Medicare annual wellness visits conducted by a pharmacist in an internal medicine clinic


The clinical and financial outcomes of an initial Medicare annual wellness visit (AWV) administered by a clinical pharmacist practitioner (CPP) in an academic internal medicine clinic are described.
As a result of the Patient Protection and Affordable Care Act, Medicare Part B allows for coverage of an AWV at no cost to eligible beneficiaries. The AWV is directed at health prevention, disease detection, and coordination of screening available to beneficiaries. CPPs are pharmacists who are recognized as advanced practice providers in the state of North Carolina and are authorized to administer AWVs. Eligible Medicare beneficiaries at least 65 years of age in an academic internal medicine clinic were mailed invitations to schedule an AWV. Patients who scheduled an AWV were mailed a packet to complete before the visit. During the visit, the packet was reviewed and interventions were made based on prespecified criteria derived from evidence-based medicine recommendations. After completion of the AWV, patients were provided with a detailed and individualized prevention plan. Between August 2011 and May 2012, 98 patients attended an AWV, all performed by the same CPP. The average time from check in to checkout for all patients was 73 minutes. The CPP made 441 interventions during these 98 visits, averaging 4.5 interventions per AWV completed. All initial AWVs were reimbursable up to a maximum of $159.38 per visit.
A Medicare AMV administered by a CPP resulted in a wide variety of patient interventions and reimbursement for services provided.

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    Journal of the American Pharmacists Association: JAPhA 07/2014; 54(4):435-40. DOI:10.1331/JAPhA.2014.13234 · 1.24 Impact Factor
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    ABSTRACT: Objective: To describe the development and implementation of a pharmacist-delivered Medicare Annual Wellness Visit (MWV). Setting: Physician-owned, private family practice office. Practice innovation: Pharmacist-delivered MWV. Main outcome measures: Patient visits and practice income. Results: Because of time constraints in the practice, physicians, nurse practitioners, and a physician assistant had been unable to offer MWVs, a new service available to Medicare beneficiaries under the Affordable Care Act. A pharmacist who was previously providing patient care services 1 day/week at a fixed hourly rate was able to add an additional 1 day/week for provision of MWVs. These visits involve updating medical and medication histories; measuring weight, mass, and blood pressure; assessing cognitive and physical function; and screening the patient and recommending preventive services. From September 2012 to February 2013, 174 patients participated in the pharmacist-delivered MWV. Pharmacist visits were billed using codes G0438 and G0439, and the practice realized a positive net income for the MWVs. Conclusion: Pharmacist-delivered MWVs are financially viable and allow for greater pharmacist participation on the primary care team.
    Journal of the American Pharmacists Association: JAPhA 07/2014; 54(4):427-34. DOI:10.1331/JAPhA.2014.13218 · 1.24 Impact Factor
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    ABSTRACT: Purpose. This article discusses how to plan and implement an ambulatory care pharmacist service, how to integrate a hospital- or health-system-based service with the mission and operations of the institution, and how to help the institution meet its challenges related to quality improvement, continuity of care, and financial sustainability. Summary. The steps in implementing an ambulatory care pharmacist service include (1) conducting a needs assessment, (2) aligning plans for the service with the mission and goals of the parent institution, (3) collaborating with patients and physicians, (4) standardizing the patient care process, (5) proposing the service, (6) attaining the necessary resources, (7) identifying stakeholders, (8) identifying applicable quality standards, (9) defining competency standards, (10) planning for service payment, and (11) monitoring outcomes. Ambulatory care pharmacists have current opportunities to become engaged with patient-centered medical homes, accountable care organizations, preventive and wellness programs, and continuity of care initiatives. Common barriers to the advancement of ambulatory care pharmacist services include lack of complete access to patient information, inadequate information technology, and lack of payment. Conclusion. Ambulatory care pharmacy practitioners must assertively promote appropriate medication use, provide patient-centered care, pursue integration with the patient care team, and seek appropriate recognition and compensation for the services they provide.
    American Journal of Health-System Pharmacy 08/2014; 71(16):1357-65. DOI:10.2146/ajhp140077 · 1.88 Impact Factor
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