Challenges posed by siloed records and access to information
Information-sharing and integration are barriers that keep community retail pharmacies from being able to truly coordinate with the health systems with whom they share patients.
Hospital-owned retail pharmacies have the advantage of having access to the EHR, so those pharmacists can log in and read the progress note from the last visit or easily message the clinic if they have questions, but I have not heard of any traditional community-based pharmacy having that kind of access to medical records.
That’s part of the gap in care that currently is hard for pharmacists and providers to overcome.
Without the automatic electronic connections that system-linked organizations enjoy, independent pharmacies have to embrace their role as a hub of the community and really start to build those relationships with providers in their community to optimize service delivery and streamline whatever back-and-forth regularly occurs. For example, if the pharmacy is able to offer services around prior authorization and take on some of those administrative burdens on behalf of the provider, they are likely able to embed themselves more into the decision-making and care delivery process.
While there may not be any more technologically advanced initiatives on the horizon for community pharmacists to break through information silos and share more patient data with health systems, an upstream solution may be forming in the initiative to embed pharmacists in multidisciplinary frontline care teams in health systems and hospitals. Some health systems are expanding their embedded clinic pharmacists because if they can influence decisions at the time the provider is writing prescriptions, many important pharmacy questions will be addressed upfront, and it’s less likely the retail team is going to need to make those time-consuming callbacks that delay care.
Paying for pharmacy services
An additional challenge pharmacies face is that, even as they expand their patient care services and care community collaborations, they aren’t designated as providers by the Centers for Medicare & Medicaid Services (CMS), which means they can’t bill for many of those services. While 41 states now mandate some form of payment for pharmacists’ clinical services, gaps still exist in achieving widespread financial recognition for their contributions.
Generally speaking, the way CMS and government decisions go, the commercial sector is likely to follow. Until there is legislative and systemic support for a reimbursement infrastructure for pharmacy-provided clinical services, retail pharmacies are not incentivized to provide this additional care.
Federal recognition of pharmacy services as reimbursable care would provide the financial footing necessary for community pharmacies to sustain their patient-focused models.
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