Paid Consultations

Paid Consultations
Opportunities and Timesavers

Alicia Chin, RPh, BScPhm
© Ontario Pharmacists Association 1

Presenter Disclosure
• Presenter’s Name: Alicia Chin
• Relationships with commercial interests:

• Advisory Board/Speakers Bureau: Sanofi Advisory Board
• Research/Clinical Trials: LMC Manna Research
The Centre for Memory and Aging
• Speaker/Consulting Fees: OPA, Morrish Pharmacy IDA
• Current/past Employee of:
• LMC Pharmacy
• Alicia Chin – The Pharmacist Is IN
• McKesson Canada Retail Banner Services
• Remedy’sRx
• Speaking Fees for current program:

• I have received a speaker’s fee from OPA for this learning activity

Commercial Support Disclosure
• This program has received no financial or in-kind support

from any commercial or other organization

Learning Objectives
1. Identify and describe paid consultations and non-

dispensing clinical activities for pharmacy professionals
in Ontario
2. Assess personal paid scope activity preferences
3. Understand strategies to integrate paid consultations
and streamline documentation
4. Design tools to streamline Pharmaceutical Opinion and
MedsChecks documentation

We care!
https://www.pharmacists.ca/cpha-ca/assets/File/cpha-on-the-issues/ScopeofPracticeinCanada_Dec2018.pdf

We care… But what pays?!
https://www.pharmacists.ca/cpha-ca/assets/File/pharmacy-in-canada/Publicly-Funded%20Pharmacy%20Services%20by%20Province(1).pdf

https://cfpnet.ca/bank/document_en/129-2018-provincial-chart.pdf


https://www.cfpnet.ca/en/news/details/id/263

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Quick Quiz Time
Where can you get information about a variety of

publicly-funded pharmacy services?
□ Ontario Pharmacists Association (OPA)

□ MOHLTC
□ Canadian Pharmacists Association (CPhA)
□ Canadian Foundation for Pharmacy
 All of the above


MOHLTC / OHIP / ODB Paid Pharmacy Activities
• Medication reviews, assessments, MTM
• Clinical recommendations, pharmaceutical opinions

• Smoking cessation counselling and medications
• Opioid safety, naloxone, methadone maintenance therapy
• Colon cancer education and distribution of Fecal Occult
Blood Test kits

Blood Test kits
• Adherence, compliance, blister packs

Blood Test kits
• Refusal to fill
• Forgeries

Blood Test kits
• Refusal to fill
• Forgeries
• Flu shots – pharmacist or health-care agency
administered options

Blood Test kits
• Refusal to fill
• Forgeries
• Flu shots – pharmacist or health-care agency
administered options
• Peds, youth

Properties

Green Shield Canada Paid Pharmacy Activities
GSC – Pharmacist Health Coaching
• Cardiovascular Program
• Smoking Cessation Program

GSC Frequent Dispensing

GSC Frequent Dispensing
GSC Patient-Impact Scorecards

• 3 quality measures – Adherence, Disease Management,
Patient Safety
• 8 specific metric points
• Initial scorecards to pharmacies; continued scorecard
access via EQUIPP
• 2020 – GSC to reward high-performing pharmacies

Medavie Blue Cross Paid Pharmacy Activities
MBC – Managing Chronic Disease Service (MCDS)

• Better Lung Health for Asthma/COPD
• Quit Smoking Program
• Diabetes Care
• Better Heart Health


• Diabetes Care
• Open to all certified HCPs – CRE, CAE, CTE, CDE,

OPA CV


• Diabetes Care
• Open to all certified HCPs – CRE, CAE, CTE, CDE,

OPA CV
• Payment amount plan dependent

Properties

Collect and Charge!
Collect it!
• Blood glucose meter training

Collect and Charge!
Collect it!
Charge for it!

• Anything we do that’s paid → also offer and charge non-
plan members

Collect and Charge!
Collect it!
Charge for it!

• Anything we do that’s paid → also offer and charge non-
plan members
• Anything we’re able to do, but don’t have coverage for yet
- Injections
- Authority to administer drugs by injection and inhalation for
education and demonstration
- Authority to adapt or renew
- Authority for emergency refills
- Authority to perform a procedure below the dermis for education
and demonstration

Collect and Charge!
• OPA Suggested Fee Guide for Uninsured Clinical and
Professional Pharmacy Services
https://www.opatoday.com/Media/Default/Suggested%20Fee%20Guide/OPA_Uninsured_Clinical_and_Professional_Service_F
ee_Guide_17/HTML/files/assets/common/downloads/publication.pdf

Collect and Charge!
Collect it!
Charge for it!

