Community and ambulatory pharmacy: evaluation of patient care services and billing patterns before implementation of Medicare part D

Transferring Key Success Factors from Ambulatory Care into the Community Pharmacy in the United States

In the United States, pharmacists' scope of practice continues to expand, with increasing opportunities for pharmacists in all practice settings to enhance health in society. In ambulatory care, pharmacists remain integral members on the healthcare team and have demonstrated positive impacts on patient care. Sharing similar characteristics as pharmacists in the community setting, a deeper look into common elements of a successful ambulatory care practice that can be applied in the community pharmacy setting is warranted. Key success factors identified from ambulatory care include (1) maximizing a pharmacist's unique knowledge base and skill set, (2) forming collaborations with physicians and other providers, (3) demonstrating outcomes and value, and (4) maintaining sustainability. Opportunities exist for pharmacists in the community setting to utilize these success factors when developing, implementing, and/or expanding direct patient care services that improve accessibility to quality care and population health.

Current trends in outpatient pharmacy services and billing

OBJECTIVES

To provide a summary of community and ambulatory pharmacy practices and billing patterns for medication therapy management (MTM) services and to identify reasons pharmacists report not billing for direct patient care services.

DESIGN

Cross-sectional study.

SETTING

United States, February 2011.

PARTICIPANTS

Members of the American College of Clinical Pharmacy Ambulatory Care Practice and Research Network, American Society of Health-System Pharmacists Ambulatory and Chronic Care Practitioners, and American Pharmacists Association MTM e-community.

INTERVENTION

Online survey.

MAIN OUTCOME MEASURES

Practice setting, pharmacy services performed, billing technique, and payer, as well as reasons for not billing.

RESULTS

MTM services were provided by 287 pharmacists. The most common practice settings included physician office (23.6%), health-system outpatient facility (21.7%), and community pharmacy (20.2%). A total of 149 of 276 pharmacists (54.0%) reported billing for MTM services; 16 of 276 (5.8%) did not know if they were currently billing. Community pharmacists were more likely to bill than all other sites combined (80.5% vs. 53.1%, P < 0.001), and pharmacists with >75% of visits face-to-face were more likely to bill (66.2% vs. 46.6%, P < 0.002).

CONCLUSION

A variety of MTM services are provided in outpatient settings with inconsistent billing techniques and reimbursement. Pharmacists should continue to work toward consistent, sustainable reimbursement to expand MTM services.

Review of Survey Articles Regarding Medication Therapy Management (MTM) Services/Programs in the United States

Objective: To provide a summary of published survey articles regarding the provision of medication therapy management (MTM) services in the United States. Methods: A literature search was conducted to identify original articles on MTM-related surveys conducted in the United States, involving community and outpatient pharmacists, physicians, patients, or pharmacy students and published by the primary researchers who conducted the study. Search engines used included PubMed, Medline, and International Pharmaceutical Abstracts (IPA). If MTM was in the keyword list, mesh heading, title, or abstract, the article was reviewed. References from these articles were searched to determine whether other relevant articles were available. Results: A total of 405 articles were initially reviewed; however, only 32 articles met the study requirements. Of the 32 articles, 17 surveyed community/outpatient pharmacists, 3 surveyed pharmacy students, 4 surveyed physicians, and 8 surveyed patients. The survey periods varied across the different studies, with the earliest survey conducted in 2004 and the most recent survey conducted in 2009. The surveys were conducted via the telephone, US mail, interoffice mail, e-mails, Internet/Web sites, hand-delivered questionnaires, and focus groups. Conclusion: Despite the identified barriers to the provision of MTM services, pharmacists reportedly found it professionally rewarding to provide these services. Pharmacists claimed to have adequate clinical knowledge, experience, and access to information required to provide MTM services. Pharmacy students were of the opinion that the provision of MTM services was important to the advancement of the pharmacy profession and in providing patients with a higher level of care. Physicians supported having pharmacists adjust patients’ drug therapy and educate patients on general drug information but not in selecting patients’ drug therapy. Finally, patients suggested that alternative ways need to be explored in describing and marketing MTM services for it to be appealing to them.

Health Perception Changes of State Employees following a Health Screening Event

Background:

Health screenings can identify patients at risk for chronic medical conditions. Additionally, screenings may influence behavior changes as depicted by the Health Belief Model.

Objective:

To examine the perceptions of state employees regarding their health and risk for medical conditions, assess whether unexpected or abnormal screening results will impact perceptions, and identify barriers to scheduling an annual physical examination.

Methods:

State employees participated in screenings for diabetes, dyslipidemia, and osteoporosis. Participants were asked to complete a pre- and post-survey. Pre-survey questions gathered information on demographics, chronic medical conditions, perception of overall health, and willingness to have an annual physical examination. The post-survey assessed self-health perceptions based on screening results, their risk for chronic medical conditions, and the likelihood that the screening results would encourage scheduling a provider appointment.

