Transitions of Care, a Primary Care Perspective
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Clinical Pearl Transitions of Care: A Primary Care Perspective Andrea Bishop, PharmD, BCACP, CDE Northwest Pharmacy Convention Coeur d’Alene, ID June 1, 2013 Background National Committee for Quality Assurance (NCQA) Patient Centered Medical Home (PCMH) Hiring RN Specialists Current state 4 RN Specialists 2014 adding 10 RN Specialists Key focus of RN Specialist: transitions of care Pharmacy’s Role Collaborate with RN Specialist Avoid competing initiatives and rework Work at the top of license Creating algorithm for RN Specialist to identify patients for referral to pharmacist after discharge Current Ideas Automatic Appointment Discuss with Pharmacist CHF or COPD exacerbation • CHF or COPD A1C > 9% ≥ 2 medication changes excluding short-term pain medications and antibiotics Smoking cessation New anticoagulation start RN Specialist determination of need • Diabetes measures not at goal • Current anticoagulant therapy • Adverse drug event • Other Current Ideas Automatic Appointment Discuss with Pharmacist • CHF or COPD exacerbation CHF or COPD • A1C > 9% • ≥ 2 medication changes excluding short-term pain medications and antibiotics • Smoking cessation • New anticoagulation start • RN Specialist determination of need Diabetes measures not at goal Current anticoagulant therapy Adverse drug event Other Appointment In conjunction with PCP Independent of PCP Pros Patient-centered Facilitates immediate and direct communication One charge Pros • Appointment 30-60 min • Easily scheduled • Phone/electronic communication Cons Scheduling conflicts Appointment 20 min Cons • Two charges if pharmacist is face-to-face • Asynchronous communication Appointment In conjunction with PCP Independent of PCP Pros • Patient-centered • Facilitates immediate and direct communication • One charge Pros Appointment 30-60 min Easily scheduled Phone/electronic communication Cons • Scheduling conflicts • Appointment 20 min Cons Two charges if pharmacist is face-to-face Asynchronous communication Billing Standard Office Visit Pharmacist unable to charge for phone/electronic communication Joint appointment results in one charge ($65-97) Independent appointments result in two charges (additional $50) Transition of Care Codes One charge ($160-215) Pharmacist involvement can be face-to-face, phone or electronic Joint or independent appointments work Dependent on meeting criteria Billing Standard Office Visit Pharmacist unable to charge for phone/electronic communication Joint appointment results in one charge ($65-97) Independent appointments result in two charges (additional $50) Transition of Care Codes One charge ($160-215) Pharmacist involvement can be face-to-face, phone or electronic Joint or independent appointments work Dependent on meeting criteria Transition of Care Codes Pharmacist Role Communication with the patient or caregiver within two business days of discharge • Phone, electronic or face-to-face Transition of Care Codes Pharmacist Role Communication with the patient or caregiver within two business days of discharge • Phone, electronic or face-to-face PCP Role CPT Code 99495 Involves medical decision making of at least moderate complexity and a face-to-face visit within 14 days of discharge CPT Code 99496 Involves medical decision making of high complexity and a face-to- face visit within 7 days of discharge What are some keys to success for this type of team based care and collaboration? What other ideas do you have for the referral algorithm? Current Ideas Automatic Appointment Discuss with Pharmacist CHF or COPD exacerbation CHF or COPD A1C > 9% ≥ 2 medication changes excluding short-term pain medications and antibiotics Smoking cessation New anticoagulation start RN Specialist determination of need Diabetes measures not at goal Current anticoagulant therapy Adverse drug event Other Clinical Pearl Transitions of Care: A Primary Care Perspective Andrea Bishop, PharmD, BCACP, CDE Northwest Pharmacy Convention Coeur d’Alene, ID June 1, 2013
