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Please Turn Off All Cell Phones . Pharmacy Reimbursement for Cognitive Services. David Greer, Christian Hamm, Mary McKay, Rebecca Morrell, Alissa O’Connell, Jenny Riddell, Kevin Whalen. We can save boxes of money. We are trusted. We are highly educated. Cognitive services. - PowerPoint PPT PresentationTRANSCRIPT
Please Turn Off All Cell Phones
Pharmacy Reimbursement for Cognitive Services
David Greer, Christian Hamm, Mary McKay, Rebecca Morrell, Alissa
O’Connell, Jenny Riddell, Kevin Whalen
We are trusted
We can save boxes of money
We are highly educated
Cognitive services
Disease state monitoringDiabetesHypertensionAsthma
Smoking cessationEmergency contraception*Immunizations*Etc.
The Law is in our Favor
RCW 48.43.045Mandates that insurance companies reimburse any category of provider When the service is:- covered under the Basic Health Plan- within practitioner’s scope of practice- cost effective and efficaciousWAC 284-43-205Effectuates RCW- no providers licensed in Washington may be denied when the stipulations of the RCW hold true- carriers may rule out some services when relevant evidence show that services are not cost effective and efficacious
As it stands, pharmacists are not being reimbursed for their services, so we set out to change that…
What we thought the problem was
Insurance companies
Us
-- Private Insurance companies (not Medicare & HMO) rejected pharmacists reimbursement for cognitive services
BUT - Are we so innocent?
Surprise Problem
YES I would like to be paid for my
services but NO I have not tried billing
APATHY is defined as lack of interest or concern
More certification needed?*Demonstrate there is a need for pharmacist clinical services* Show how these services save health care $$$
*Reimbursement under the current system requires accountability from all health care providers.
Competency
*Periodic reexaminations *Certification *NCPA - Pharmacist Care diploma credentials
NCPA certification Disease State Management Certificates
Available in:
• Arthritis and Pain Care• Diabetes Care• Immunization Skills• Lipid Management• Nutrition and Weight Management• Osteoporosis Care• Respiratory Care• Therapeutic Footcare
Pharmacist’s Value
• “Community pharmacists providing pharmaceutical care to asthma patients in an HMO decreased hospitalizations by 77% and decreased emergency room visits by 78%.
• Journal of the American Pharmaceutical Association; 1997 Nov-Dec; 37(6):694-9
• “Pharmacists providing disease management services in their community saved an average of $2700 per year per patient in total medical costs.”
• Clinical Therapeutics. 1997; 19(1):113-23.
Alternatives
Technical Political Administrative
Educative “Toolkit” + + ~Petition Ins. Comm. - - -Forum + ~ ~
Conclusion
• It’s time to take action!!!!
• Apply Pressure to Insurance Companies
Increase awarenessContinued involvementInformed pharmacists
• Make sure to check your e-mail for Mary’s Article – hopefully to be published!