The clinical services include chronic care management for patients with chronic or complex diseases and health conditions, transitional care management for patients being discharged from a hospital, and intensive behavior therapy for weight management counseling, among others.
Benzer’s independent pharmacy network has more than 65 locations in Tennessee, Florida, Michigan, Virginia, North Carolina, Texas, Georgia, Nevada, Oklahoma, Iowa, Arkansas, Colorado, Louisiana and California.
“No other retail pharmacies in the area are providing these types of collaborative services, making Benzer Pharmacy a pioneer in clinical innovation and pharmacy practice advancement,” stated Benzer chief clinical officer Lindsay Wall.
If a physician’s office doesn’t have the time or is unwilling to perform the services for whatever reason, Benzer’s pharmacists can step in to help. Once the doctor signs a collaborative practice agreement, Benzer pharmacists can start providing the designated services, such as ordering lab tests, making recommendations on medication therapy and offering education.
Benzer pharmacists will never initiate, modify or discontinue any therapy without a physician’s approval, Wall noted. “This allows for building trust and collaboration within the health care teams caring for common patients,” she said.
Typically, a physician’s office gets reimbursed by insurance for these clinical services, sometimes up to $200 per service, according to Benzer. The company said Medicare Access and the CHIP Reauthorization Act of 2015 provides alternative payment models that include clinical services on top of the services that physicians already provide to their patients.
“If the physician’s office is participating in providing these services, CMS [Centers for Medicare and Medicaid Services] will provide an incentive payment of 5%. This is in addition to the payment received for the services,” Wall explained. “If the physician’s office does not participate, the practice will incur a penalty in the form of a negative 4% payment adjustment.”
Going forward, these payment adjustments stand to rise and are projected to be plus or minus 9% by 2022, Benzer said. “Getting involved now will generate profit in the short term while ensuring maximum incentives in the long run,” added Wall.