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Benefit to the Physician’s Medical Practice:

  • Help increase Medicare reimbursement rates by improving Quality Payment Program (QPP) scores and by offering specific services to increase Quality scores and decrease Costs
  • Fewer patient complications and decreased communication with insurance companies regarding medication issues
  • Decreased risk of hospitalization and re-hospitalization
  • Improvement in patient quality of life and satisfaction with medical services
  • Free up physicians to see more patients and to deal with more complicated issues
  • Enhanced clinical outcomes
  • Access to drug knowledge
  • Creation of multi-disciplinary models
  • Improve efficiency of provided health care services

Pharmacists see patients in the physician’s office, adding value to the scope of care provided by the Medical Practice.

  • Patients meet with Pharmacist in their doctor’s office and perceive the value-added care as part of services provided by the Medical Practice
  • Pharmacist can directly access the patient records for necessary information, decreasing the amount of time spent by office staff and improving communication

The arrangement allows the patient’s insurance to be billed for services rendered by the pharmacist.

  • Under current US law, pharmacist cannot independently bill insurances for clinical services
  • If patient is seen in MD office then insurance can be billed using “incident to physician” billing codes
  • Improvement in service utilization:  If the patient sees the pharmacist outside the vicinity of their doctor’s office, then the patient would need to pay for these services out of pocket, significantly decreasing the likelihood of seeking and benefiting from these services

Business arrangement between Consulting Pharmacist and Medical Practice:

  • Pharmacist to act as independently licensed contractor and to carry own liability and malpractice insurance
  • A formal contract between the Pharmacist and Physician Practice delineates responsibilities of each party and further protects the physician
  • Pharmacist to compensate physician practice for use of physical space, secretarial and billing services (e.g. hourly rate)

Legal Considerations

MTM at MD office proposal

1-page summary of scope of services, benefits to physician practice, legal and financial considerations.

MTM Proposal

3-page document describing the process of  services, benefits for parties involved, and supporting information from literature

Pharmacist review process

1-page overview of the logistics of how services are provided and manner of coordination with physician practice and the patient.  

Physician Reimbursement

 A very brief description of the Medicare Access and CHIPP Authorization Act of 2015’s impact on value-based physician reimbursement structures. 

KM Network Consulting Services Presentation

an overview of the program founder and the important aspects of the services, including scope of practice, legal and financial considerations. 

Clinical Pharmacists are a valuable asset on patient care teams and are utilized extensively by larger practices, clinics, and hospitals that typically either employ their own pharmacists or partner with pharmacy schools.  Similarly structured programs have provided significant clinical and financial benefits throughout the United States.  Our program brings the same type of proven pharmacy services to smaller or independent physician practices.

  •  A specially trained clinical pharmacist will meet with selected patients to help them manage their medications more effectively and achieve physician-established therapy goals, freeing up the physicians to see more patients.
  •  The pharmacist seamlessly fits into the medical office’s processes and will enhance patient perception of the breadth and quality of care that the medical practice provides.        
  •  Medicare and other third party payers are transitioning from fee-for-service to value-based reimbursement models.  Our program can help your office achieve higher scores that directly translate to higher reimbursement rates on all your patients that participate in such programs. Capitated programs realize financial benefits through more efficient and effective use of medications and lower risks of side effects and other drug-related misadventures.  

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