.
A retrospective study assessing financial performance of pharmacist-led CCM was conducted for the 12-month period from May 1, 2018, through April 30, 2019, at an academic multiclinic medical practice. Pharmacist-led CCM encounters included a combination of telephone and in-clinic visits. Return on investment, a ratio of net income to financial investment, was the primary outcome. Secondary outcomes included the number of CCM encounters, time spent by pharmacists delivering CCM (ie, "time-on-task"), and third-party claim reimbursement.
Sixty-five patients were enrolled in CCM during the 12-month study period. Pharmacists provided 236 CCM encounters, including 31 enrollment visits and 102 hours of clinical time-on-task. Gross revenue for CCM during the 12-month period was $7,433.91, and expenses totaled $6,430.36, resulting in a 15.6% return on investment. Out of 158 CCM claims, 131 (83%) were paid and 27 (17%) were unpaid or remained in adjudication at study completion.
Pharmacist-led CCM resulted in a modest positive return on investment compared to other reimbursable pharmacy services. Practitioners should evaluate opportunities to synergize CCM with other fee-for-service and quality-based reimbursement programs.
本研究旨在评估临床药师在初级保健环境中提供的慢性病管理（CCM）的财务绩效和报销情况，使用的是 2017 年 Medicare 医师费用表中新增的当前程序术语（CPT）代码。
本回顾性研究评估了 2018 年 5 月 1 日至 2019 年 4 月 30 日期间，在一家学术多诊所医疗实践中，由药师主导的 CCM 的财务绩效。药师主导的 CCM 包括电话和门诊就诊相结合的方式。投资回报率（净收入与财务投资之比）是主要结果。次要结果包括 CCM 就诊次数、药师提供 CCM 服务所花费的时间（即“任务时间”）和第三方索赔报销。
在 12 个月的研究期间，有 65 名患者参与了 CCM。药师共提供了 236 次 CCM 就诊，包括 31 次入组就诊和 102 小时的临床任务时间。在 12 个月期间，CCM 的总收入为 7433.91 美元，支出总计 6430.36 美元，投资回报率为 15.6%。在 158 次 CCM 索赔中，131 次（83%）得到了支付，27 次（17%）未支付或仍在理赔中。
与其他可报销的药学服务相比，由药师主导的 CCM 产生了适度的正投资回报率。从业者应评估将 CCM 与其他按服务收费和基于质量的报销计划协同增效的机会。
