PharmacyForward

John Gums, PharmD, FCCP - Professor and Associate Dean for Clinical and Administrative Affairs - and Eric A Dietrich, PharmD, BCACP, CPC-A, CEMC, CPB - Clinical Associate Professor from the University of Florida College of Pharmacy talk with us about billing for pharmacy services.

Key Lessons:

• A sustainable clinical practice model is formulated by creating a business plan that considers the services to be provided as well as reasonable estimates of the number of patient encounters, the duration for each patient encounter, billable revenues, collections, and costs. 
• Evaluation and Management (EM) codes are used to bill services.  The complexity of the patient encounter characterizes the "level" of service, ranging from level 1 (minimal complexity, self-limiting problem) to level 5 (High, Chronic Conditions, Severe Exacerbation, Disease Progression).
• Comprehensive medication management services provided by pharmacists are typically billed by a recognized provider (physician / nurse practitioner) using an "incident to" billing method.
• Pharmacists can also bill for transitional care management (TCM), chronic care management (CCM), and annual wellness visits (AWV) - but each of these services must meet specific conditions and requirements under Medicare Part B.
• Learning to speak the language of billers and coders is critically important.
• Consider training or certification through the American Academy of Professional Coders (AAPC)
• There is a significant difference between what is billed and what is collected.
• Pharmacists should track their time, number of patient encounters, billable units of services, and collections to determine if their initial estimates are correct.  When there are discrepancies, determine the sources and address the causes.

Check out these guidelines and resources on how to develop a business-practice plan and bill for pharmacists' patient care services:

• • American College of Clinical Pharmacy (ACCP) - Developing a Business-Practice Model for Pharmacy Services in Ambulatory Care Settings
  • American Association of College of Pharmacy (AACP) - Integration of Clinical Pharmacy Faculty in Professional Practice Care Settings
  • National Council for Prescription Drug Programs (NCPDP) - Billing Guidance for Pharmacists' Professional and Patient Care Services

Lucinda L. Maine, Ph.D., R.Ph. - Executive Vice President and Chief Executive Officer of the American Association of Colleges of Pharmacy - talks with us about how to manage major career changes and why a degree in pharmacy is so valuable.

Key Lessons:

• Career pivots can be welcomed and sought ... or arise from something unexpected and unwanted.
• Most professionals will experience several major career changes during their working years.
• A pharmacy degree enables a surprisingly broad range of career paths.
• Being prepared for new opportunities by continually updating your knowledge and skills is critical.
• Having the financial resources available to obtain additional education, training, or experience is an essential career insurance policy.
• Active engagement in professional pharmacy associations, at both the state and nation level, provides a great way to network and keep current with the latest trends.
• Many people, especially women, are reluctant to make a major career change without having "all the necessary" credentials and experiences.  But consider what is essential ... you can learn the rest on the job.
• Several resources are available to help you explore the career options that align with your strengths, skills, and interests:
  • Check out the American Pharmacists Association Career Pathway Evaluation Program and ADVANCE for continuing professional development
  • AACP-APhA Pharmacy Opportunities Network (PharmON) 

Cynthia Knapp Dlugosz, BSPharm, NBC-HWC - Solopreneur and Owner of Being in Balance Coaching and Artemis Health Care Communications - and Elizabeth Buckley, PharmD, CDCES - Professor, Department of Pharmacy Practice, Concordia University Wisconsin — talk to us about threats to our well-being and self-care practices.

Key Lessons:

• We are surrounded by stressors that adversely impact our sense of well-being.
• The ubiquitous use of technology has increased the demands on our attention.
• The pillars of well-being based on research from the Center for Healthy Minds at the University of Wisconsin-Madison are: Awareness, Connection, Insight, and Purpose.
• Much of our dissatisfaction and psychological suffering stems from our desire to push away or change the unpleasantness in our lives.
• Mindfulness is a state of being where we are attentive in the present moment with receptivity, non-judgment, and compassion with what arises.
• Meditation and yoga are practices that cultivate our ability to be mindful - our ability to be more attentive, receptive, less judgmental, and compassionate.
• Gratitude increases our happiness. Those with the least material wealth are often able to recognize and express gratitude for the blessings in their lives but anyone can learn to be more grateful.
• Health professionals feel acutely stressed today because the environmental demands are beyond their ability to successfully cope due to unpredictability, uncontrollability, and overload.
• Organizations have a responsibility to implement strategies to address the environmental demands and the underlying causes of stress.

Resources and Books:

Center for Healthy Minds, the University of Wisconsin-Madison

Brown B.  Atlas of the Heart.  Mapping Meaningful Connection and the Language of Human Experience.  New York: Random House, 2021.

