How Pharmacists Can Find Telehealth Opportunities
According to the American Pharmacists Association, known as APhA, telehealth is the use of electronic information and telecommunications technologies to support or promote long-distance clinical health care, patient and professional education, public health, and health administration. Telepharmacy is defined by the Model Act as the provision of pharmacy care by registered pharmacies and pharmacists that use telecommunications or other tech for patients or their agents within the United States.
Pharmacy organizations, such as the American Society of Health-System Pharmacists, have gone on to expand the telepharmacy definition to include pharmacists’ use of telecommunications to oversee aspects of pharmacy operations or provide patient care services.
A recent study published in the NIH’s National Center for Biotechnology Information states that the effectiveness of telepharmacy has been demonstrated through the following:
Reductions in dispensing error rates
Increased number and type of pharmacist interventions
Time saved, so pharmacists can focus more quality-enhancing initiatives
Instant Rx savings for insured and uninsured patients
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Telehealth and COVID-19
In the wake of the COVID-19 pandemic, access to medical care via telehealth services has experienced a massive surge. Stay-at-home orders and requirements from medical practices have moved many patients into a telemedicine model, allowing providers to engage with patients while maintaining safety.
Telemedicine has been in place for several years as a way of providing care to rural and underserved areas with limited access; however, restrictions placed by the Centers for Medicare and Medicaid Services, or CMS, as well as other factors led to limited use. Now we can see that telehealth has become ubiquitous and is here to stay. That said, what movement and efforts are being made in the world of pharmacy?
Pharmacists at your virtual service
Telepharmacy allows pharmacists to provide several services to patients remotely, including the following:
Medication therapy management (MTM)
Chronic disease management/chronic care management (CCM), such as diabetes self-management training
Dispensing, medication order entry, and verification
Ambulatory care
Transitions of care
There are a variety of ways pharmacists can deliver these services, but how have they been used and what benefits do they provide?
Pharmacies using telepharmacy to treat COVID-19 patients (either suspected or confirmed) had a lower incidence of dispensing errors than pharmacies not equipped to provide these services, according to the study cited above on telepharmacy’s effectiveness. There were also significant differences related to COVID-19 recommendations — such as use of acetaminophen for fever, or maintenance of home quarantine — at pharmacies with telepharmacy, compared with those without.
Let’s explore further how telepharmacy services could be implemented.
Telehealth-based chronic disease management programs
These clinical pharmacy services can improve disease state management and access to healthcare in rural veteran populations. For example, researchers assessing the impact of such telehealth services found statistically significant improvements in diabetes and hypertension outcomes, according to a study published by the NIH’s National Center for Biotechnology Information.
Real-time, pharmacist-led, clinic-based video telehealth
Used for chronic disease state management, clinic-based video telehealth resulted in improvements in A1C values and patient satisfaction scores in veteran populations. Conversely, telepharmacies dispensing medications with an off-site pharmacist to ameliorate pharmacy closures and improve medication access resulted in varying levels of medication adherence, compared with the use of traditional pharmacies.
Policies, billing, and guidance
Major organizations such as the American Medical Association have recognized telehealth as a way to fight COVID-19, and have provided guidance and tips to physicians using telemedicine in their practices. APhA and other pharmacy organizations also have released statements about telehealth services by pharmacists. To this end, the CMS has relaxed requirements for telehealth to permit supervision via audio and video, though other telehealth regulations remain in effect. Pharmacists as clinical staff should be able to provide telehealth services in what’s called “incident to” a Medicare provider.
There are specific rules and regulations involved in delivering in-person care; the same applies for virtual services. When delivering telepharmacy, pharmacists are required to adhere to the policies and regulations in the state in which the patient is located, regardless of where the telehealth service is based. HIPAA requirements still exist for patients receiving telepharmacy services; this applies to electronic files, consultations, encrypted technology, and so on.
Many states also require that the healthcare provider hold a license in the state in which the patient resides. Here are a select set of resources to review:
National Consortium of Telepharmacy Resource Centers: Contains evidence for use, COVID-19 resources, telehealth development kits, and more
Center for Connected Health Policy: Allows sorting by categories and state laws for reimbursement and policy related to CMS and private insurers, as well as professional regulations/health and safety
PharmacyTimes’ State Regulation of Telepharmacy: Contains an overview of some requirements and regulations to be aware of, along with particular boards of pharmacy
Pharmacists have found that billing for services has sometimes been challenging. Last year, the APhA strongly urged CMS to clarify what physicians and other qualified practitioners can bill for pharmacist-provided “incident to” services via telehealth to Medicare beneficiaries at higher evaluation and management codes within their state scope of practice and training.
When developing telepharmacy services, pharmacists can consider training programs and startup kits. APhA provides four modules on the role of the telehealth pharmacist. In addition, a white paper from the American College of Clinical Pharmacy provides guidance for pharmacists providing telehealth services, including insights on the following:
Assessment techniques for patients and medications
Clinical pharmacist qualifications
Collaboration, credentialing, and privileging
Costs and compensation
Development and implementation of a plan of care
Documentation
General telepharmacy concepts
Professionalism and ethics
Technology requirements for each step of the process
Telehealth as a paradigm shift
Although barriers remain, telepharmacy is a rapidly growing area of practice, particularly during the current pandemic. Pre-COVID-19, it was estimated that more than 3.2 million patients used telehealth services per year. During the COVID-19 crisis, this number is expected to have greatly increased.
Such an expansion has been seen in many types of pharmacy practices and in many different areas of practice. Pharmacists should continue to advocate for recognition and reimbursement in this area to provide improved care to patients.
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