• Anything we do that’s paid → also offer and charge non-plan
members
• Anything we’re able to do, but don’t have coverage for yet
- Injections
- Authority to perform a procedure below the dermis for education and
demonstration
• Travel health services, weight management programs
• POC testing
• Medical directive

Collect and Charge!
Collect it!
Charge for it!

• Anything we do that’s paid → also offer and charge non-plan
members
• Anything we’re able to do, but don’t have online coverage yet
- Injections
- Authority to perform a procedure below the dermis for education and
demonstration
• Travel health services, weight management programs
• POC testing
• Medical directive
• HSA, RevCan medical expense

Collect and Charge!
• HSA, RevCan medical expense
https://www.canada.ca/en/revenue-agency/services/tax/individuals/topics/about-your-tax-return/tax-return/completing-a-
tax-return/deductions-credits-expenses/lines-330-331-eligible-medical-expenses-you-claim-on-your-tax-return/authorized-
medical-practitioners-purposes-medical-expense-tax-credit.html

Collect and Charge!
• OPA Pharmacy Services Invoice Template
https://www.opatoday.com/professional/resources/for-pharmacists/tools-and-forms/clinical-invoice

Collect and Charge!
H$A

Collect and Charge!

Collect and Charge!

Collect and Charge!

Collect and Charge!
H$A

Collect and Charge!
H$A

Properties

Learning Objectives
1. Identify and describe paid consultations and non-

dispensing clinical activities for pharmacy professionals
in Ontario
2. Assess personal paid scope activity preferences
3. Understand strategies to integrate paid consultations
and streamline documentation
4. Design tools to streamline Pharmaceutical Opinion and
MedsChecks documentation

We Care… but have Preferences!
What are your inclinations and interests?
• Dispensing catches
• Adherence, compliance,
blister packs
• Medication synchronization
• Dose compression,
de-prescribing
• Peds
• Seniors

We Care… but have Preferences!
What are your inclinations and interests?
• Dispensing catches • Heart disease
• Adherence, compliance, • Stroke
blister packs • Cancer
• Medication synchronization • Asthma
• Dose compression, • COPD
de-prescribing
• Diabetes
• Peds
• Arthritis
• Seniors
• Alzheimer's / dementia
• Mood disorders / depression
• Anxiety disorders

Properties

We really dislike…
Concerns, apprehensions, annoyances:
• Getting the patient to sign a consent

• Not getting paid for the advice and care I give
• Repeating myself on so many different forms
• The time it takes to properly complete the documentation
• The checklist approach
• So many pages…

Combating Documentation Frustration
Most industries automate repetitive actions

Lowest common denominator solutions

• POPs = fax doctor + word document of common scenarios
• POPs = POP template + add patient/doctor info
• MedsChecks = software + word document of common
phrases

Lowest common denominator solutions

• POPs = fax doctor + word document of common scenarios
• POPs = POP template + add patient/doctor info
• MedsChecks = software + word document of common phrases
A bit more savvy

• Macros
Have megabucks or a programmer?

• Integrated solutions – drop downs embedded in document
templates
• AI in the future!

This is what we did about it…

A Practical Approach
• Start by being prepared to invest some time initially,
knowing it will make life easier overall moving forward

• Recognize the good advice you give on a day-in, day-out
basis

basis
• Identify your most common cognitive activities

basis
• For each paid (payable) activity / subcategory, organize
and categorize your most common responses

basis
• Format these into word documents so you can clip and
paste per your documentation system (software, special
modules, etc.)

basis
modules, etc.)
• Create files to support your top three most common
billable activities

basis
modules, etc.)
• Create files to support your top three most common
cognitive activities
• Use your “templates” to save time, ensure audit-
worthiness, and support staff consistency

Case Studies
• Scenario 1 – Pharmaceutical Opinion

• Scenario 2 – MedsCheck for Diabetes Follow-Up

Scenario 1 – Pharmaceutical Opinion
Scenario: Statin use in diabetes
Patient: “A. Diabetic”

Age: 40 years old
Meds: Metformin 500mg BID
No statin has been prescribed!
Exercise: Write up the POP to doctors and

speaking points to the patient.
Make your comments concise!
http://guidelines.diabetes.ca/docs/CPG-quick-reference-guide-web-EN.pdf

