Reimbursement for services provided by clinical pharmacists in primary care: Description of changes over time in an academic primary care network in Ohio following the recognition of pharmacists as provider.

Abstract

Disclaimer: In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time.

Purpose: In January 2021, Ohio pharmacists were recognized by Medicaid as providers, became eligible to obtain Medicaid provider identification numbers, and were able to begin billing for services using evaluation and management codes. The objectives of this study were to compare outcomes before (2020) and after (2021 and 2022) pharmacist provider status was implemented in a network of primary care clinics: (1) the percent change in pharmacist-provided services that were billed and reimbursed, 2) the percent change in pharmacist-provided services that were billed as "incident-to" versus with the pharmacist as provider, and (3) the percent change in reimbursement per encounter as a result of pharmacist-provided services.

Methods: A retrospective review of all encounters and administrative claims (all payors) provided by pharmacists (7.9 full-time equivalents) within 7 primary care clinics affiliated with a large academic medical center was conducted. The data were compared year-to-year using descriptive statistics to determine the magnitude of change.

Results: A total of 14,416 encounters were included in the study (1,863 in 2020, 4,963 in 2021, and 7,590 in 2022). In 2020, 37.8% (705/1,863) of pharmacist encounters were billed for reimbursement. In 2021, this percentage increased to 39.1% (1,939/4,963) encounters, with a further increase in 2022 to 49.1% (3,725/7,590). Differences in the percentage of pharmacist encounters billed as incident-to versus pharmacist as provider were also evident, with 37.8% (705/1,863) of pharmacist encounters billed incident-to in 2020, as compared to 36.8% (2,796/7,590) in 2022. In this same time period, mean reimbursement for pharmacist-as-provider encounters increased by 189.5% (from $10.45 to $30.25) per encounter, and the number of pharmacist-as-provider encounters increased year over year (from 0% [0/1863] in 2020 to 1.1% [54/4,963] in 2021 and 12.3% [929/7,590] in 2022; P < 0.001).

Conclusion: This study found an increase in the billing and reimbursement attributable to clinical pharmacists in primary care settings in Ohio after their recognition as providers.