Transcript Transitions of Care, a Primary Care Perspective

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