Moss J.  The Burnout Epidemic: The Rise of Chronic Stress and How to Fix It.  Boston: Harvard Business Press, 2021

Bruce Berger, Ph.D. - Berger Consulting LLC and Professor Emeritus, Auburn University - and Col. John D. Grabenstein, R.Ph., Ph.D. - Vaccine Dynamics SP - talk with us about treatment hesitancy, its root causes, and how health professionals can engage patients in treatment decisions more effectively.

Key Lessons:

• Treatment and vaccine hesitancy is often grounded in inadequate information, changing information (leading to doubt), personal beliefs,  misinformation, distrust (of the health care professional's motivations), and (sometimes) apathy. 
• Actively soliciting and listening to a patient's concerns is the key to understanding the sources of doubt and hesitancy.
• Confrontation and dismissing a patient's understanding will cause "face loss" and lead to more resistance, not less.
• Monologues about "the facts" are not helpful. It is important to ask permission and then gently offer new information for the patient to consider.
• The patient is always driving the bus and all treatment decisions rest with them. The goal should be to become a trusted advisor who's always on the patient's side.
• It may take some patients several months (or even years) to arrive at a decision to start a new treatment or receive a vaccine.
• Our words can alienate a patient and sever a relationship. This is perhaps the worst possible outcome because it prevents us from having a positive influence in the future.

Want to learn more about motivational interviewing and vaccinations?  Be sure to check out these resources:

 Immunization Action Coalition (www.immunize.org)

 ComMIt - Comprehensive Motivational Interviewing (MI) Training

 eLearning MI Training for Health Professionals - Purdue University

 Berger B.  Using Care and Compassion to Respond to Vaccine Hesitancy.

Andrew Traynor, Pharm.D., BCPS - Professor and Assistant Dean for Experiential Education at the University of Minnesota - and Brent Reed, Pharm.D., BCPS - Associate Professor at the University of Maryland and Doctoral Student in Organizational Sciences at UNC Charlotte - talk to us about job satisfaction.

Key Lessons:

• Autonomy, mastery, and purpose contribute to our motivation and energy level ... and increase our sense of satisfaction from our work.
• Finding your "why" and being passionate about your work is helpful but doesn't account for the small, everyday things (tasks) that make the work fulfilling. 
• The job demands-resources model helps to explain why some jobs are more satisfying (or conversely dissatisfying) than others.  Do you have the right resources to meet the challenges and hindrances in your work?
• The pebbles in your shoes can really make a big difference in terms of your satisfaction with your job.
• Job satisfaction is not just about individuals learning to be more resilient and productive but it's also about the organization addressing the hindrances and providing sufficient resources to meet the demands of the work.
• High employee turnover and customer dissatisfaction can be "red flags" that the work environment may be problematic.
• Being self-aware - understanding your strengths and values - is important to finding employment that's a good fit.
• Try to get/set realistic expectations when entering a new job by getting an honest "preview" of the work.
• Job crafting can help an employee shape the work to make it more satisfying — finding new challenges, removing hindrances, and seeking resources.

Special Host Timothy Bloom, Ph.D. - Associate Dean of Academic Affairs and Associate Professor, Bernard J Dunn School of Pharmacy, Shenandoah University  - and Guests Heather Petrelli, MA, Ph.D. - Associate Dean of Students Affairs, Taneja College of Pharmacy, University of South Florida - and Teresa O'Sullivan, Pharm.D. - Director of Experiential Education Scholarship and Metrics, School of Pharmacy, University of Washington - talk with us about how faculty can facilitate professional identity formation.

Key Lessons

• Faculty and preceptors play a critical role in students' formation of their professional identity.
• Colleges/schools are now beginning to introduce the concept of professional identity to their students and faculty.
• Experiential education and practice-based experiences are critical to professional identity formation.
• Preceptors and faculty can promote reflection by asking questions about authentic practice-based experiences.
• Explore the why - what is the motivation?  Help students to identify their values, their future goals, and how their (current) behavior reflects (or fail to reflect) those values and goals.  Use motivational interviewing strategies to create cognitive dissonance when appropriate.
• Early and authentic practice experiences are important. Conversations with students about their journey toward "feeling like a pharmacist" can prompt reflection.
• Assessing professional identity formation is a major challenge. How will we know if the curriculum is building professional identity and preparing students well?  This is an area ripe for new evaluation models and scholarship.

