Department of Pharmacy Practice, Palm Beach Atlantic University, West Palm Beach, FL, USA.
Department of Pharmacy Practice, Belmont University, Nashville, TN, USA.
Am J Health Syst Pharm. 2023 Nov 23;80(Suppl 4):S143-S150. doi: 10.1093/ajhp/zxad046.
Improvement in patient outcomes from collaboration between pharmacists and physicians in ambulatory clinics has been well documented. Barriers to payment have made widespread growth of these collaborations slow. Medicare annual wellness visits (AWVs) and chronic care management (CCM) provide an opportunity for pharmacist-physician collaborations that are directly revenue generating. The objective of this study was to evaluate the impact of pharmacist-led AWVs and CCM on reimbursement and quality measures in a private family medicine clinic.
This was a retrospective observational study in which the rate of reimbursement for AWVs and CCM was compared before and after implementation of pharmacist-provided services. Claims data were reviewed for Current Procedural Terminology codes and reimbursement applicable to AWVs and CCM. Secondary outcomes included the total number of AWV and CCM appointments, Healthcare Effectiveness Data and Information Set (HEDIS) measure completion rates, and average change in quality ratings. Outcomes were analyzed utilizing descriptive statistics.
Reimbursement from AWVs increased by $25,807.21 in 2018 and $26,410.01 in 2019 compared to 2017. Reimbursement from CCM increased by $16,664.29 in 2018 and $5,698.85 in 2019. In 2017, 228 AWVs and 5 CCM encounters were completed. After implementation of pharmacist services, the number of CCM encounters increased to 362 in 2018 and 152 in 2019 and the number of AWVs totaled 236 and 267, respectively. Completed HEDIS measures and star ratings increased during the study.
Pharmacist provision of AWVs and CCM addressed a gap in care by increasing the number of patients who received these services while also increasing reimbursement in a privately owned family medicine clinic.
在门诊诊所中，药师与医师之间的合作改善了患者的预后，这一点已得到充分证明。支付障碍使得这些合作的广泛发展变得缓慢。医疗保险年度健康访视（AWV）和慢性病管理（CCM）为药剂师与医师的合作提供了机会，这些合作可以直接产生收入。本研究的目的是评估药剂师主导的 AWV 和 CCM 对私人家庭医学诊所报销和质量措施的影响。
这是一项回顾性观察性研究，比较了实施药剂师服务前后 AWV 和 CCM 的报销率。审查了当前程序术语（CPT）代码和适用于 AWV 和 CCM 的报销的索赔数据。次要结果包括 AWV 和 CCM 预约的总数、医疗保健效果数据和信息集（HEDIS）完成率以及质量评分的平均变化。利用描述性统计分析结果。
与 2017 年相比，2018 年和 2019 年的 AWV 报销额分别增加了 25807.21 美元和 26410.01 美元，CCM 报销额分别增加了 16664.29 美元和 5698.85 美元。2017 年，完成了 228 次 AWV 和 5 次 CCM 就诊。在实施药剂师服务后，2018 年 CCM 就诊次数增加到 362 次，2019 年增加到 152 次，AWV 就诊次数分别为 236 次和 267 次。在研究期间，完成的 HEDIS 措施和星级评分有所增加。
药剂师提供的 AWV 和 CCM 通过增加接受这些服务的患者数量来解决护理差距，同时也增加了私人拥有的家庭医学诊所的报销额。
