Pharmacist-Physician Covisits—One of Many Emerging Models

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Sometimes health care seems to plod along without much change. But that view is often held by cynics whose expectations are that the entire paradigm be completely upended merely by one demonstration project or innovation. Health care has indeed changed quite rapidly, and that includes the proliferation of various service models that are interdisciplinary in nature. What must be understood is that there is no, single model entirely representative of all the changes.

One model described by Ulrich et al is a pharmacist-physician covisit model in a family medicine practice.1 In this model, an embedded pharmacist provided care 3 half-days per week under a collaborative practice agreement, which allowed for independent initiation, adjustment, and discontinuation of medications. The pharmacist provided targeted drug therapy management, comprehensive disease state management, and annual wellness visits. Before the covisit model, the pharmacist saw patients in face-to-face visits that were scheduled without regard to physician appointments. Additionally, the physician would offer the pharmacists’ consultative services, and there were many occasions where the patient would miss the appointment. Additionally, the integration of the patient’s record and documentation by both practitioners was witness to greater coordination and fewer events wherein the physician would miss the pharmacist’s notes on the patient. An analysis found that 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. The physician was able to see an additional 1.3 patients per half-day in the covisit model, and there was an average of 3.2 open physician appointments per half-day with covisits compared with 1.4 with separate visits.

Pharmacy practice is indeed becoming more integrated into the health system and featuring more collaborative practice opportunities, even if that is not always widely evident at every local pharmacy. Managers can be progressive and prepared for opportunities such as this one, as the pharmacist integrated in this model could also very well work in a community practice. This presents an excellent opportunity not only for persons officially titled as clinical pharmacists, but for most any pharmacist, and effective managers could deploy some resources to diversify revenue streams. Moreover, the effective self-managing pharmacist is one more likely to make a model like this one work out.

Additional information about Implementing Value-Added Services and Entrepreneurship and Innovation can be found in Pharmacy Management: Essentials for All Practice Settings, 5e. If you or your institution subscribes to AccessPharmacy, use or create your MyAccess Profile to sign-in to Pharmacy Management: Essentials for All Practice Settings, 5e. If your institution does not provide access, ask your medical librarian about subscribing.

1Ulrich IP, Patel S, Gilmer B. Evaluation of a pharmacist-physician covisit model in a family medicine practice. J Am Pharm Assoc. 2019;59(1):129-135.

Shane Desselle

Professor of Social and Behavioral Pharmacy, Touro University California

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Shane Desselle 29 days ago

Can you see yourself working in a practice like this one? Creating a practice like this one?