Save Time & Money
How can rheumatology clinics afford to add a pharmacist? It may be feasible only for practices within larger systems, the panelists agreed. However, this model may save costs over time, said Sooyeon Kwon, PharmD, PhD, a clinical pharmacy resident at The Center for Rheumatology (TCFR), a three-clinic network in upstate New York.
“High healthcare costs are not sustainable. It’s been the driving force for every researcher to find a model to really sustain and provide the best care outcomes given the resources,” Dr. Kwon said. In addition to dispensing medications, a pharmacist on an interdisciplinary care team can educate patients to improve adherence and clinical outcomes and, eventually, save direct and indirect costs by preventing future, more costly outcomes, such as hospitalization or emergency visits, she added.
Pharmacists at TCFR, a private practice with 18 providers, are in charge of counseling and teaching patients about new pharmacological therapies, disease state, medication use, self-injection technique and adverse reactions. Based on recent internal patient survey data at TCFR, patients have a high level of anxiety when they start new treatments, especially biologics. After a teaching and counseling visit with a pharmacist, 96% of patients reported they either agree or strongly agree they feel comfortable with the new treatment.
Pharmacists also developed evidence-based justification letters to obtain insurance coverage for off-label drugs. This program streamlined and shortened the approvals process by weeks or months, which is very important patient advocacy, Dr. Kwon said. If this process is delayed, the person who suffers is the patient who needs the medication. To receive an approval from insurance at first submission for off-label use, it is necessary to include the most recent literature to support and justify the use of medication for the patient, which requires time and extensive literature review. From 2009–2014, TCFR found the rate of initial denials for insurance coverage of off-label drugs dropped to near zero.3
Another important aspect of the pharmacy service is saving physician’s time, Dr. Kwon noted. TCFR estimated a pharmacist saved between $1,000 and $4,000 in physician’s billable hours per quarter. Physicians can be more readily available for direct patient care by being freed from time-consuming, insurance-related tasks, such as letter preparation or peer-to-peer process. In a 2016 internal survey, 54% of providers at TCFR estimated pharmacists saved them two or more hours of work per week. In the 2018 updated survey, 70% of providers answered they saved two or more hours per week.
With more pharmacologic agents, such as biologics, available in the market for patients and providers to compare and choose from, the contribution of a pharmacist as a member of a multidisciplinary team to take care of patients becomes more and more important, Dr. Kwon said.
Jessica F. Farrell, PharmD, director of the TCFR pharmacy service, noted in 2017 in Arthritis & Rheumatology that the staff concluded that adding a pharmacist improved the quality of patient care at the clinic, particularly through improved medication safety and prior authorizations.4
Reimbursements also rose after TCFR expanded the pharmacy staff, based on coding data, Dr. Kwon said. Currently, because pharmacists are not recognized as a healthcare provider by the Centers for Medicare & Medicaid Services, revenue generation to compensate pharmacy services may be difficult for a small practice that does not have a specialty or dispensing pharmacy operation, she noted. A quality improvement program linked with insurance companies may open an avenue to generate funds to compensate for pharmacy services. Also, having an on-site pharmacist and the ability to perform medication reconciliations are measures rheumatology practices may report to Medicare to increase reimbursement rates through the Merit-Based Incentive Payment program, Dr. Kwon said.
