Special - Hot Topic Themed Presentations
Sunday, October 13, 2024
12:45 PM–02:15 PM
Abstract
Service or Program:
Colorado has a strong legislative base for pharmacist scope of practice, including some provisions for direct billing. When Medicaid provider status was obtained in 2021, University of Colorado (CU) primary care pharmacy faculty collaborated with medical partners to initiate pharmacist billing for clinical services. The first pathway was Medicaid direct billing for chronic disease care delivered through collaborative drug therapy management, followed by incident-to billing at practice sites where permitted, Medicare Annual Wellness Visits, and a specialty practice initiated pharmacist billing in 2024. A new pathway utilizing Principal Care Management codes will be implemented in fall of 2024. Emboldened by success, we convened clinical pharmacy leadership, medical directors, state pharmacy society legislative experts, and CU Medicine’s Associate Director of Contracting to brainstorm opportunities to seek pharmacist provider status through commercial contracting agreements. Conversations with the first payer are scheduled for September 2024.
Justification/Documentation:
Eleven primary care pharmacy faculty support 14 CU Medicine Primary Care Clinics totaling 8 FTE devoted to clinical care. Billing opportunities vary according to practice population and hospital-based status differences. Revenue generation has grown from a few hundred dollars per month in 2023 to a few thousand per month in 2024. One pharmacist in a specialty practice began incident-to billing in March 2024, and has generated revenue to support nearly 80% of her clinical time.
Adaptability:
Several elements have contributed to CU’s success and may be key elements for success in other ambulatory care settings: strong medical provider support, skilled and motivated pharmacists willing to forge new paths, persistent follow-up to prod administrative barriers, and collaboration with a strong state society.
Significance:
The value of pharmacist services in improving healthcare quality and provider satisfaction is well-established and could be expanded through billing-derived revenue streams.
Presenting Author
Sarah Billups PharmDUniversity of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences
Authors
Danielle Fixen PharmD
University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences
Ben Hill PharmD
University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences
Kelsey Schwander PharmD
University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences