Integration of Clinical Pharmacy In Primary Care

Clinical pharmacy is an evolving practice.  We need to continue to push for an expanded role.  Too many patients can benefit from what we do as pharmacists.  One of the things that I’m working on is integrating clinical pharmacy in primary care.

I want to identify a few major hurdles that I have encountered and will encourage others who have worked with primary care to share theirs as well.  I also wanted to share this really good article on primary care and clinical pharmacy.

Here’s a few important points I’ve learned.

  1. Understand what your providers don’t like about medication management or what they really struggle with.  This is a unique opportunity to provide a solution to a problem and really demonstrate value.  An example of this would be to identify that your clinic has a challenging time with timely follow up of patients following medication changes.
  2. Respectfully eavesdropping.  If you hear nurses and/or providers clearly talking about medication related problem, quietly interject and say “I couldn’t help but overhear you talking about (insert concern)…can I help in some way?
  3. Encourage questions.  By having a kind spirit and a desire to solve problems even when there isn’t a good solution, this increases your approachability and will likely help you get integrated into your clinic.

These are just a few examples of how to help integrate clinical pharmacy in primary care.  Below is a list really important bullet points from the article linked in the first part of the post.

  • Determine the needs and priorities of the team and its patients
  • Develop a pharmacist job description
  • Educate the team about the pharmacist role
  • Educate themselves about other team members’ roles
  • Ensure clinic infrastructure supports the pharmacist role
  • Be highly visible and accessible to the team
  • Ensure their skills are strong and up to date
  • Provide proactive care and take responsibility for patient outcomes
  • Regularly seek feedback from the team
  • Develop and maintain professional relationships with other team members

What else would you add?

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4 Comments

  1. Tony

    What do retail pharmacists do? There’s just not enough commonality and rapport. I live in a big city. Clinical seems like a losing battle. My chain wants clinical to be front and center…. how do us non clinic-based pharmacists succeed?

    Reply
    • Eric Christianson

      Value based and clinical based payments are gaining more and more steam, while fee for service (Rx, office visit, etc.) is slowly going away…stay sharp, stay educated, and most importantly stayed tuned to the rapidly changing healthcare environment. I can’t predict how this will all play out, but I think those prepared for change will be most able to handle it and thrive in new and changing systems.

      Reply
  2. Andrew

    I hope for opposite and this is one of those rare situation were I disagree with Eric. Clinical pharmacy services have taken off in states where pharmacist are reimbursed for their cognitive abilities. States that have opened cpt codes for pharmacist have been able rapidly expand clinical pharmacist role in health care. Value based systems are going to expand, however, ffs will still be be present. What will likely go away is the incident to ffs billing structure. Take look at Oregon, Wisconsin, Minnesota, Iowa, and New Mexico expansion of ffs billing opportunities for pharmacists. Do not listen to what you read online about billing for services. Most pharmacist believe that you cannot bill higher then 99211 for Medicare incident-to billing (wrong). CMS has stated that this pharmacists can bill up to 99215 as long as their documentation supports it. In states that have given pharmacist provider status all have built out ffs billing for clinical services. Washington and Ohio being the most recent. The biggest barrier we have for sustainable ambulatory practice for our profession is ourselves. State determines scope, advocate, credential, buy an AMA cpt code book, look into your states FQHC laws, and start educating you colleagues. In the community setting be aggressive with part D MTM, med sync, adherence, immunization, CMRs, and medication reconciliation. Sadly, the 3rd round of cms innovation project regarding medication therapy management (pharm2pharm, iharp, USC,PSU’s) really put is in tough spot in regards to obtaining provider status at a national level. the last thing we want Is our profession to be attached solely to value based payment models. We are not the art program or music program that get cut when the budget gets tight. We are doctors of pharmacy and deserve reimbursement for our cognitive services.
    Here is an excellent outdated source for you to look at: http://www.ncsl.org/research/health/medication-therapy-management.aspx

    In addition take a looks at the PSPC work in this space.

    Reply
    • Rebecca

      Andrew,
      Thank you so much for your response! Really informative. I know this is a late reply but I was curious if these CPT codes are only incentive to doctors that have Medicaid and Medicare patients? Do you know If patients private insurance is also doing quality measures that are holding physicians accountable or is it just CMS so only docs with CMS patients have an incentive to use us? I guess i could start offering my services to doc’s with high CMS patients and then through my experience offer docs that have more private insurance patients to bill under ffs, talk to different docs and see if there is something I can offer them that would incentivize them to do ffs with me. I understand the quality measures for the CMS population but maybe I’m confused, however I didn’t think that the private insurances were participating in the quality measures so insurance wouldn’t charge the physician on their outcomes. If you happen to know if I am totally misunderstanding the situation and have time to point me in the right direction with some reading that would help me understand the billing services/code options for private insurance and those doctors incentive to use pharmacist that would be so amazing! I know it that a lot and completely understand if Your busy but if you ever find time. Thank you so much and have a wonderful day!
      Becca

      Reply

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Written By Eric Christianson

January 1, 2017

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