GSC – Quality Measure Calculations
There are three primary types of measures:
1. Adherence Measures (Proportion of Days Covered or PDC)
→ Hypertension (RASA) PDC
→ Cholesterol PDC
→ Diabetes PDC
2. Disease Management Measures
→ Statin Use in Persons with Diabetes (SUPD)
→ Asthma – Suboptimal Control
→ Asthma – Absence of Controller Therapy
→ GSC Cardiovascular Health Coaching
3. Patient Safety Measures
→ High-risk Medication Use in the Elderly (HRM)
https://www.providerconnect.ca/carriers/greenshield/pharmacy/pharmacyscores/en_ca/UnderstandingGSCScorecard.pdf

POP documentation must include as a minimum:
1. Details of the drug related problem (there are eight reasons for not dispensing
the prescription as written / prescribed)
2. Medication(s) involved
3. Recommendation to the prescriber
4. The date and the name of the prescriber who was contacted
5. Action plan / discussion with the patient
6. Wording to indicate the outcome; there are three possible outcomes. (Not filled
due to a confirmed forgery or clinical concern; recommendation provided by
pharmacist but prescription filled as prescribed / therapy continued as
prescribed; recommendation provided by pharmacist and prescription therapy
changed.)
7. The date of the transaction and the pharmacist’s signature
8. Other comments required to substantiate the decision
9. In the case of a MedsCheck, an updated MedsCheck medication review list is
provided to the patient and the physician as per MedsCheck standards
http://www.health.gov.on.ca/en/pro/programs/drugs/pharmaopinion/

https://www.opatoday.com/professional/resources/for-pharmacists/tools-and-forms/pop

Scenario – No Statin has been prescribed!



Upon review and assessment of A.

Diabetic's medications, it was noted
that he is not currently taking a
statin, per 2018 Diabetes Guidelines.

Recommend adding a statin per 2018 Diabetes
Guidelines
[ ] Atorvastatin 10mg daily, or
[ ] Rosuvastatin 5mg daily
Recommended supply: 1 month trial + 2 repeats for
total of 3 months
Please also issue a lab requisition for a lipid
assessment to be conducted 1-2 weeks prior to
finishing the medication.

- Reviewed diabetes meds with patient and
noted/explained statin recommendation per 2018
Diabetes Guidelines to reduce CV risk / to protect heart
- Informed the patient I would make the recommendation
to his doctor; and he would be informed of next steps
after we hear back from the doctor
- If agreed upon, we will fill and counsel more about the
new medicine at the time of pick up; as well as provide an
updated med list

n/a - patient needs additional drug
therapy

2
1
3 Documentation template
for next similar scenario!
Whether for ODB patient,
4 6
or not
Be proactive and seek
similar scenarios, or have
template ready for the
next encounter

Scenario 2 – Diabetes MedsCheck Ed Follow Up
Scenario: Improper sharps disposal
Patient: “A. Diabetic”

Age: 40 years old
Meds: Metformin 500mg BID, Atorvastatin 10mg HS
Outcomes: Meeting glycemic targets
BGSM: 1-2 times a week
Disposes of lancets and strips in garbage or fireplace 
Exercise: Write up the documentation for a

MedsCheck for Diabetes Education Follow Up.
Make your comments concise!

Scenario 2 – Diabetes MedsCheck Ed Follow Up
• Diabetes Education Checklist
- list of different subjects including insulin education if applicable to be covered
during MedsCheck diabetes education sessions; and should be addressed
according to the patient’s needs, learning capabilities and the pharmacist
availability
• Diabetes education and training are based on the Diabetes Canada

Clinical Practice Guidelines and include different subjects such as
- insulin education
- advice on blood glucose meters and test strips
- diabetes supplies
- drug and sharps disposal
- diet and lifestyle management
http://www.forms.ssb.gov.on.ca/mbs/ssb/forms/ssbforms.nsf/FormDetail?OpenForm&ACT=RDR&TAB=PROFILE&SRCH=1&ENV=WWE&TIT=4969&NO=49
69-47E
http://www.health.gov.on.ca/en/pro/programs/drugs/medscheck/docs/guidebook.pdf

Scenario: Improper sharps disposal / Diabetes Education Patient Take-Home Summary
Summary of today’s discussion:
• Dialog with patient revealed improper lancet
(sharps) disposal - garbage and fireplace.
• Pharmacist educated patient about hazards of
improper sharps disposal - potential
inadvertent "needle injury" to others handling
garbage throughout the disposal process;
environmental hazards of burning plastic in
your home, and having sharps tips / metal bits
in the fireplace.
• Pharmacist educated patient about safe sharps
disposal - type of containers to use, availability
of free safe containers, where to dispose of full
containers and get new containers.

