Pharmacist Participation in Wellness Visits Boosts Primary Care Revenue

Medicare Annual Wellness Visits could be a way to support a pharmacist position in a primary care office.

Medicare Annual Wellness Visits (AWVs) may allow pharmacists to gain greater involvement in patient care, even without provider status, a pair of studies suggests.

The studies, published in the July-August 2014 issue of the Journal of the American Pharmacists Association, found pharmacist-led wellness visits could be financially viable options for primary care practices.

The first study assessed the value of pharmacist-delivered AWVs in a private family practice office that serves approximately 2000 Medicare beneficiaries. The program was implemented after patients began asking for the service, and physicians did not have time to conduct the visits. A part-time pharmacist was already providing services within the practice, and the physicians felt that the pharmacist could fulfill the need for AWVs if given more office hours.

During wellness visits, the pharmacist updated medical and medication histories; measured weight, mass, and blood pressure; assessed cognitive and physical function; and provided screening and recommendations for preventative services. In addition, the pharmacist provided medication therapy management for a small group of patients.

From September 2012 through February 2013, 174 patients attended wellness visits with the pharmacist. Overall, the practice income for the visits totaled $27,880.98. Each initial wellness visit was covered by Medicare at a rate of $163.51. The practice determined that the pharmacist-led program was profitable, and that they would continue to have the pharmacist participate on the primary care team.

“Pharmacist participation in (AWVs) can increase medication reviews in primary care practice,” the authors of the first study concluded. “Other practitioners may be qualified to deliver the service, but pharmacists can enhance attention to medication-related problems, expand the scope of the primary care team, and increase the extremely low level of (AWVs) delivery across the country.”

In the second study, the value of pharmacist-led Medicare Annual Wellness Visits (AWVs) was analyzed in a large, teaching ambulatory clinic in North Carolina.

“Because of the lack of provider status, a variety of complex billing techniques must be used to offset a pharmacist’s salary in physicians’ offices,” the authors of the study explained. AMVs, they hypothesized, could be a way to support a pharmacist position in a primary care office.

Pharmacists began conducting wellness visits for patients referred by primary care providers in April 2012. From April 2012 through January 2013, the pharmacists conducted 69 wellness visits at a total revenue of $10,000. Based on this practice experience, a pharmacist’s salary could be supported by approximately 2.4 wellness visits per half-day worked, the researchers concluded.

The authors of the study then used publically available reimbursement rates to determine how many patients needed to receive wellness visits in order to generate enough revenue to cover the cost of the pharmacist at practices of various sizes. The results indicated that a small practice would need all eligible Medicare patients to complete a wellness visit, a medium practice would need 54% of their patients to complete a visit, and a large practice would only require 17% of their patients to complete a visit in order to support the pharmacist’s position.

“As a team-based approach to care is essential in primary practice today, use of nurses or medical assistants in conjunction with pharmacy in completing these visits may be beneficial,” the study authors wrote. “However, providers within the (practice) found that pharmacists are best suited to execute AWVs based on the value added from conducting a thorough medication review.”