October 20, 2014
- By conducting 1,070 Medicare annual wellness visits a year, pharmacists in medical practices could cover for the cost of their salaries while using only 40 percent of their time.
- Wellness visits were created in 2011 as part of the Affordable Care Act. In 2013, only 11 percent of eligible patients nationally actually use their wellness visit benefit.
- The UNC faculty pharmacists conducting wellness visits in an Asheville clinic are on track to see 60 percent of eligible patients come in this year thanks to special efforts to boost participation.
Physicians seeking a way to pay for the expertise of a pharmacist in their medical practices could look to Medicare annual wellness visits to help cover the cost, according to a study from the UNC Eshelman School of Pharmacy.
Medicare Part B covers an annual visit to the doctor for the purpose of developing or updating a personalized plan to prevent disease and disability. Pharmacists can conduct these visits under a physician’s supervision and be reimbursed at the same rate. The visit includes activities such as administering a health survey, conducting a complete medication review, and taking measurements of weight, blood pressure, and cognitive function.
Bigger is Better
It takes 1,070 wellness visits a year—or approximately six visits per day—to cover a $120,000 pharmacist’s salary, the study’s authors calculated. Their findings were published in the Journal of the American Pharmacists Association.
- For a large medical practice (fifteen physicians), at least 18 percent of its eligible patients must complete an annual wellness visit with a pharmacist to reach $120,000 in reimbursements.
- A medium-sized practice (five physicians) needs at least 54 percent of its patients to come in.
- A small medical practice with two physicians would not have enough patients to afford a pharmacist funded by wellness visits alone.
UNC Eshelman School of Pharmacy and UNC School of Medicine faculty based in Asheville, North Carolina, conducted the study. They assumed that each practice has 2,000 patients per physician with 20 percent on Medicare. The hypothetical pharmacist in the study is available to see patients nearly thirty-eight weeks a year. The study also accounts for the fact that a patient’s first wellness visit is reimbursed at a higher rate than subsequent visits.
Here’s the Catch
Only 11 percent of eligible patients nationally actually use their wellness visit benefit, according to a 2013 report from the U.S. Department of Health and Human Services. That’s up from 9 percent in 2012. The wellness visits were created in 2011 as part of the Affordable Care Act.
The study authors practice at the Mountain Area Health Education Center clinic in Asheville. MAHEC would be a large practice in the study based on the number of patients seen. Physicians there started conducting wellness visits in 2011 and found them difficult to complete in the fifteen minutes allotted.
MAHEC started a pilot program in 2012 where a pharmacist took over the wellness visits for three physicians. Patients received information about the scope and purpose of the visits before coming in, which helped keep the visits focused and on schedule, says Courtenay Wilson, PharmD, senior author of the study and a MAHEC pharmacist.
“I can listen to their concerns and make sure that patients know that I’m hearing their concerns,” Wilson says. “I then schedule a follow-up visit with a physician who will know all of the issues that we have identified and have up-to-date records for the patient. It’s a nice partnership.”
By January 2013, all wellness visits at MAHEC were automatically scheduled with a pharmacist.
“From the doc’s perspective, the wellness visit takes a fair amount of time,” says Lisa Ray, MD, another author of the study and a MAHEC physician. “Handing it over to someone who is extremely competent frees us up to see other patients in those time slots. The added bonus is that every one of our Medicare patients has a pharmacist looking over their medication list.
“A third benefit that the pharmacists are actually getting reimbursed in a way that allows them to do the other great things that they do for our practice,” Ray says.
“The amount of good that came from this one thing is tremendous.”
In the first quarter of 2013, MAHEC pharmacists conducted fifty-one wellness visits. In the first quarter of 2014, that number rose to 438 of 459 total visits.
“We have been actively calling and offering wellness visits to patients,” says Irene Park, PharmD, one of the study’s authors and a MAHEC pharmacist. Grant funds pay for a dedicated scheduler, and patients get signed letters from their physician informing them of the wellness visit benefit and alerting them to the scheduler’s call.
The clinic has set a goal of 75 percent participation by MAHEC’s approximately 3,000 eligible patients, Wilson says. The clinic is on track to see 60 percent participation this year.
- Lead author Irene Park, PharmD, is an assistant professor of clinical education in the School’s Division of Practice Advancement and Clinical Education and clinical pharmacist at Mountain Area Health Education Center.
- Susan E. Sutherland, PhD, is director of the Mission Hospital Research Institute in Asheville.
- Lisa Ray, MD, is a clinical assistant professor in the UNC School of Medicine and assistant residency director of the MAHEC Family Medicine Residency Program.
- Senior author Courtenay Gilmore Wilson, PharmD, is an assistant professor of clinical education in the School’s Division of Practice Advancement and Clinical Education, a clinical instructor at the UNC School of Medicine, and associate director of pharmacotherapy at MAHEC.