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Current trends in outpatient pharmacy services and billing
Stuart J Beatty1, Kelly M McCormick, David J Beale
1College of Pharmacy, Ohio State University, Columbus, OH 43210, USA. beatty.52@osu.edu
Journal of the American Pharmacists Association : Japha
|February 29, 2012
Summary
Pharmacists provide medication therapy management (MTM) services in various settings, but billing for these direct patient care services remains inconsistent. Community pharmacists are more likely to bill for MTM than other practice sites.
Area of Science:
- Pharmacy Practice
- Health Services Research
Background:
- Medication Therapy Management (MTM) services are crucial for optimizing patient outcomes.
- Understanding current MTM service delivery and billing practices is essential for sustainable pharmacy reimbursement.
Purpose of the Study:
- To summarize community and ambulatory pharmacy practices for MTM services.
- To analyze billing patterns for MTM services.
- To identify reasons why pharmacists do not bill for direct patient care services.
Main Methods:
- A cross-sectional study was conducted in the United States in February 2011.
- An online survey was distributed to members of key pharmacy practice networks.
- Data collected included practice setting, services performed, billing techniques, payer information, and reasons for non-billing.
Main Results:
- MTM services were provided by 287 pharmacists across physician offices, health-system outpatient facilities, and community pharmacies.
- Only 54.0% of pharmacists reported billing for MTM services.
- Community pharmacists (80.5%) and those with predominantly face-to-face visits (66.2%) were more likely to bill for MTM.
Conclusions:
- MTM services are offered in diverse outpatient settings, yet billing and reimbursement remain inconsistent.
- Pharmacists need to pursue consistent and sustainable reimbursement models to facilitate the expansion of MTM services.
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