Diabetes Self-Management Education Accreditation Provides Billable Opportunity for Pharmacists

Travis Wolff, PharmD, BCACP, the CEO and founder of PharmFurther, and director of CPESN Medical Billing Special Purpose Effort in Sapulpa, Oklahoma, joins Pharmacy Times to continue our discussion about diabetes self-management education (DSME), an accreditation that pharmacies can get which allows pharmacists to educate patients on self-managing diabetes. You don't want to miss this follow-up interview with Wolff, who discusses the current difficulties associated with getting DSME accreditation and performing medical billing for their work helping with diabetes, and the criteria pharmacists need to meet before applying for accreditation.

PT Staff: With the growing epidemic of diabetes [there are so many more patients]. I feel that it's so important that patients know these resources [like DSME] exist, but I'm also curious about your point of view. How does communication about this program increase? What else is needed for patients to have confidence in going to the pharmacist knowing that they're going to receive the care that they deserve?

Travis Wolff, PharmD, BCACP: Being the most accessible person on the healthcare team, I feel like they're already coming to us. I feel like we also get stuck and not wanting to step on the physicians’ toes, and I think that's absolutely true. I think that we are not trained the way that I wish we were in diagnosis, and there are things that absolutely we need a physician to have a pair of eyes on, but I think that we can work towards more of this provider parity.

You know, my goal is to be shaking the [hand of the] president of the United States sometime in my career, whenever the centers for Medicare and Medicaid Services (CMS) gives us the full provider status, because it's hard. Medical billing is so difficult for pharmacists. And even if you're taking great care of your patient and you're producing very good outcomes, which is the number 1 goal, the legislators and the payers are measuring those outcomes by paid dollars.

You can be working your tail off in clinical encounters, but if you're not billing those out, they don't see the good that you did—CMS ties it back to the provider and they got paid for it. So you could run a full-blown medical clinic for free and not ever get paid as a pharmacist, even if you have tremendous patient outcomes. But the doctors that you're sending all the requests to and the changes to [will get paid], all the things they get paid to manage that patient's health. CMS is following the dollars [which are with doctors].

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