Please Turn Off All Cell Phones

Please Turn Off All Cell Phones

Pharmacy Reimbursement for Cognitive Services

David Greer, Christian Hamm, Mary McKay, Rebecca Morrell, Alissa

O’Connell, Jenny Riddell, Kevin Whalen

We are trusted

We can save boxes of money

We are highly educated

Cognitive services

Disease state monitoringDiabetesHypertensionAsthma

Smoking cessationEmergency contraception*Immunizations*Etc.

The Law is in our Favor

RCW 48.43.045Mandates that insurance companies reimburse any category of provider When the service is:- covered under the Basic Health Plan- within practitioner’s scope of practice- cost effective and efficaciousWAC 284-43-205Effectuates RCW- no providers licensed in Washington may be denied when the stipulations of the RCW hold true- carriers may rule out some services when relevant evidence show that services are not cost effective and efficacious

As it stands, pharmacists are not being reimbursed for their services, so we set out to change that…

What we thought the problem was

Insurance companies

Us

-- Private Insurance companies (not Medicare & HMO) rejected pharmacists reimbursement for cognitive services

BUT - Are we so innocent?

Surprise Problem

YES I would like to be paid for my

services but NO I have not tried billing

APATHY is defined as lack of interest or concern

More certification needed?*Demonstrate there is a need for pharmacist clinical services* Show how these services save health care $$$

*Reimbursement under the current system requires accountability from all health care providers.

Competency

*Periodic reexaminations *Certification *NCPA - Pharmacist Care diploma credentials

NCPA certification Disease State Management Certificates

Available in:

• Arthritis and Pain Care• Diabetes Care• Immunization Skills• Lipid Management• Nutrition and Weight Management• Osteoporosis Care• Respiratory Care• Therapeutic Footcare

Pharmacist’s Value

• “Community pharmacists providing pharmaceutical care to asthma patients in an HMO decreased hospitalizations by 77% and decreased emergency room visits by 78%.

• Journal of the American Pharmaceutical Association; 1997 Nov-Dec; 37(6):694-9

• “Pharmacists providing disease management services in their community saved an average of $2700 per year per patient in total medical costs.”

• Clinical Therapeutics. 1997; 19(1):113-23.

Alternatives

Technical Political Administrative

Educative “Toolkit” + + ~Petition Ins. Comm. - - -Forum + ~ ~

Conclusion

• It’s time to take action!!!!

• Apply Pressure to Insurance Companies

Increase awarenessContinued involvementInformed pharmacists

• Make sure to check your e-mail for Mary’s Article – hopefully to be published!