Current trends in outpatient pharmacy services and billing

• Published in: Journal of the American Pharmacists Association Vol. 52; no. 2; p. 154
• Main Authors: Beatty, Stuart J, McCormick, Kelly M, Beale, David J, Bruggeman, Athena M, Rodis, Jennifer L, Mehta, Bella H, Bennett, Marialice S
• Format: Journal Article
• Language: English
• Published: United States 01.03.2012
• Subjects: Ambulatory Care - economics; Community Pharmacy Services - economics; Community Pharmacy Services - trends; Cross-Sectional Studies; Health Care Costs; Humans; Pharmaceutical Services - economics; Pharmaceutical Services - trends; Pharmacists; Reimbursement Mechanisms - trends; United States; United States
• ISSN: 1544-3450
• DOI: 10.1331/JAPhA.2012.11213

To provide a summary of community and ambulatory pharmacy practices and billing patterns for medication therapy management (MTM) services and to identify reasons pharmacists report not billing for direct patient care services. Cross-sectional study. United States, February 2011. Members of the American College of Clinical Pharmacy Ambulatory Care Practice and Research Network, American Society of Health-System Pharmacists Ambulatory and Chronic Care Practitioners, and American Pharmacists Association MTM e-community. Online survey. Practice setting, pharmacy services performed, billing technique, and payer, as well as reasons for not billing. MTM services were provided by 287 pharmacists. The most common practice settings included physician office (23.6%), health-system outpatient facility (21.7%), and community pharmacy (20.2%). A total of 149 of 276 pharmacists (54.0%) reported billing for MTM services; 16 of 276 (5.8%) did not know if they were currently billing. Community pharmacists were more likely to bill than all other sites combined (80.5% vs. 53.1%, P < 0.001), and pharmacists with >75% of visits face-to-face were more likely to bill (66.2% vs. 46.6%, P < 0.002). A variety of MTM services are provided in outpatient settings with inconsistent billing techniques and reimbursement. Pharmacists should continue to work toward consistent, sustainable reimbursement to expand MTM services.