A Practical Billing and Payment Plan for Cognitive Services

Rx-to-OTC Switch Movement

“…The FDA has also rejected the proposition (Hadeler 1985). The Department of Justice argued against it because it might &dquo;restrain competition, inconvenience the consumer, depart from U.S. economic policy, and cause price increases for the consumer with no attending benefit&dquo; (Segal 1991, 11; see also Christensen, Fassett, and Andrews 1993).33 DRUG MANUFACTURERS Pharmaceutical drug manufacturers profit substantially from the switch movement. They support the easing of restrictions on overthe-counter availability because nonprescription status results in wider use, increased sales, and higher returns to the manufacturers (Temin 1990, 3).…”

Development and Reliability Testing of the Clinical Pharmacist Recommendation Taxonomy

“…However, as pharmacy budgets are stretched and the potential for billing and associated documentation expands, validated methods of classifying cognitive services are needed. 4,5 Another important role for the classification of cognitive services lies in the realm of clinical interventions involving pharmacists. Although numerous studies have demonstrated the value of clinical pharmacists in both outpatient [6][7][8] and inpatient settings, 9,10 systematically comparing the interventions and applying them to practice is difficult.…”

“…Some studies simply created lists of categories of services; others developed more extensive and unwieldy lists. 5,8,9,[11][12][13][14][15][16][17][18][19][20][21][22] Predictive validity of the categories has not been employed, even for relationships with outcome measures such as health-related quality of life, morbidity, mortality, and reduced actual or potential adverse drug events.…”

Current Status of Prospective Drug Utilization Review

“…Some limited examples of compensation systems exist in the private and public sector. 43,44 ss Meeting the Challenge There are several challenges in implementing the above recommendations for making pDUR systems more useful. These can be grouped into those involving (a) the technical aspects of these systems and (b) how health care providers, particularly pharmacists, interpret and respond to potential drug therapy problem alerts generated by the systems.…”

“…We believe that such a compensation policy is both feasible and practical. 43,44 ss Summary and Conclusion Despite its noble purpose, a growing body of literature documents numerous problems and concerns with respect to the quality of DUR criteria, DUR alerts, and the response of health care professionals to these alerts. Problems with the current pDUR "system" can be grouped into those involving technical aspects (e.g., duplicate messaging from in-store and online systems, or message text limitations) and those involving human aspects, specifically how pharmacists and other health care providers interpret and respond to potential drug therapy problem alerts generated by the electronic systems.…”