Florida Hospital Using Pharmacist Led Chronic Care in Doctor’s Offices
The comprehensive health management service at Martin Health System of Stuart, Florida now includes pharmacist-led care in doctors’ offices. The new approach targets patients suffering from multiple chronic conditions including: diabetes, high blood pressure, high cholesterol, chronic obstructive pulmonary disease (COPD), asthma, and heart failure.
The program began in early 2014, and about 140 people have enrolled in the service. The decision to allow pharmacists in the primary care offices as improved the care of these complex patients, most of which who have at least three disease states, and aligns with Medicare’s shift toward payment for value rather than volume.
How the Program Works
Clinical pharmacists work on-site at several doctors’ offices that serve a Medicare-rich population on the Treasure Coast of South Florida. Potential patients are identified by acute care, transitions and care, or pharmacists in the emergency department at Martin Health, as well as the health system’s primary care doctors.
The referral process is built into the electronic medical record system. Potential patients appear in the queue and are then screened either by telephone or in office to determine whether they meet the service’s requirements.
After enrolled, the patient meets with a clinical pharmacist. The first visit takes roughly an hour and follows the structured format. It includes a health literacy assessment, physical exam, allergy and immunizations screening, disease state specific assessment, medication reconciliation, and goal setting, as well as other elements. Subsequent follow-up visits occur in the office and over the telephone at intervals determined on the patient’s individual needs and progress.
Early data from survey of enrollees suggested that about 90% of patients were satisfied with the care they received from their pharmacist. The service is not a pharmacy-centric initiative, but team-based. The patients do not belong to the pharmacists, but the pharmacists serve as the communication points between the doctors and the patients to help guide them towards success.
Is the Program Worth it?
All service protocols are evidence-based, developed by consensus, and approved by the appropriate doctors’ specialty leadership and medical executive committee. Seeing the pharmacists in the primary care office shows patients that they work as part of the team, increasing the patient’s willingness to come back to see the pharmacist. Doctors who are willing to make referrals to the program showed that they recognize the pharmacists are making a difference in patient care.
Paying the Pharmacists
Determining how to pay for pharmacist services in primary care offices can present a barrier to placing them in these types of settings. Martin Health could seek Medicare reimbursement for office-based pharmacist services through the new chronic care management programs as well as other incidents to service and billing models. The health system chose not to take this path because these models require the collection of additional copayments from patients who are already subject to many copayments.