Industry Leader to Student Pharmacists: Bill for Patient Services

Buffington advises School of Pharmacy students, residents to continue push for adoption of billing codes for pharmacy health care services

By Steve Berberich
November 14, 2008

Visiting lecturer Daniel Buffington, PharmD, MBA, recently issued a wake up call to an audience of about 150 eager pharmacy students and their professors. “You have to embrace business principles,” he said.

Buffington was the 2008 Francis S. Balassone speaker at University of Maryland School of Pharmacy. He is president and CEO of Clinical Pharmacology Services in Tampa, Fla., but calls himself the “practice director.”

He is a leading voice for strong business models for pharmacists. He is also an excellent role model for students who will try to achieve success in a profession with expanded health care roles, said Natalie D. Eddington, PhD, dean of the School, in her introduction.

In his lecture on Oct. 31, Buffington described converging trends in U.S. health care that are shifting the ground right under the feet of pharmacists, who will need to become more business savvy to adjust to the tremors.

One trend is a rising number of prescriptions being filled, while profits on dispensing medications are falling steadily. U.S. spending for prescription drugs is projected to increase by 10.7 percent annually between 2004 and 2013, according to HealthAffairs.com, a trend that may put further pressure on a widely projected work force shortage of pharmacists in many cities and states.

Second, the average age of the U.S. population is advancing quickly. Maturing baby boomers are adding demands on pharmacists for more and more drug counseling.

Other trends include the automation and outsourcing of prescriptions. These trends are freeing pharmacists to return to their roots from generations ago, when the pharmacists were front-line health care professionals, perhaps dispensing as much advice as pills.

To return to expanded patient services is not out of nostalgia but of necessity, according to Buffington.

Another trend, documented in a report by the National Academy of Sciences’ Institute of Medicine, is the rise of drug-related medical errors. Buffington said that pharmacists with expanding health care duties are positioned to help the nation reduce the number of drug-related mistakes. Those in hospitals alone in 2006 led to $3.5 billion in added medical costs to patients. The Institute documented other studies revealing that 400,000 preventable drug-related injuries occur each year in hospitals, 800,000 in long-term care facilities, and roughly 530,000 occur among Medicare recipients alone in outpatient clinics.

But there is a business problem, Buffington warned. Many pharmacists are still not being paid appropriately for the new health care services they are taking on, services such as patient education and drug regimen review, problem intervention/adherence/persistence, disease management, and medication management. They are all considered medication management, but the reimbursement codes of health care insurance providers don’t easily agree, said Buffington who added, “Minus a revenue stream for doing that, it’s not going to work.”

“Why are pharmacists always on the Guinness listing of most trusted professions?” Buffington asked the audience rhetorically. “One of the reasons is that we give everything away,” he answered.

Buffington advised students that there is now a national billing model evolving, including reimbursement codes appropriate for pharmacists’ clinical services rendered to patients. Pharmacists’ professional associations are active in pushing the adoption of those codes for pharmacy services.

He asked the students to enter the field with new business goals: increase the volume of services and billing for them, adapt documentation models, increase media visibility for their “new” responsibilities, and meet with the health care insurance payers in their communities.

The Francis S. Balassone Memorial Lecture is named for a 1940 University of Maryland School of Pharmacy graduate, who was a leader in all levels of the profession. Among his many honors was the Harvey W. Wiley Award, the nation’s highest award in the field of drugs, food, and cosmetic law.