How Good are Your Physician Relationships?
Over the last decade independent physicians and physician practices have seen huge market consolidations and acquisitions by health systems. In response they have developed more personalized care and innovative practice models to remain independent. This should sound exceedingly familiar to independent pharmacies across the country.
The good news is that the goal has not changed. Physicians and pharmacists alike strive to provide the best patient care possible in more efficient ways. Collaboration and team-based care is one of those growing trends with an ever increasing body of evidence that demonstrates efficacy of the model.
Pharmacist-Physician Collaborative Management (PPCM) studies in hypertension, diabetes and asthma have shown to significantly improve clinical markers when pharmacists help manage vital signs, review labs, order tests, manage the medication history and adherence, provide patient education, and manage medication regimens. In fact, a study in uncontrolled hypertension showed decreased of systolic and diastolic blood pressure of 14-36 mmHg and 7-15 mmHg respectively. That same study showed that at 9 months post intervention the group receiving collaborative care was more likely to have controlled hypertension than the control group (43% vs. 34%). Studies in diabetes and asthma demonstrated similar results, while there are ongoing studies in COPD, Chronic Kidney Disease, dyslipidemia, and congestive heart failure.1
The research into proving cost efficacy is still somewhat lacking (although pointing toward PPCM being cost effective) mainly due to barriers to implementing PPCM models. There are some implementation barriers, like how to target patients, variable state laws and regulations around collaborative practice agreement, and delivering structured/efficient interventions. However, the biggest barrier remains reimbursement. CMS and most 3rd party commercial payers still do not recognize pharmacists as providers. So while the road to provider status is still being paved, most PPCM models use “incident to” billing under the physician for reimbursement. Under incident to billing, pharmacists can perform activities like chronic care management for Medicare patients.
Collaborative practice arrangements will become more and more common as we adapt our healthcare system to preventive care and chronic care management using new payment models. As that happens, think about how well you know the physicians in your neighborhood and how you might work together. You both share patients and a common independent spirit; why not work together and share the work, the reward and improved patient care? Hwang AY, Gums TH, Gums JG. The benefits of physician-pharmacist collaboration. J Fam Prac. December 2017. 66(12); E1-E8.