Analysis of provider-generated revenue and impact on medication reconciliation from a pharmacist-led chronic care management service

Abstract

BackgroundPublished data on pharmacist-provided chronic care management (CCM) services is limited, particularly for programs led by community-based pharmacists. ObjectiveThe objective was to quantify the total revenue generated from a community pharmacist-led CCM service, including CCM billing and appointment referrals. A second objective was to identify the types and frequencies of medication discrepancies identified during medication reconciliation. Practice descriptionRealo Drugs is a group of 18 independent community pharmacies serving eastern North Carolina. Practice innovationExploration of revenue generated from a community pharmacist-led CCM service. Evaluation methodsThis retrospective analysis assessed interventions completed by pharmacists between April 1, 2018 through June 30, 2019. Data was extracted from the electronic health record (EHR), including revenue generated from CCM billing codes, appointment referrals made by the pharmacist resulting in a completed in-office appointment, and which patients received medication reconciliation. The types and frequencies of medication discrepancies were documented, including medication no longer being used by the patient, medication omission, and strength or dose mismatch. Descriptive statistics were used to analyze data. ResultsOver 15 months with a total of 112 patients, a total of $26,148 was generated from CCM services, representing an average of $15.56 per patient per month. The majority (approximately 80%) of the revenue was generated from noncomplex patient encounters. Of the 239 medication reconciliations completed, 609 medication discrepancies were identified. The majority of medication discrepancies (67%) were categorized as “patient no longer takes medication listed on EHR medication list.” The second most common discrepancy was “patient takes medication not listed on the EHR medication list” (22%), followed by “strength/dose mismatch” (10%). ConclusionThese data can demonstrate to provider partners the sources of revenue that can be provided through CCM services. In addition to revenue, pharmacists can positively impact patient care through identification of medication discrepancies through medication reconciliation.