Provision of Pain Management by a Pharmacist With Prescribing Authority
Provision of Pain Management by a Pharmacist With Prescribing Authority
Purpose: The clinical and financial outcomes of a pain clinic managed by a pharmacist with prescribing authority are described.
Summary: Pharmacist clinicians in a for-profit, integrated health system recently received permission to bill for their services in certain ambulatory clinics. A pharmacist clinician, who had an individual Drug Enforcement Administration number and whose services are billable under New Mexico law, was chosen to assume the medication management responsibilities in a clinic where 90% of the patient population is treated for chronic non-cancer-related pain. No additional personnel were needed, and no additional space was required, eliminating overhead for the space and utilities needed for operating a new clinic. With the ability to bill for the pharmacist clinician's services, a new model for justification of clinical pharmacy services was developed for the ambulatory care clinics. The revenue generated was tracked by a medical billing system, and clinical outcomes were tracked using the clinic's database for patients' individual visual analogue scale (VAS) pain scores. Between June 2004 and June 2005, an average of 18 patients were seen by the pharmacist clinician each day. The clinic generated $107,550 of actual revenue and saved the health plan over $450,000. There was a consistent decrease in mean VAS pain scores with continued visits.
Conclusion: Patients with chronic non-cancer-related pain were managed effectively by a pharmacist with prescribing authority and refill authorization in a pain management clinic. The favorable clinical outcomes, revenue generated, and cost savings achieved justified the pharmacist clinician's services in this health system.
Considering the crucial importance of clinical pharmacy services to the profession of pharmacy and its core role in pharmaceutical care, the lack of wholesale adoption of clinical pharmacy services is surprising. One explanation for this may be that clinical pharmacy services are more expensive on a patient-by-patient basis than the cost of dispensing functions of pharmacists. Therefore, the existence of clinical pharmacy services must be justifiable in most institutional settings. These services are almost exclusively justified by the cost savings they generate for an institution and the resultant clinical outcomes of hospitalized patients.
Lovelace Medical Group (LMG) is a for-profit, integrated health system, which includes a health plan, 5 hospitals, and 14 ambulatory clinics, located in Albuquerque, New Mexico. In April 1993, the legislature of New Mexico enacted the Pharmacist Prescriptive Authority Act, which granted prescriptive authority to pharmacists designated as pharmacist clinicians. In New Mexico, a pharmacist clinician is a registered pharmacist with advanced training in the areas of physical assessment and pharmacotherapy who is eligible for prescriptive authority and enters into a collaborative practice agreement with a supervising physician. A pharmacist clinician with prescriptive authority can prescribe, modify, and monitor drug therapy in accordance with a written protocol registered with the New Mexico State Board of Pharmacy. The pharmacist clinicians in our health system recently received permission to bill health insurances for the services rendered in our ambulatory clinics. Because our clinic is hospital based, we cannot bill "incident to" charges but only evaluation and management (E&M) code 99211 (technical level).
In 2004, a telemanaged lipid clinic and an anticoagulation clinic were being managed by our clinical pharmacy service. The anticoagulation clinic successfully made the transition from a cost-saving to a revenue-generating service; the telemanaged lipid clinic did not.
In response to the Drug Enforcement Administration's (DEA's) investigation of providers who prescribe high amounts of opiate medications, our health care system evaluated the internal medicine clinic's controlled substance prescribing and determined that a structure was required to track controlled substance prescribing in the clinics.
The pharmacist clinician clinic was developed in conjunction with LMG's pain and spine clinic. The primary mission of the clinic was to provide high-quality clinical pharmacy services to patients with chronic non-cancer-related pain and chronic diseases, such as dyslipidemia, and to provide medication-safety expertise to identify potential problems while triaging the medicine refills in the clinic.
The effectiveness of the clinic was evaluated using a multidimensional assessment process. Specifically, four outcomes were measured: (1) clinical outcomes, measured by the change in patients' self-rated pain scores on the visual analogue scale (VAS), (2) effectiveness of the medication-safety program, measured by the number of near-miss medication errors and the development of a controlled-substance monitoring program, (3) revenue generated by the clinic, and (4) costs avoided by the provision of care by pharmacist clinicians.
