VictorOfHungerGames

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"Relating to reimbursement under certain health benefit plans for certain services and procedures performed by pharmacists."


I'm too illiterate, or too lazy... lol someone interpret this. Based on what I'm reading, as long as there is a doctor involved, pharmacists can be reimbursed for certain services such as MTM, flu, cholesterol, glucose testing service and other patient education programs?

I know we can do this at the VA but could this possibly be done on retail setting?
 

zelman

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State laws affect state insurance plans. Do you think Medicaid will pay enough to make the paperwork worth doing?
 
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VictorOfHungerGames

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State laws affect state insurance plans. Do you think Medicaid will pay enough to make the paperwork worth doing?
Good question. Not sure about medicaid but I'm sure others may pay a decent amount. There is a good amount of reimbursements for some of the MTMs we do. It would be a good way to generate revenue for pharmacies if this could be set up at independent pharmacies.
 

zelman

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Good question. Not sure about medicaid but I'm sure others may pay a decent amount. There is a good amount of reimbursements for some of the MTMs we do. It would be a good way to generate revenue for pharmacies if this could be set up at independent pharmacies.
Good question. Not sure about medicaid but I'm sure others may pay a decent amount. There is a good amount of reimbursements for some of the MTMs we do. It would be a good way to generate revenue for pharmacies if this could be set up at independent pharmacies.
Others will not pay until this is a federal regulation.
 

VictorOfHungerGames

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You realize you don't even get "paid" for this in the VA, Encounters don't work that way for non-count clinics.
Yes, I do know that theyre not specifically being paid for each service. I meant youre able to do this at the VA under a MD supervision.

So then this law would benefit pharmacists even more if put into practice. Heck, I wiuldnt mind providing these services to patients and get paid doing so haha
 

RxAndroid

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Time management in your standard modern retail/chain setting dictates this seems like a non-profitable waste of time. Not worth the time for paperwork/documentation/regulatory ontop of everything else. Maybe more practical @ an independent
 
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Wickett

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Yes, I do know that theyre not specifically being paid for each service. I meant youre able to do this at the VA under a MD supervision.

So then this law would benefit pharmacists even more if put into practice. Heck, I wiuldnt mind providing these services to patients and get paid doing so haha

I am skeptical, at least for the majority of pharmacists that work in chain retail. Anything that could be billed, most companies would just add to a RPh workload without extra pay. How many chains give pharmacists a cut of the MTM revenue they generate (mine does, but definitely not the norm)? Maybe it will open avenues for indies to make money and survive in different ways, though.
 
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lord999

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Sigh, I don't think you all understand the negative math involved.


Look at Table 1:

None of the organizations in pharmacy want to approach the CMS RVU committee for HCSPCS, because the rates would be too low. For the experiment, the rates set by MN were 1.5 times that of Medicine, and we still could not break even.

If you consistently saw 16 Level 3 patients a day, which would be 2 drug therapy problems, that would be a $1,312 day, that would supposedly work up to $341,120. But that's not actually what happens. Because those rates in the pilot were outrageously high.


Slide 10 are the standard rates, they're honestly pathetic and have been that way for as long as I can remember although they used to be even worse. The talks that I give the medical students basically are that if you go into primary care, you're basically going into a financially unrewarding practice to work ratio and I hope they like the work, because the money just is not there comparative to their labor.

This is what the actual physicians schedule is closer to, and even optimistically, you cannot expect pharmacists to be able to match 100% of a physician for time. Almost all FP, IM, and Peds start at these rates for reimbursement. They have to bill somewhere on the order of 3X their takehome to get their salaries due to administrative overhead, cost of business (the building for one), and the liability concerns.

My guess at a full-time services only pharmacist take-home with theoretically having all Level 3 or higher patients is somewhere between $75k and $95k depending on CMS locality. It bears out with an analysis of the Encounters system in VA (in fact, most clinical pharmacists fail to even reach one FTE equivalent to what they encounter, which is always going to be a closed service in the private sector), and I wrote the original reports for that analysis.

You want to do pharmaceutical care services, go right ahead. But you then have to accept the inherent problem that a services based salary is even more punishing than what we do now. We lost that opportunity to get more favorable rates four decades ago, and if you think it sucks for us, you should talk to our PA, NP, and primary care physician (FP, Peds, IM) and how much they enjoy their relationships with their reimbursement bureaucracy. I know of no IM physician who works primary care that is not under increasing pressure to generate more revenue if working in direct reimbursement practice (meaning not the VA or somewhere that dissociates CPT generation from salary calculations).

That's just the fiscal portion. Have you ever had to build a practice before? Have to go out and put yourself out there for referrals? Sign contracts? Maintain patient relationships? I find that it is a very small minority of even the clinical pharmacists who have the charisma and business savvy to make that work, because Walgreens cannot do that sort of set practice. No private organization (even companies like HCA) has completely been able to control physicians or service practitioners on salary alone due to the liability or productivity requirements needed to keep practice up.
 
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Hels2007

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Have you ever had to build a practice before? Have to go out and put yourself out there for referrals? Sign contracts? Maintain patient relationships?
Yes. And add to that, the sometimes months-long reimbursement limbo, while you still have to pay your bills on time, so you better have a good cash cushion to start with.
 
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