I had a discussion with Blair Thielemier at the Pharmapreneur Academy (the queen of developing clinical pharmacy practices) the other day about developing a clinical pharmacist practice in an outpatient clinic. To give a little background, I spent approximately 2 and a half years in a clinic that had never had a clinical pharmacist in the past. There were a lot of challenges and successes as you could imagine. For those that are working to develop this type of practice, I wanted to share some of my experiences and suggestions for developing a clinical pharmacist practice in an outpatient clinic.
Identify Areas of Concern
I think every pharmacist who is considering this type of practice thinks that they are going to go in and help the clinic with what they are good at. I thought that I could provide a lot of help with their geriatric population and I did do some of that. However, what was really important to the clinic was some of the clinical quality metrics that meant a lot to the clinic financially. It is important to recognize what the clinic actually wants and needs versus your desire to deliver certain services. My strong suggestions would be to identify areas that the clinic cares about most and help them with those tasks before looking at doing other things.
Be Good to Nurses
Nurses are the lifeblood of the clinic and keep things running smoothly. They were incredibly helpful to me in answering EMR questions, rooming patients, and giving me insider information on specific patients to help me better prepare for my patient medication reviews. I believe that the overwhelming majority enjoyed having me there to answer questions and serve as a middleman in situations where they didn’t know an answer or were questioning a provider’s order.
People are busy and they forget that you are there. That is expected with a new service that they have never had. Attending meetings was a good way to remind others that I was here to help. Providing presentations, educational handouts, and clinical practice updates to the providers is also a great way to increase visibility, credibility and demonstrate that you are on top of your game.
In one situation, I remember receiving heavy praise from a provider at a meeting I was attending. Had I not been at that meeting, would that moment have happened? It is hard to say, but my guess is that it would have been a lot less likely if that provider didn’t see me sitting there. In moments like that, this gave added credibility to what I was doing and in my mind helped turn the tide for other providers who were on the fence about using our services.
Understand the Finances of a Clinic
There was terminology that was absolutely foreign to me prior to beginning my work in the clinic. RVU’s (relative value unit) is a term that is meant to help determine the amount of work that a provider does when seeing a patient. Providers are judged off of this value. Coding for more complex visits (visits where more things are addressed or more conditions identified) can lead to a higher RVU number. With value-based payments, the clinic is paid bonuses for reaching target percentages of their patients that quit smoking, hit their A1C goal, blood pressure goal, etc. Recognizing where revenue comes from within your clinic can help you identify target areas of savings, bonuses or ways to increase provider RVU’s.
Identify a Champion and Work With Them
Depending upon the size of the clinic, you will likely have providers who are very excited to have you and some that are more indifferent about having a clinical pharmacist on the team. That’s ok. Focus on working with those providers who are open to developing the practice and do your best to save them time and improve the health of their patient population. Ultimately others will come around if you can demonstrate your ability to improve the lives of patients and help save the providers’ time.
Those are my 5 tips for developing a clinical pharmacist practice in an outpatient clinic. Are you currently working in this type of practice? I’d love to have you share any comments below!
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