Examples of Ambulatory Care Practice Sites

What is ambulatory care?

outpatient care - patients who are still able to walk and do not require hospitalization

Examples of Practice Settings in Ambulatory Care

- community health care centers

- hospital outpatient departments (population health, anticoagulation)

- health plans

- physician offices

- veterans affairs outpatient clinics

- remote opportunities

- rural health

- other

What services are commonly provided by ambulatory care clinical pharmacists?

- access services or care coordination

- chronic disease state management

- comprehensive medication management

- drug information

- healthcare provider education (immunization screenings and administration)

- medication reconciliation

- MTM

- National Committee for Quality Assurance (NCQA) reporting

- ordering, interpreting, and monitoring laboratory tests

- participate in transitions of care, annual wellness visits, and group visits

- participate in Physician Quality Reporting System (PQRS)

- patient education and counseling

- preventative care or wellness screenings

- prospective or retrospective chart reviews

- refill authorization

- research and clinical trials

- shared visits with other healthcare providers

Most state including GA allow pharmacists to independently modify drug therapy under an approved protocol in conjunction with a physician which is know as...

Collaborative Drug Therapy Management (CDTM)

Drug Therapy Modifications include

- adjustment of dosages

- dosage schedules

- medications

How do Collaborative Practice Agreements (CPA) in hospital setting differ from independent practices?

They fall under jurisdiction of the hospital

Some states allow pharmacists to ________ under a statewide protocol

prescribe

Statewide protocol may not require ______ but may have __________

a special license; CE requirements

Prescribing services may include

- hormonal contraception

- travel health

- immunizations

- tobacco cessation

- naloxone

- chronic conditions (Idaho)

______ or _______ is a challenge for ambulatory care pharmacy

lack of state; national provider status

Normally, physicians bill insurance and the pharmacists sees the patient, however in states like ____ and ____, pharmacists are allowed to bill Medicaid CPT codes

California; Oregon

CPT code 99201

10 minute new patient encounter

CPT code 99212

10 minute established patient encounter

CPT code 90471

immunization administration

Depending on the state, pharmacist reimbursement may be ______ vs ________ the physician rate

equivalent; 85%

Pharmacists can contribute to billable services under the supervision of the provider such as

- annual wellness visits

- chronic care management (CCM)

- remote patient monitoring (RPM)

- continuous glucose monitoring (CGM)

Supervision is ______ or ________ depending on the service provided

direct; indirect

General Supervision (Indirect)

when the service is not personally performed by the billing provider and is performed under his or her overall direction and control, although provider presence is not required

Direct Supervision

Provider must be present in the office suite and immediately available to furnish assistance and direction

PharmD Interventions: DM Management

- prescribe basal insulin

- patient education (TLC, glucometer, adherence)

- order lab f/u

PharmD Interventions: Statin Therapy

- calculate ASCVD risk score

- initiate statin

PharmD Interventions: HTN goals

- prescribe higher dose of lisinopril

- order lab f/u

PharmD Interventions: Foot exam

complete and document or refer

PharmD Interventions: Eye Exam

refer

PharmD Interventions: Vaccines

assess, order, and administer