You want collaborative practice? Win provider status
The rocky path to creating a clinical pharmacy practice in an ambulatory care setting
In 1998 a family practice physician in Columbus, Ohio, asked me to help manage an uncontrolled type 2 diabetes population. The practice invited United Health Care (UHC) officials to visit to determine requirements for documentation; collaborative interaction between the pharmacist, physician, and patients; and appropriate billing with Evaluation and Management (E&M) codes. We were told to follow the Marshfield Clinic guidelines for documentation and the Medicare definitions for the selection of the appropriate CPT codes for the services rendered.
In 2004 we invited the CMS Region V team to evaluate and possibly endorse to CMS in Baltimore what we were doing; we hoped to see pharmacists approved as providers recognized by CMS.
The group of administrators, physicians, and lawyers came and spoke with our patients and the clinical team about the services rendered and results achieved by our collaborative practice. At this point we had put nearly 275 patients on the service.
In 2007 the practice decided to stop taking Medicaid patients and the number of patients dropped to about 150.
The three elements of physician practices upon which you do not want to intrude are:
- Space. The more space you take up, the less space the physician is able to move patients into.
- Time. Be mindful of how much time you require of physicians. Even though you are generating income, their perception will be that they could be earning more money in the time you are asking of them.
- Money. Physicians are generally averse to sharing any income for which they have to do the billing. And pharmacists cannot directly bill for services. You see the problem.