Tip of the Week: Pharmacist-Physician Covisits

Sometimes health care seems to plod along without much change. But that view is often held by cynics whose expectations are that the entire paradigm be completely upended merely by a single demonstration project or innovation. Health care has indeed changed quite rapidly, and that includes the proliferation of various service models that are interdisciplinary in nature. What must be understood is that there is no, single model entirely representative of all the changes.

One model described in published research is a pharmacist-physician covisit model in a family medicine practice.1 In this model, an embedded pharmacist provided care 3 half-days per week under a collaborative practice agreement that allowed for independent initiation, adjustment, and discontinuation of medications. The pharmacist provided targeted drug therapy management, comprehensive disease state management, and annual wellness visits.

Before the covisit model was formally restructured, the pharmacist saw patients in face-to-face visits that were scheduled without regard to physician appointments. Additionally, the physician would offer the pharmacists’ consultative services, and there were many occasions where the patient would miss the appointment. Moreover, the physician would often be unaware of the pharmacist’s notes on the patient.

An analysis found that compared with physician billing alone, covisits generated an additional $4924.41 in 14 half-days, or $158,291.04 over 1 year. Compared with separate visits, the covisit model increased estimated clinic revenue by $2757.89 over the 14 half-days and $88,646.47 over 1 year. The physician was able to see an additional 1.3 patients per half-day in the covisit model, and there was an average of 3.2 open physician appointments per half-day with covisits compared to 1.4 with separate visits.

Pharmacy practice is becoming more integrated into the health system and features more collaborative practice opportunities, even if that is not always widely evident at every local pharmacy. Managers can be progressive and prepared for opportunities such as this one, as the pharmacist integrated in this model could also work in a community practice. This presents an excellent opportunity not only for persons officially titled as clinical pharmacists, but for most any pharmacist.

Effective managers can deploy and restructure the use of certain resources to diversify revenue streams. The pharmacist effective at self-management, including time management and organization skills, is more likely to make a model like this one work out.

Additional information about “Implementing Value-Added Services and Entrepreneurship and Innovation” can be found in Pharmacy Management: Essentials for All Practice Settings, 5e.

Shane P. Desselle, RPh, PhD, FAPhA, is a professor of social and behavioral pharmacy at Touro University California in Vallejo.

REFERENCE

Ulrich IP, Patel S, Gilmer B. Evaluation of a pharmacist-physician covisit model in a family medicine practice. J Am Pharm Assoc. 2019;59(1):129-135.