Reimbursement outcomes of a pharmacist‐physician co‐visit model in a Federally Qualified Health Center

Abstract

AbstractBackgroundPharmacists have demonstrated a positive impact in providing patient care in ambulatory settings. Pharmacists have faced multiple barriers to reimbursement, especially in a Federally Qualified Health Center (FQHC) setting. A commonly cited barrier is lack of recognition as providers under Medicare.ObjectivesThe objective of this study was to describe the reimbursement potential, physician appointment capacity, and billing levels with the use of a pharmacist‐physician co‐visit model in an urban FQHC.MethodsThis was a retrospective, observational cohort study. Patient visits were included in the co‐visit model cohort if they were completed with the pharmacist and/or collaborating physician on the same clinic half‐day from May‐September 2019. Comparator group patient visits were included in the physician‐only cohort if they were with one of five physicians practicing at the FQHC on a day without the pharmacist. Patient visits were excluded if the visit was nonbillable.ResultsRealized reimbursement per half‐day in clinic [mean (SD)], was significantly less with the physician‐only visits compared to the co‐visit billing model [$558 (242) vs $850 (410), P = .001]. The addition of a pharmacist through the co‐visit billing model increased the median (IQR) billing per half‐day in clinic from $1613 (1173, 1788) to $2108 (1832,2620) (P < .001), and the median (IQR) number of patients seen per half‐day from 9 (7, 10) to 12 (10, 14) (P < .001). Unpaid patient bills ($39 599) were excluded from reimbursement analysis in both groups.ConclusionsThe pharmacist‐physician co‐visit model in an FQHC increased revenue to justify the addition of one full‐time equivalent position within our facility, increased the number of patients seen by the physician, allowed for higher‐complexity billing, and provided physicians with variety in responsibilities. The benefits of team‐based care extend beyond the financial implications of a co‐visit model. Without direct pharmacist‐billing mechanisms, this model justifies the expansion of pharmacist‐managed services.