Evaluation of a pharmacist-physician covisit model in a family medicine practice

Abstract

Objectives: To describe the financial implications, efficiency, and patient access to care with the use of a pharmacist-physician covisit model in a primary care practice.

Setting: A rural satellite practice of a large, teaching, multidisciplinary, family medicine organization.

Practice description: Mountain Area Health Education Center (MAHEC) is a large, multisite, family medicine teaching practice. Our site is a rural practice of MAHEC that serves western North Carolina.

Practice innovation: Pharmacist-physician covisit model.

Evaluation: Fourteen half-days of the covisit model from June 1, 2016, to January 31, 2017, were evaluated. Change in estimated clinic revenue was assessed for the physician only, separate pharmacist and physician visits, and the covisit model. Number and types of visits billed before and after implementation of the covisits were used to evaluate efficiency, and number of available appointments was used to evaluate patient access to care.

Results: 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. During the pilot period of the covisit model, the pharmacist and physician combined billed a total of 189 visits, compared with 164 visits on matched days with separate visits. With covisits, more high-complexity codes and initial Medicare Annual Wellness Visits were billed. The physician was able to see an additional 1.3 patients per half-day in the covisit model compared with separate visits, and there was an average of 3.2 open physician appointments per half-day with covisits compared with 1.4 with separate visits.

Conclusion: Compared with both the physician-only and the separate-visit models, the covisit model is projected to substantially increase clinic revenue. In this model, more patients can be seen, higher-complexity visits are billed, and there are more available appointments.