Goal:
Practice safe lancet disposal –
both from a safety and environmental
perspective.

What I will do to get there:

Use proper sharps container to dispose
of used lancets.
Return full containers to the pharmacy
(not throw in garbage).

List of resources & contacts:

Stewardship Ontario brochure.
Sharps container with pharmacy
contact info attached.

Referrals information:
Referral to pharmacy staff for disposal
of full sharps container, and getting a
new sharps container in the future.

Scenario: Improper sharps disposal / Diabetes Education Checklist
Pharmacists comments on drug

therapy:
Statin started recently.
Adherent / compliant with
medications.

• Nothing on page 2 specific to scenario

• Can still complete other fields as known

Training on use and disposal of

diabetes supplies (needles, lancets):
Lancet disposal (was throwing in
garbage or fireplace)
Other material given to the patient:

Stewardship Ontario brochure (safe
sharps disposal)

Summary of today’s discussion:

• Lancet/sharps disposal - identifying
improper disposal issue
(garbage/fireplace), explaining personal
safety and environmental hazards of
current practice, education on proper
disposal, provision of a sharps container,
education where to return full container
and get a new container.
• Patient agreed to recommendations.

Summary of discussion to be added to

Patient Take-Home Summary:
• Pharmacist educated patient about
hazards of improper sharps disposal –
in garbage/fireplace
• Pharmacist educated patient about
safe sharps disposal

Reaching the goal:

Patient agreed to
• practice safe sharps disposal
• use a sharps container (provided)
• return the full container to the
pharmacy (not throw in garbage)

Wrap-up Encouragement
• Take the time to make documentation sets
 Build them to be compliant and audit-worthy

• Make the time to use them
 Appointment-based medication synchronization business model
 Additional staff to capture your opportunities

• Make the time to use them
 Appointment-based medication synchronization
 Additional staff to capture your opportunities
• Make the effort to bill for your services!
 Start with the care you naturally give
 Get efficient with documentation for your usually billed services
 Add documentation templates to facilitate billing for other care you
provide but are not currently getting paid for
 Your company’s financial health = your financial and workplace health
 Our professional obligation to make a consultation-based model
beneficial and viable

Additional Resources
• Appointment-based model medication synchronization
 www.PharmacyU.ca
 APhA resources http://www.aphafoundation.org/align-my-refills
 GSC article https://www.greenshield.ca/en-ca/news/post/getting-in-
sync-improving-adherence-through-medication-synchronization
• OPA Tools and Forms for Your Practice

 https://www.opatoday.com/professional/resources/for-
pharmacists/tools-and-forms
• OPEN
 http://www.open-pharmacy-research.ca/research-projects
• CPhA resources
- https://www.pharmacists.ca/education-practice-resources/patient-care

References & Suggested Reading
• Pharmacists’ Scope of Practice in Canada
https://www.pharmacists.ca/cpha-ca/assets/File/cpha-on-the-issues/ScopeofPracticeinCanada_Dec2018.pdf
• Publicly Funded Services by Province
https://www.pharmacists.ca/cpha-ca/assets/File/pharmacy-in-canada/Publicly-Funded%20Pharmacy%20Services%20by%20Province(1).pdf
• Fees and Claims Data for Government-Sponsored Pharmacy Services, by Province
https://www.cfpnet.ca/en/news/details/id/263
• Self-Monitoring of Blood Glucose (SMBG) Recommendation Tool for Healthcare Providers
http://guidelines.diabetes.ca/BloodGlucoseLowering/SMBGRecommendationSheet?_ga=2.237862400.1296937545.1524452322-
1832535714.1524452322
• MOHLTC / OHIP / ODB Paid Pharmacy Activities
http://www.health.gov.on.ca/en/pro/programs/drugs/medscheck/resources.aspx
http://www.health.gov.on.ca/en/pro/programs/drugs/pharmaopinion
http://www.health.gov.on.ca/en/pro/programs/drugs/smoking
https://www.opatoday.com/professional/resources/for-pharmacists/programs/methadone
https://www.opatoday.com/professional/resources/for-pharmacists/tools-and-forms/naloxone
http://www.health.gov.on.ca/en/pro/programs/publichealth/flu/uiip
https://www.opatoday.com/professional/resources/for-pharmacists/tools-and-forms/FrequentofDispensingandCompliancePackaging
http://www.health.gov.on.ca/en/pro/programs/drugs/odbf/exempted_medications.pdf
http://www.health.gov.on.ca/en/pro/programs/drugs/ohipplus/docs/ohip_pharmacist.pdf
https://www.opatoday.com/professional/resources/for-pharmacists/programs/colon-cancer-check

