ReCAP: Pharmacists’ Impact in Hematopoietic Stem-Cell Transplantation: Economic and Humanistic Outcomes

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Abstract
QUESTION ASKED: What is the impact of clinical pharmacy services in the care of patients undergoing hematopoietic stem-cell transplantation? SUMMARY ANSWER: Pharmacy services in this patient population result in additional revenue generation through pharmacy billing, provider time savings, and outpatient pharmacy prescription referrals. Additionally, both patients and providers have very positive perceptions of the value of pharmacists’ involvement in hematopoietic stem cell transplant care. METHODS: Pharmacy services were (1) translated to revenue generated through pharmacy billing and prescription revenue, (2) associated with time savings estimated by providers, and (3) evaluated for patient and provider perceptions via survey analysis. BIAS, CONFOUNDING FACTOR(S), DRAWBACKS: In our evaluation, the economic impact of pharmacy services is estimated by pharmacy billing, provider time savings, and prescription revenue. Although prescription revenue is estimated by actual revenue generated after reimbursements, billing for pharmacy services and provider time savings serve as estimates of potential revenue generated and opportunity for additional revenue. Although pharmacists bill for services via facility fee charges, it is challenging to capture actual reimbursement data for pharmacy charges billed, particularly due to the bundling of charges submitted by pharmacists and other providers. Thus, we have used charges submitted as a measure of potential revenue generation. However, to estimate reimbursement, we captured the difference in charges before and after pharmacy services, estimating an average amount charged per patient for pharmacy services. We then considered the contracted reimbursement rates of common third-party payers to estimate an average reimbursement rate for pharmacy services. Although the provider time savings we have demonstrated are not a direct measure of revenue, it should be considered that physicians and advanced practice professionals can bill for services at higher levels than can pharmacists, making time for additional patient visits an opportunity for additional revenue. REAL-LIFE IMPLICATIONS: Our data show that pharmacists can have meaningful impacts on economic and humanistic outcomes in the hematopoietic stem-cell transplantation setting. We demonstrate how pharmacy services in this setting offer several opportunities for revenue generation. Proof of economic advantage is vital as this allows for justification of continued expansion and growth of pharmacy services in the stem-cell transplantation setting. Furthermore, we show that both patients and providers have positive perceptions of having pharmacists involved in the care of patients undergoing stem-cell transplantation. These positive perceptions are key to allowing pharmacists to continue to explore innovative ways to serve their patients and provider colleagues. With justification for sustained pharmacy services, the ultimate goal is to show that these services have a positive impact on patient outcomes. [Table: see text]

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