Texas A&M Irma Lerma Rangel College of Pharmacy, 1010 W. Avenue B, Kingsville, TX, 78363, USA.
University of Florida College of Pharmacy, 1225 Center Dr, Gainesville, FL, 32610, USA.
Res Social Adm Pharm. 2023 May;19(5):778-782. doi: 10.1016/j.sapharm.2023.01.004. Epub 2023 Jan 6.
The implementation of chronic care management (CCM) services has often been hindered by issues with reimbursement, raising concerns about sustainability. To date, little if any literature has examined the financial feasibility and sustainability of CCM services in rural practice settings.
Assess financial reimbursement and productivity metrics for pharmacist-led CCM services at a rural, medically underserved family medicine clinic.
This study retrospectively examined data from the clinic's CCM program from October 2020 through May 2021 and included total clinical encounters, minutes of pharmacist time spent on calls, CCM claims, work relative value units (wRVU), financial reimbursement, and overall personnel costs.
Over an 8-month period, 46 patients were enrolled in CCM services. Of the 49 CCM calls placed during this time, 31 (63.3%) were billable, though only 20 (64.5% of billable calls) were ultimately reimbursed. Approximately 37% of pharmacist "time-on-task" was not billable. Compared to the $643 required to cover pharmacist time on CCM calls, $822 of reimbursement was collected. This $179 profit, or 27.8% return-on-investment, is similar to results from more urbanized practices. Furthermore, services were "net productive" in wRVU generation, which may appeal to physician stakeholders interested in such targets.
Concerns about profitability and sustainability have prevented more widespread CCM implementation. In the present study, pharmacist-led CCM services achieved a 27.8% return-on-investment. Though rural-based CCM services may never attain significant profit margins, this data suggests they can still be financially self-sustaining and "net productive," all while providing high-quality patient care.
慢性护理管理（CCM）服务的实施经常受到报销问题的阻碍，这引发了对可持续性的担忧。迄今为止，几乎没有文献研究过农村实践环境中 CCM 服务的财务可行性和可持续性。
评估农村医疗服务不足的家庭医学诊所中，药剂师主导的 CCM 服务的财务报销和生产力指标。
本研究回顾性分析了该诊所 CCM 计划 2020 年 10 月至 2021 年 5 月的数据，包括总临床就诊次数、药剂师在电话中花费的时间、CCM 报销、工作相对价值单位（wRVU）、财务报销和总体人员成本。
在 8 个月的时间里，有 46 名患者参加了 CCM 服务。在此期间，共进行了 49 次 CCM 电话咨询，其中 31 次（63.3%）可计费，但最终仅报销了 20 次（可计费电话的 64.5%）。大约 37%的药剂师“任务时间”不可计费。与支付 CCM 电话咨询药剂师时间所需的 643 美元相比，共收取了 822 美元的报销费用。这 179 美元的利润，即 27.8%的投资回报率，与更城市化实践的结果相似。此外，服务在 wRVU 生成方面是“净生产性”的，这可能会吸引对这些目标感兴趣的医生利益相关者。
对盈利能力和可持续性的担忧阻碍了 CCM 的更广泛实施。在本研究中，药剂师主导的 CCM 服务实现了 27.8%的投资回报率。虽然农村 CCM 服务可能永远无法获得显著的利润率，但这些数据表明，它们仍然可以在财务上自给自足并实现“净生产性”，同时提供高质量的患者护理。