• Green Shield Canada Paid Pharmacy Activities
https://www.providerconnect.ca/HealthCoaching/ProgramInformation.aspx
https://www.providerconnect.ca/SmokingCessation/Intro.aspx
https://www.providerconnect.ca/Carriers/GreenShield/Forms/en_CA/Exception-Request-Compliance-Packaging-
Maintenance-Fill-Limits.pdf
https://www.providerconnect.ca/AdminContent/Forms.aspx?type=pharmacy
https://cfpnet.ca/bank/document_en/120-2017-cfp-pharmacy-forum-report.pdf
• Medavie Blue Cross Paid Pharmacy Activities
https://www.medaviebc.ca/en/health-professionals/resources
• Pharmaceutical Opinion / Statin Use in Diabetes
https://www.opatoday.com/professional/resources/for-pharmacists/tools-and-forms/pop
• MedsCheck for Diabetes Education Follow-Up

http://www.forms.ssb.gov.on.ca/mbs/ssb/forms/ssbforms.nsf/FormDetail?OpenForm&ACT=RDR&TAB=PROFILE&SRCH=1&
ENV=WWE&TIT=4969&NO=4969-47E
http://www.health.gov.on.ca/en/pro/programs/drugs/medscheck/docs/guidebook.pdf

• Appointment-based model medication synchronization
PharmacyU.ca
http://www.aphafoundation.org/align-my-refills
https://www.greenshield.ca/en-ca/news/post/getting-in-sync-improving-adherence-through-medication-
synchronization
• OPA Tools & Forms for Your Practice
https://www.opatoday.com/professional/resources/for-pharmacists/tools-and-forms
• OPEN
http://www.open-pharmacy-research.ca/research-projects
• CPhA resources
https://www.pharmacists.ca/education-practice-resources/patient-care

Thank you –
Now go get paid for the good work
and patient care you are doing!

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Opportunities and Timesavers

© Ontario Pharmacists Association 1

• Relationships with commercial interests:

• Speaking Fees for current program:

© Ontario Pharmacists Association 2

• This program has received no financial or in-kind support

© Ontario Pharmacists Association 3

1. Identify and describe paid consultations and non-

© Ontario Pharmacists Association 4

© Ontario Pharmacists Association 5

© Ontario Pharmacists Association 6

© Ontario Pharmacists Association 7

© Ontario Pharmacists Association 8

© Ontario Pharmacists Association 9

Edit in Quizmaker Edit Properties

© Ontario Pharmacists Association 10

Where can you get information about a variety of

□ Ontario Pharmacists Association (OPA)

© Ontario Pharmacists Association 11

© Ontario Pharmacists Association 12

© Ontario Pharmacists Association 13

© Ontario Pharmacists Association 14

© Ontario Pharmacists Association 15

© Ontario Pharmacists Association 16

© Ontario Pharmacists Association 17

© Ontario Pharmacists Association 18

Edit in Quizmaker Edit Properties

© Ontario Pharmacists Association 19

© Ontario Pharmacists Association 20

GSC Frequent Dispensing

© Ontario Pharmacists Association 21

GSC Frequent Dispensing

GSC Patient-Impact Scorecards

© Ontario Pharmacists Association 22

MBC – Managing Chronic Disease Service (MCDS)

© Ontario Pharmacists Association 23

MBC – Managing Chronic Disease Service (MCDS)

• Open to all certified HCPs – CRE, CAE, CTE, CDE,

© Ontario Pharmacists Association 24

MBC – Managing Chronic Disease Service (MCDS)

• Open to all certified HCPs – CRE, CAE, CTE, CDE,

• Payment amount plan dependent

© Ontario Pharmacists Association 25

Edit in Quizmaker Edit Properties

© Ontario Pharmacists Association 26

© Ontario Pharmacists Association 27

Charge for it!

© Ontario Pharmacists Association 28

Charge for it!

© Ontario Pharmacists Association 29

© Ontario Pharmacists Association 30

Charge for it!

© Ontario Pharmacists Association 31

Charge for it!

© Ontario Pharmacists Association 32

© Ontario Pharmacists Association 33

© Ontario Pharmacists Association 34

© Ontario Pharmacists Association 35

© Ontario Pharmacists Association 36

© Ontario Pharmacists Association 37

© Ontario Pharmacists Association 38

© Ontario Pharmacists Association 39

© Ontario Pharmacists Association 40