Future of Community Pharmacies Linked to Medical Billing Tech Adoption, New Report Shows
Workflow Services published a paper today that argues that the survival of community pharmacists hinges on the adoption of the pharmacist-led clinical services programs.
Co-authored by Nancy Gagliano, MD—a former NIH official and current advisor to Workflow Services— the paper first acknowledges the significant challenges the industry currently faces, including downward pricing pressure, stringent reimbursement rates, and alternative markets such as Amazon Pharmacy. Drawing on data from Workflow Service’s pharmacy customers in 46 states, Dr. Gagliano argues that if community pharmacies do not adopt a medical-billing platform that enables higher-margin, pharmacist-led clinical services, those pharmacies risk closure.
“It’s not hyperbole to say that our country’s community pharmacies are in dire straits,” says Dr. Gagliano, who spent over six years as a chief medical officer for MinuteClinic at CVS Health. “Yet from these challenges, comes tremendous opportunity. Pharmacies are positioned to redefine their role in healthcare as community health hubs. Patients, primary-care providers, and payors all benefit by making the community pharmacist a key member of the healthcare team.”
In the paper entitled “How Medical Billing Is Unlocking Healthcare’s Most Underutilized Asset: The Community Pharmacist,” Dr. Gagliano and her co-author Zachary Rosko, PharmD, BCPS, Directory of Pharmacy at Workflow Services, argue that this transformation won’t be simple. Medical billing is complex and pharmacists do not have the expertise to do it alone.
“Traditionally, pharmacists have not been paid for time spent with patients,” says Rosko. “A primary reason is that medical billing in the pharmacy setting has been a complex, disjointed process. While the complexity remains, the right tool with the proper guardrails and guidance can unlock reimbursement opportunities for care that pharmacists have already been providing patients.”
As a case study, the authors point to Colorado as a state that has passed legislation (HB21-1275) allowing pharmacists to practice at the top of their license. In such cases, pharmacists can increase their reimbursement from $2 to $200, for example, when they counsel a Medicare patient for more than eight minutes versus simply refilling a prescription.
“Pharmacies are healthcare’s front door,” says Dr. Gagliano. “Community pharmacists are often the easiest, cheapest, fastest, and closest healthcare provider for most Americans. When we expand pharmacists’ scope of practice, everybody wins. Patients get treated faster. Pharmacists perform higher-margin services. Payors get reimbursed for care at a lower-cost setting and overextended primary-care providers can focus on more complex cases.”
The full report is available to download here.