For more information about professional identity formation, read the Report of the 2020-2021 AACP Student Affairs Committee: A Pathway to Professional Identity Formation

Special Host Eric G. Boyce, PharmD - Professor of Pharmacy Practice, University of the Pacific Thomas J. Long School of Pharmacy - and Guests Alex N. Isaacs, PharmD, MS, BCPS - Clinical Associate Professor, Purdue University College of Pharmacy - and Sally A. Arif, PharmD, BCPS, BCCP - Associate Professor, Midwestern University College of Pharmacy, Downers Grove - talk with us about professional identity formation, people and events that influenced their professional identity, and the importance of reflection.

Key Lessons

• Our identities are who we are and aren't easily changed (but can and do evolved over time)
• Our lived experiences have a significant influence on our professional identity
• Role models and mentors play a critical role in our professional identity formation
• Emotional experiences have a powerful effect in shaping our beliefs and motivations
• Reflection and introspection can help us solidify and clarify our values and beliefs
• Developing a regular and ongoing reflective practice can help us think through challenges and plan for the future so that we are clear about our purpose and what aspire to be

For more information about professional identity formation, read the Report of the 2020-2021 AACP Student Affairs Committee: A Pathway to Professional Identity Formation

Special Host Kristin Janke, PhD - Senior Associate to the Dean and Professor, University of Minnesota College of Pharmacy - and Special Guests Jessica L. Johnson, PharmD, BCPS - Associate Professor, William Carey School of Pharmacy - and Karen Kopacek, BPharm, MS - Associate Dean and Associate Professor, University of Wisconsin School of Pharmacy - talk with us about professional identity formation, how our identities are formed, and why they are important.

Key Lessons

• Our identities shape our sense of self ... which influence our values, beliefs, and actions
• All of us have multiple identities ... including a professional identity
• Professionalism and professional identity are related but distinct concepts
• Students and residents may feel uncomfortable or experience identity conflicts as they form their professional identity — assimilating the values and norms of the profession
• Our professional identities are developed through interactions with colleagues and mentors
• A strong professional identity can help counterbalance work stressors and negative emotions that lead to burnout

For more information about professional identity formation, read the Report of the 2020-2021 AACP Student Affairs Committee: A Pathway to Professional Identity Formation

Charmaine Rochester-Eyeguokan, PharmD, BCACP, CDCES - University of Maryland School of Pharmacy - and Jeffrey Tingen, PharmD, MBA, BCPS, BCACP, CDCES - VCU Health, Department of Family Medicine & Population Health - talk to use about the ins and outs of collaborative practice agreements.

Key Lessons

• Collaborative practice is governed by state law and regulations; it is important to be familiar with the specific rules for constructing collaborative practice agreements (CPA) in your state.
• Many states require pharmacists to have specific training and experience in order to enter into a CPA - but some states have relatively few requirements or none at all.
• CPAs are useful tools to enable greater efficiency by granting the pharmacist greater autonomy to carry out certain patient care functions; however, a CPA is not required to perform many functions that are ordinarily a part of a pharmacist's scope of practice.
• It's important to have a significant level of rapport and trust with your providers crafting a CPA together.
• While CPAs are fairly common in ambulatory clinics, they are a potentially useful tool in community pharmacy practice, long-term care facilities, and specialty pharmacy practice.

To learn more about collaborative practice and CPA, check out the Collaborative Practice Resource Page on the iForumRx.org website.

Alan J. Zillich, PharmD — William S. Bucke Professor and Head of the Department of Pharmacy Practice, Purdue University College of Pharmacy — talks with us about getting your work published; from identifying great ideas, collaborating, writing, and revising your manuscript.

Key Lessons:

• From review articles to meta-analyses, from case reports to observational studies and controlled trials, getting your work published is immensely gratifying.  But it requires many months (and sometimes years) of effort.
• Working with a mentor who has experience producing scholarly work and getting published is a great first step.
• Good research questions arise from practice.  When there are gaps in our knowledge, that's where a scholarly project that's potentially publishable often emerges.
• Working with an authoring team - bringing together people with different skills - can really improve the quality and rigor of your scholarly work.
• Use explicit criteria to determine who qualifies as an author on a paper.  Be sure to acknowledge those who contributed but not meet the definition of author.
• Finding the "right" journal for your work is important.  Each journal has a different audience and mission.
• Getting rejected is part of the process. The feedback from peer reviewers can be extremely helpful and you are one step closer to getting published.  
• Beware of predatory journals (who don't provide a rigorous peer review but still charge high publication fees).
• Blocking time in your schedule to regularly engaging (at least weekly) in scholarly activities - researching and writing - is critical to success.  Make an appointment with yourself. Unfortunately, this might require early mornings, evenings, or weekends if you can't negotiate the time into your workday.