Tampa General Hospital

Practice Setting

Tampa General Medical Group Pharmacotherapy Clinic is the primary care division of Tampa General Hospital, a major teaching hospital and Level 1 trauma center in Tampa, FL.   Currently, there are 16 primary clinics with expected growth of 1-2 clinics per year. Each clinic has approximately 3-5 physicians or APP. Pharmacists are responsible for approximately 3-4 clinic locations. There are six PGY1 residents that rotate throughout the clinics as well as one PGY2 ambylatory care resident, whose primary training site is the Pharmacotherapy Clinic. The primary responsibility of the ambulatory care clinical pharmacist is direct patient care, which can occur in the clinic setting or via telephone for the chronic care management program.  In addition, the clinic provides pharmacotherapy services via telehealth for patients  that do not live in close proximity to a clinic with a pharmacist on staff.

Why was the pharmacy service developed? (Describe any compelling data collected prior to implementation)

The service was developed approximately 17 years ago to ease the burden of anticoagulation for the clinic physicians. Evidence of improved patient outcomes in a pharmacist-managed anticoagulation clinic versus standard of care via decreased hosptializations, decreased bleeds, decreased thrombosis and improved patient satisfaction has been demonstrated. Since the start of the pharmacotherapy clinic services have expanded beyond anticoagulation and now include management of COPD, HTN, hyperlipidemia and diabetes.  In addition, the service has allowed physicians to see more complex patients.

What training, certification, credentialing, and practice agreement is utilized by the practice setting pharmacist(s)?

All Tampa General Hospital clinical pharmacists are residency trained and hold board certification or advanced specialty certifications.  The clinic operates under a collaborative practice agreement that is updated yearly, as well as, disease state management protocols.

What outcomes are being measured to evaluate the model's success? (Clinical metrics, revenue, cost-savings, patient satisfaction, etc.)

A comparision between the revenue generated by the pharmacotherapy service for chronic care management compared to the total revenue generated by the clinic is being evaluated. In addition, the % of INRs in therapeutic range (goal is 65%), the number of medication-related problems identified during at transition of care visit, and the % of diabetic patients that we get the A1C to be less than 9% is tracked.

How have you made this service sustainable? (Include billing, reimbursement, etc.) 

Incident-to billing is used in the current model, however, a significant amount of revenue for the medical group in comparison to the providers as not yet been demonstrated. The sustainability of the service stems from improvement in patient outcomes, decreased hospital readmissions, and achievement in blood pressure, A1C, and anticoagulation goals.  Clinical pharmacists have help to improve both patient and provider satisfaction.

How did you gain support of administrators, providers, and other key stakeholders to implement your practice model?

Support for pharmacotherapy services was achieved by demonstrating evidence of improved outcomes in the anticoagulation clinic (pharmacist-managed versus standard of care).  Trust and confidence from providers as well as the creation of strong relationships allowed for the implementation of additional pharmacotherapy services such as diabetes and blood pressure monitoring.