Impact of pharmacist-provided Medicare annual wellness visits and chronic care management on reimbursement and quality measures in a privately owned family medicine clinic.

Abstract

Improvement in patient outcomes from collaboration between pharmacists and physicians in ambulatory clinics has been well documented. Barriers to payment have made widespread growth of these collaborations slow. Medicare annual wellness visits (AWVs) and chronic care management (CCM) provide an opportunity for pharmacist-physician collaborations that are directly revenue generating. The objective of this study was to evaluate the impact of pharmacist-led AWVs and CCM on reimbursement and quality measures in a private family medicine clinic. This was a retrospective observational study in which the rate of reimbursement for AWVs and CCM was compared before and after implementation of pharmacist-provided services. Claims data were reviewed for Current Procedural Terminology codes and reimbursement applicable to AWVs and CCM. Secondary outcomes included the total number of AWV and CCM appointments, Healthcare Effectiveness Data and Information Set (HEDIS) measure completion rates, and average change in quality ratings. Outcomes were analyzed utilizing descriptive statistics. Reimbursement from AWVs increased by $25,807.21 in 2018 and $26,410.01 in 2019 compared to 2017. Reimbursement from CCM increased by $16,664.29 in 2018 and $5,698.85 in 2019. In 2017, 228 AWVs and 5 CCM encounters were completed. After implementation of pharmacist services, the number of CCM encounters increased to 362 in 2018 and 152 in 2019 and the number of AWVs totaled 236 and 267, respectively. Completed HEDIS measures and star ratings increased during the study. Pharmacist provision of AWVs and CCM addressed a gap in care by increasing the number of patients who received these services while also increasing reimbursement in a privately owned family medicine clinic.