Purpose: The clinical and financial outcomes of a pain clinic managed by a pharmacist with prescribing authority are described.
Summary: Pharmacist clinicians in a for-profit, integrated health system recently received permission to bill for their services in certain ambulatory clinics. A pharmacist clinician, who had an individual Drug Enforcement Administration number and whose services are billable under New Mexico law, was chosen to assume the medication management responsibilities in a clinic where 90% of the patient population is treated for chronic non-cancer-related pain. No additional personnel were needed, and no additional space was required, eliminating overhead for the space and utilities needed for operating a new clinic. With the ability to bill for the pharmacist clinician's services, a new model for justification of clinical pharmacy services was developed for the ambulatory care clinics. The revenue generated was tracked by a medical billing system, and clinical outcomes were tracked using the clinic's database for patients' individual visual analogue scale (VAS) pain scores. Between June 2004 and June 2005, an average of 18 patients were seen by the pharmacist clinician each day. The clinic generated $107,550 of actual revenue and saved the health plan over $450,000. There was a consistent decrease in mean VAS pain scores with continued visits.
Conclusion: Patients with chronic non-cancer-related pain were managed effectively by a pharmacist with prescribing authority and refill authorization in a pain management clinic. The favorable clinical outcomes, revenue generated, and cost savings achieved justified the pharmacist clinician's services in this health system.
Considering the crucial importance of clinical pharmacy services to the profession of pharmacy and its core role in pharmaceutical care, the lack of wholesale adoption of clinical pharmacy services is surprising. One explanation for this may be that clinical pharmacy services are more expensive on a patient-by-patient basis than the cost of dispensing functions of pharmacists. Therefore, the existence of clinical pharmacy services must be justifiable in most institutional settings. These services are almost exclusively justified by the cost savings they generate for an institution and the resultant clinical outcomes of hospitalized patients.
Lovelace Medical Group (LMG) is a for-profit, integrated health system, which includes a health plan, 5 hospitals, and 14 ambulatory clinics, located in Albuquerque, New Mexico. In April 1993, the legislature of New Mexico enacted the Pharmacist Prescriptive Authority Act, which granted prescriptive authority to pharmacists designated as pharmacist clinicians. In New Mexico, a pharmacist clinician is a registered pharmacist with advanced training in the areas of physical assessment and pharmacotherapy who is eligible for prescriptive authority and enters into a collaborative practice agreement with a supervising physician. A pharmacist clinician with prescriptive authority can prescribe, modify, and monitor drug therapy in accordance with a written protocol registered with the New Mexico State Board of Pharmacy. The pharmacist clinicians in our health system recently received permission to bill health insurances for the services rendered in our ambulatory clinics. Because our clinic is hospital based, we cannot bill "incident to" charges but only evaluation and management (E&M) code 99211 (technical level).
In 2004, a telemanaged lipid clinic and an anticoagulation clinic were being managed by our clinical pharmacy service. The anticoagulation clinic successfully made the transition from a cost-saving to a revenue-generating service; the telemanaged lipid clinic did not.
In response to the Drug Enforcement Administration's (DEA's) investigation of providers who prescribe high amounts of opiate medications, our health care system evaluated the internal medicine clinic's controlled substance prescribing and determined that a structure was required to track controlled substance prescribing in the clinics.
The pharmacist clinician clinic was developed in conjunction with LMG's pain and spine clinic. The primary mission of the clinic was to provide high-quality clinical pharmacy services to patients with chronic non-cancer-related pain and chronic diseases, such as dyslipidemia, and to provide medication-safety expertise to identify potential problems while triaging the medicine refills in the clinic.
The effectiveness of the clinic was evaluated using a multidimensional assessment process. Specifically, four outcomes were measured: (1) clinical outcomes, measured by the change in patients' self-rated pain scores on the visual analogue scale (VAS), (2) effectiveness of the medication-safety program, measured by the number of near-miss medication errors and the development of a controlled-substance monitoring program, (3) revenue generated by the clinic, and (4) costs avoided by the provision of care by pharmacist clinicians.