Results:

One hundred twenty-six of 128 (98.4%) employees completed the survey. Thirty-five percent of employees had cholesterol levels >200 mg/dL and 23% had T-scores less than or equal to −1.0. When asked about preexisting medical conditions, 40% of those with elevated cholesterol levels reported that they had high cholesterol, and 5% with low T-scores stated that they had osteoporosis. Following the screenings 54% and 55% responded that they were at risk for high cholesterol (p = 0.02) and osteoporosis (p < 0.001), respectively. Participants who reported having had no annual physical examination but who planned to schedule a visit as a result of their screening had a higher total cholesterol level than those who reported annual physical examinations prior to the screening (207 ± 42.6 mg/dL vs 189 ± 33.2 mg/dL; p = 0.03).

Conclusions:

Health screenings increased awareness of dyslipidemia and osteoporosis among state employees. Higher than normal cholesterol results influenced health perceptions and encouraged respondents to schedule a provider visit.

Pharmacists' acceptable levels of compensation for MTM services: a conjoint analysis

BACKGROUND

The Medicare Modernization Act of 2003 requires prescription drug plans to provide medication therapy management (MTM) services to Medicare beneficiaries who are at high risk for inappropriate use of medications. However, inadequate compensation has been a barrier for MTM expansion among pharmacists.

OBJECTIVES

The objective of this study was to determine pharmacists' acceptable levels of compensation for MTM services.

METHODS

A preference-based fractional factorial design of conjoint analysis was used by surveying 1524 active pharmacists in Tennessee. Pharmacists were asked to select between packages (scenarios) of MTM services that represented combinations of MTM attributes (characteristics). The MTM attributes included type of patient (new or returning), patient's number of chronic conditions (1, 3, or 6), patient's number of medications (4, 8, or 16), patient's annual drug costs ($2000, $3000, or $4000), service duration (15 minutes, 30 minutes, or 45 minutes), and price of MTM services ($30, $60, or $120). A survival analysis model was used to predict pharmacists' willingness to select 1 versus another MTM service package. Pharmacists' acceptable level of compensation was estimated as the marginal rate of substitution between the parameter estimates of an attribute and the price attribute of MTM.

RESULTS

The parameter estimates were -0.0303 (P<.0001) for service duration and 0.0210 (P<.0001) for price of MTM services, respectively, so pharmacists were willing to accept $1.44/min (0.0303/0.0210), or $86.4/h, for MTM services. Pharmacists' characteristics were associated significantly with their acceptable levels of compensation: years of practice was associated with a higher need for compensation, pharmacy ownership (vs nonowner) associated with a lower need, and having provided MTM previously (vs having not provided MTM) was associated with a higher need.

CONCLUSIONS

Pharmacists' acceptable level of compensation is in the higher part of current ranges from $30 to $100/h. To increase participation in MTM services, pharmacist compensation needs to be increased. Future studies might continue to corroborate the generalizability of findings from this study.

Using personal strengths with intention in pharmacy: implications for pharmacists, managers, and leaders

BACKGROUND

The importance of allowing individuals to use their strengths in a work environment has been articulated through research focused on general audiences as well as by thought leaders within pharmacy. In particular, the work of Gallup has described how organizations that foster an environment in which employees frequently use their strengths achieve increased productivity, customer and employee satisfaction, and improved success at meeting goals. Despite acknowledging the importance of such an environment, little has been articulated in the pharmacy literature regarding how pharmacists can identify and apply their unique strengths within their profession.

OBJECTIVE

To provide an overview of the concept of individual strengths, the value of utilizing strengths in the profession, and the authors' experiences facilitating an awareness of this concept with student pharmacists, pharmacy residents, and pharmacists.

METHODS

Discovery and application of strengths has become a foundational theme in leadership development activities at the University of Minnesota College of Pharmacy. The learning process begins with building awareness and identifying individual talents using the Clifton StrengthsFinder Profile and reflecting on previous use of these talents. Throughout the activities, participants are encouraged to examine how professional experiences that correlate with their talents intersect and affect their knowledge and skills. Finally, participants are encouraged to utilize and maximize their talents in a team environment.

RESULTS

Experience has been gained delivering this educational process to 225 student pharmacists, 39 ambulatory care residents, and 22 practicing pharmacists. Participants have viewed this program favorably and articulated that utilization and growth of strengths is valuable to their career.

CONCLUSIONS

In order to achieve our potential as a profession, it is critical to identify and apply the strengths that individual pharmacists bring to their practice settings. The identification, understanding, and application of strengths have the potential to increase professional satisfaction, enhance leadership, and empower change that will evolve patient-centered care.

The nontraditional role of pharmacists after hurricane Katrina: process description and lessons learned

In the week before Hurricane Katrina's landfall in August 2005, emergency management officials in Jefferson County (Birmingham), Alabama, began to make plans for the potential influx of evacuees from the Gulf Coast. No pharmacy component to the plan was in place at that time. The Jefferson County Department of Health (JCDH) discovered that local pharmacies and hospital emergency departments were dealing with significant requests for medication refills. JCDH, in cooperation with a local school of pharmacy, developed a plan for addressing the unforeseen need for routine prescription refills by evacuees. This article discusses this novel pharmacy plan and lessons learned from the event, and may serve as a model for other municipalities and/or states interested in preparing a pharmacy response to future natural disasters.