Implementation and Revenue Opportunities for Pharmacy-Based Transitions of Care Programs

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2 Implementation and Revenue Opportunities for Pharmacy-Based Transitions of Care Programs Sandra Leal, PharmD, MPH, FAPhA Chief Operating Officer SinfoníaRx

3 Disclosure and Conflict of Interest Sandra Leal is the Chief Operating Officer of SinfoniaRx.

4 Pharmacist Objectives At the conclusion of this program, the pharmacist will be able to: 1) List types of payers that reimburse for transition of care services. 2) State two strategies for potential revenue for pharmacist services. 3) Name at least two measures to document for transitions of care services.

5 All of the following are willing to pay for these types of services except for? 1) Nobody 2) Payers 3) Patients 4) Systems Answer: Nobody

6 Example set up and workflow

7 Click to add text N=376 patients 1,234 interventions and recommendations Source: Effectiveness of a Pharmacist- and Nurse- Managed Interprofessional, Post-Hospital Discharge Transition of Care Program at Preventing Readmissions and Reducing Costs. Health Services Advisory Group, the Quality Improvement Organization for Arizona, under contract with the Centers for Medicare & Medicaid Services, an agency of the Department of Health and Human. Publication No. AZ-11SOW-C

8 Click to add text Source: Effectiveness of a Pharmacist- and Nurse- Managed Interprofessional, Post-Hospital Discharge Transition of Care Program at Preventing Readmissions and Reducing Costs. Health Services Advisory Group, the Quality Improvement Organization for Arizona, under contract with the Centers for Medicare & Medicaid Services, an agency of the Department of Health and Human. Publication No. AZ-11SOW-C

9 Click to add text Source: Effectiveness of a Pharmacist- and Nurse- Managed Interprofessional, Post-Hospital Discharge Transition of Care Program at Preventing Readmissions and Reducing Costs. Health Services Advisory Group, the Quality Improvement Organization for Arizona, under contract with the Centers for Medicare & Medicaid Services, an agency of the Department of Health and Human. Publication No. AZ-11SOW-C

10 Click to add text Source: Effectiveness of a Pharmacist- and Nurse- Managed Interprofessional, Post-Hospital Discharge Transition of Care Program at Preventing Readmissions and Reducing Costs. Health Services Advisory Group, the Quality Improvement Organization for Arizona, under contract with the Centers for Medicare & Medicaid Services, an agency of the Department of Health and Human. Publication No. AZ-11SOW-C

11 Steps for Design/Consideration: 1) Referral 2) Evaluation 3) Person to Person Consultation Alternate 3) Consultation with the patient s living facility 4) Documentation 5) Coordination with other pharmacies, DME, specialists, primary care providers 6) Follow-up

12 Click to add text Source: Effectiveness of a Pharmacist- and Nurse- Managed Interprofessional, Post-Hospital Discharge Transition of Care Program at Preventing Readmissions and Reducing Costs. Health Services Advisory Group, the Quality Improvement Organization for Arizona, under contract with the Centers for Medicare & Medicaid Services, an agency of the Department of Health and Human. Publication No. AZ-11SOW-C

13 Which of the following are strategies for revenue generation? 1) Bill fee-for-service, utilize appropriate billing codes 2) Apply for grants 3) Have providers bill for your services 4) Have the system cover your services Answer: Bill fee-for-service, utilize appropriate billing codes

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15 Outcomes

16 Payers 1) Money 2) Penalties 3) Regulatory Mandates 4) Accreditation Requirements

17 Strategies 1) Fee-for-service 2) Leveraging billing codes 3) Coverage of FTE (full time equivalent) 4) Students/residents/technicians 5) Technology

18 What billing codes can pharmacists use directly? 1) (TCM 7 days) 2) (TCM 14 days) 3) (New patient visit) 4) G0402 (IPPE) 5) (MTM) Answer: (MTM)

19 Source: Understanding health care billing basics. Pharm Today. 2017;23(7):57 68;

20 Which of the following measures is the most difficult to track? 1) Patient satisfaction 2) Clinical measures likes A1C reduction 3) Readmission to all hospitals 4) Penalty payments Answer: Readmission to all hospitals

21 Measure Examples 1) Readmission reduction, concrete 2) Cost savings 3) Medication reconciliations within 30-day window

22 Summary 1) Numerous opportunities 2) Follow the money 3) Advocate for our clinical services 4) Always put the patient first

23 Resources 1. Effectiveness of a Pharmacist- and Nurse- Managed Interprofessional, Post-Hospital Discharge Transition of Care Program at Preventing Readmissions and Reducing Costs. Health Services Advisory Group, the Quality Improvement Organization for Arizona, under contract with the Centers for Medicare & Medicaid Services, an agency of the Department of Health and Human. Publication No. AZ-11SOW-C Understanding health care billing basics. Pharm Today. 2017;23(7):57 68; 3. American College of Physicians. What practices need to know about transition care management codes. acponline.org/practice-resources/business-resources/coding/generalcoding-resources/what-practices-need-to-know-about-transition-care-management-codes. 4. CCNC. Recommendations for Transitions of Care in North Carolina; 5. APhA: Transitions of Care Case Example Resources:

24 Speaker Contact Information