Sustaining Clinical Pharmacy Services Utilizing North Carolina Medicaid Billing Claire Austin, Courtenay Wilson Mountain Area Health Education Center PGY2 Am Care - Asheville, NC
Background/Purpose: With the shortage of primary care providers, pharmacists are able to help fill a gap in care by increasing access and providing chronic care management especially in rural areas. Financial sustainability has long been the barrier to sustaining pharmacy services. Recent recognition of clinical pharmacist practitioners (CPP), North Carolina_x0019_s (NC) version of a collaborative practice agreement, as providers by NC Medicaid enables billing and provides a possible new way to sustain pharmacy in primary care.
Methodology: A business plan was created to layout how clinical pharmacy services would be started and sustained. NC Medicaid billing practices were reviewed. NC Medicaid credentialing was processed. An Excel tool was created to identify number of visits needed to create sustainable services utilizing Medicaid billing.
Results: Utilizing a previous method of 99211 billing, 6,007 visits would be needed to sustain a CPP position assuming a pharmacist salary + benefits of $125,000. This would require 10 half days of clinic each week with 12-13 encounters each half day. Based on current Medicaid billing percentages in our clinic, 15% 99212 visits, 55% 99213 visits, and 30% 99214 visits, 2115 visits would be needed to sustain a CPP position. This would require 9 half days of clinic per week with 5 encounters per half day.
Conclusions: By utilizing NC Medicaid billing, CPPs are able to bill at the level of service provided as opposed to the traditional billing method of billing only 99211. This allows for a more realistic schedule with less visits needed to break even or sustain an ambulatory care pharmacist position financially. This option depends on having a large enough Medicaid population.
Presentation Objective: Describe a new option for financial sustainability of clinical pharmacy services in North Carolina.
Self-Assessment: What is one limitation to sustaining pharmacy services with NC Medicaid billing?
