Billing for outpatient transplant pharmacy services

Area of Science:

• Health Economics
• Pharmacy Practice
• Transplant Medicine

Background:

• Outpatient pharmacy services are crucial for managing transplant patients.
• Evaluating the economic impact of these services is essential for program sustainability.

Purpose of the Study:

• To assess the economic impact of outpatient pharmacy services within a kidney transplant program.
• To determine the financial benefits of pharmacist involvement in post-transplant care.

Main Methods:

• Implemented full-time kidney transplant pharmacy services at Providence Sacred Heart Medical Center (PSHMC) in 2008.
• Compared pharmacist patient visits to total outpatient visits in 2010.
• Analyzed billing levels and reimbursement differences between pharmacists and nurses for patient encounters.

Main Results:

• Pharmacist visits constituted 22% of outpatient kidney transplant visits in 2010.
• Pharmacists billed at a higher acuity level than nursing 48% of the time, increasing reimbursement by ~$100 per visit.
• Facility-fee billing by pharmacists increased outpatient reimbursement by ~$10,000 over the study year.

Conclusions:

• Outpatient pharmacy services, when utilizing facility-fee billing, enhance reimbursement in transplant programs.
• This model demonstrates a positive economic impact for transplant centers.
• Integrating pharmacy services into outpatient care is a financially viable strategy.