Pharmacists are trusted, essential healthcare providers for their communities and the patients they serve. However, several drivers, such as federal and state regulations, have hindered these critically important clinicians from maximizing their potential as providers.
Recently, there has been a palpable shift in the perception of pharmacists and their crucial role in the care continuum. COVID is one of those driving forces that initiated this shift. During the pandemic, pharmacists were at the center of testing, vaccination, and treatment of the virus. In addition, pharmacies were instrumental in supporting the overburdened healthcare system throughout the pandemic, including serving as pediatric and adult vaccine centers and access to life-saving medications.
More eyes are on pharmacy than ever before, particularly community pharmacy practice. Community pharmacies must take advantage of this current pendulum shift and capitalize on the increased demand for their services. Here are three ways pharmacists can expand their role beyond the bench:
1. Break the Chains Tying Pharmacists to the Bench: In order to add more to a pharmacy’s bottom line, pharmacy staff will have to spend some time away from the standard dispensing practice. Pharmacy teams should meet and discuss opportunities to optimize workflow or to allow team members to offer services they are passionate about. Having a staff member that is an expert in durable medical equipment (DME), supplements, compression stockings, etc. can attract a loyal following to the pharmacy. Creative strategies including alerts within practice management systems or clinical software tools can be utilized to target the patients insured by the payors you contract with as a reminder to perform extra services. Additional strategies to help all pharmacy team members practice at the top of their license include:
- Support legislation that prohibits unfair PBM practices and improves pharmacy reimbursement
- Offer leadership training to staff to help them further develop/refine skills, and help your pharmacy meet its financial and patient-care goals
- Support pharmacists with clinical training and the tools needed to expand their scope of work beyond traditional medication dispensing
- Implement clinical services including point of care testing, chronic disease management, and pharmacist prescribing services
2. Maximize Revenue Streams: Pharmacies often provide services that go above and beyond the requirements to dispense drugs. However, they often do not seek or receive compensation for these services due to not having the ability to bill as a traditional provider to medical plans. More pharmacists and pharmacy technicians need to come together to advocate for the profession to receive fair payments for the services provided and improve processes to become in-network providers with plans. Pharmacies need to start billing for the extra time and care put into each patient encounter. If pharmacies started billing for the services already provided, a significant amount of revenue could be added to the bottom line. Software designed for traditional provider offices (i.e., Electronic Health Records (EHRs)) can be utilized to help document clinical services and transmit claims. Pharmacies can optimize alternative revenue streams by:
- Starting to bill for the time and effort spent providing extra levels of care, for example coordinating with a provider regarding a mutual patient or extended patient counseling and medically necessary education
- Billing medical plans in addition to out of pocket for clinical services, similar to all other providers using current procedural terminology (CPT) codes developed by the American Medical Association (AMA)
- Leveraging pharmacy-specific technology tools to ensure you have the correct data needed to transmit/receive reimbursements
- Engage in traditional provider status set-up including credentialing, enrollment, and revenue cycle management (RCM)
3. Rethink Approach to Patients and Their Problems: Patients are starting to realize that they need to be more engaged in their individual healthcare journey. However, many patients struggle to find a PCP that can fit them in for appointments, particularly new patients, meaning that many must wait several months for an appointment. More and more patients, payors, and providers realize that pharmacists are an accessible healthcare provider, that can be seen in an accessible and timely manner and provide quality care. Pharmacists are trained in the management and treatment of conditions both acute and chronic and are slowly starting to collaborate with the larger ecosystem to support expanded access to care. The scope of practice for pharmacists and pharmacy technicians is expanding, albeit at a slow rate and only at a state level. There are opportunities to create collaborative practices with local providers to allow for pharmacy to further manage mutual patients, beyond the current scope of practice. Some payors are eager to work with pharmacies to help achieve health outcomes at a lower cost of care. Other payors are unaware of the impact pharmacy can make on the healthcare system or are unable to access these impactful providers due to technological limitations. Overall, it is time for pharmacies to stop thinking about only drug related problems and start thinking about the entire patient. Pharmacy team members can impact the larger patient care journey in many ways. Successful strategies currently employed in community pharmacy practice include:
- Leverage the momentum from the COVID pandemic as patients are seeking pharmacist providers’ input, now more than ever
- Partner with other providers and payors to achieve mutual healthcare outcomes and lower overall cost of care
- Re-think priorities and workflow, including any pertinent changes to staffing, scheduling, and use of pharmacy space, envision two practice models under one roof: office visits and traditional dispensing models
- Shift from reactive to proactive mindset (i.e.: proactively schedule a consultation service with patients when they come pick up their medication)
These are mental shifts that we need to make to allow us to continue to elevate our pharmacies and our profession. In addition, traditional pharmacy management systems are generally equipped to handle the robust documentation requirements for medical claims or the additional details necessary to process more complex codes and claims. The pharmacy profession must adapt and utilize other tools, like EHRs and population health management tools, to take advantage of the payment opportunities that payors are offering pharmacies. Finally, enabling provider status set up comes with a set of barriers and challenges. Pharmacists truly taking maximum advantage of provider status will take an investment of time and money to figure out all the pieces, but the payoff can be a game changer. Someday pharmacy teams in all states will not just be providing some services on the side but can incorporate them into their workflow and be regularly sought out by patients, providers, and payors alike for a better solution to health in the communities we serve.
In this ‘Beyond the Bench’ blog series, we will hear from thought-leaders on ways to take pharmacy practice to the next level. Matthew Yeates is passionate and wants to make a difference in his community and an even greater impact on our profession. Matthew works alongside Michele Belcher, owner of Grants Pass Pharmacy and president of NCPA. If you would like additional information on credentialing don’t miss her recent interview with Pharmacy Times.
