As pharmacists, it is our professional responsibility to help our patients improve their overall health. We provide services such as immunizations, medication counseling, medication therapy management (MTM), smoking cessation counseling and more in addition to our dispensing role. There is another service available to pharmacists in the state of Missouri that has the potential to benefit our patients who participate in MO HealthNet (Missouri Medicaid).
Direct Care Pro (DCPro) is an MTM tool designed exclusively for patients with MO HealthNet. This program is intended to improve their health by uncovering gaps in care and decreasing the number of complications for those with comorbid conditions such as asthma, chronic obstructive pulmonary disease (COPD), diabetes, gastroesophageal reflux disease (GERD), heart failure, hypertension, hyperlipidemia, osteoporosis, multiple sclerosis, etc.1 It encourages pharmacist collaboration with providers as it focuses on topics such as insufficient screening, medication management, gaps in care, self-care, etc. By completing these interventions, pharmacists are able to work closely with providers to ensure that our patients have numerous opportunities to improve their chronic health condition(s) and overall health.
The program allows pharmacists to sit down with the patient in private and discuss how to improve their chronic health conditions. Examples of potential improvement plans include encouraging limiting salt intake and/or recommending the DASH diet in patients with hypertension or the importance of receiving a pneumonia vaccination in patients at increased risk of contracting pneumonia.
Potential DCPro interventions are identified through dispensing software as you fill prescriptions for patients who meet specific disease-based criteria. The message from DCPro comes over in the DUR field. An example of one message is “AVL DIAB INTV,” which translates to “available diabetes intervention.” The information may also be viewed by directly logging in to the DCPro website.
The next step is viewing the intervention opportunities online using CyberAccess. CyberAccess is a robust system of information obtained from paid MO HealthNet claims. It is the web portal pharmacists use for accessing DCPro as well as the portal used for many other provider based services. Once you have contacted the patient and scheduled a time to conduct the intervention, you must then reserve the intervention within the DCPro module. Once you have completed the intervention with the patient, you must complete the intervention forms within DCPro. Once the intervention is complete, DCPro auto populates an 837 claim for you to electronically submit to MO HealthNet. All these actions are required in order to receive payment for the intervention. Pharmacists may bill interventions in 15 minute increments for the services using CPT codes 99605, 99606 and 99607. Descriptions of these CPT codes are included in the MO HealthNet Pharmacy Manual.2 Currently, payment ranges from $10-20 per 15 minute interval.
In addition to submitting information via DCPro, there are very specific requirements for documentation in order to receive payment. You must keep a log of all clinical interventions which include the patient’s name, their signature, date of service for the intervention and the beginning/end time of the intervention. You should also document any other information pertinent to the intervention including the plan of treatment, evaluation(s), test(s), finding(s), results, etc. This is important as the patient’s chart must be reproducible for auditing purposes.
As with any other services pharmacists provide, there are some barriers that have the potential to disrupt completion of DCPro interventions. The primary difficulty for many is finding the time in which to perform these interventions. Use your time wisely; consider structuring your DCPro interventions like a doctor’s appointment. When a patient schedules an appointment with their physician, they contact the office’s receptionist, not the doctor themselves. When an available intervention arises, delegate the scheduling to a pharmacy intern or technician. If other pharmacy staff is properly trained on how to schedule the appointment while explaining the details of the appointment and its importance to the patient’s health, then you have achieved the first step of the DCPro intervention while continuing to perform your other daily duties like verifying medications and medication counseling.
Additionally, consider allowing a technician or intern to complete some of the initial paperwork for the intervention. This may include documenting the patient’s medical history, the medications they are taking along with the directions of administration, any allergies, the patient’s family history, reason or purpose of the initial visit, etc. These initial visit assessments contain subjective questions regarding how the patient feels and how they rate their overall health; something a technician or intern is more than capable of performing. Again, this allows you to complete some of the initial steps of the intervention while continuing to perform other important tasks.
Another way to find the time to perform these interventions is to select interventions that fit into your schedule. With DCPro, you have the ability to select which intervention to perform as well as to bill in 15 minute increments. Consider performing a short, 15 minute intervention to start with and then go from there. Bear in mind that the ultimate goal of DCPro is for the patient to improve their health and that it will take some patients different time intervals to do so.
Another barrier that may be preventing you from utilizing DCPro is that the intervention must take place in an area that is HIPAA compliant. You may think that in order to be truly HIPAA compliant, you must conduct the interventions in a room with four walls separate from your pharmacy counter. This is a barrier that is easy to overcome. Consider using a screen or a room divider in an area of your building to provide the level of privacy required to conduct DCPro interventions. This may be similar to the privacy measures put in place when administering vaccinations.
Using these tactics to overcome barriers that may be preventing you from using Direct Care Pro, I hope you feel more empowered to take advantage of this unique opportunity. DCPro not only provides an additional opportunity to receive reimbursement; it also allows us as health care professionals to expand clinical knowledge to the benefit of our patients. Be confident in the value of services we provide as pharmacists. By completing DCPro interventions and utilizing other medication therapy services, you are advancing the pharmacy profession one patient at a time.
Next week’s blog will focus on how to meet the requirements for performing DCPro interventions, including how to apply for a certificate of medication therapeutic authority and becoming a MO HealthNet (Missouri Medicaid) provider.
St. Louis College of Pharmacy
2016 PharmD Candidate
- Missouri Pharmacist Care Network. Direct Care Pro. Accessed September 16th, 2015 at http://www.mo-pcn.com/pharmacistopportunities/direct-care-pro/
- State of Missouri MO HealthNet Manuals. State of Missouri Pharmacy Manual. Accessed September 24th, 2015 at http://manuals.momed.com/collections/collection_pha/print.pdf