Posted on April 15, 2018 in: Professional Practice
By Curtis Smith, Pharm.D., BCPS, FCCP, professor, Sparrow Hospital and Ferris State University, Lansing
This year, Michigan Society of Health-System Pharmacists (MSHP) President MacDonald chose “Demonstrating Our Value” as the MSHP theme. In February and March, John Clark and Dana Staat, respectively, wrote in the MSHP Monitor about the importance of advancing each of our practices, including the use of pharmacist extenders like pharmacy technicians and students. As I considered what to share related to the value of a pharmacist, my first thought was “aren’t we already valued?” Healthcare providers share with me all the time the importance and their appreciation of having pharmacists directly involved in patient care. And I don’t think that I’m unique in receiving these comments. So my next thought was: “Maybe we just haven’t documented our value.” But there are countless published articles about how pharmacists improve patient care and save money at the same time (just look at the March 2018 issue of Journal of the American Medication Association – Internal Medicine).1 In fact, the American Pharmacists Association has developed and published a document titled “Pharmacist‐delivered Patient Care Services Evidence Examples” that reviews the evidence supporting pharmacist value.2
So what more do we need to do? Obviously continuing to advance our skills and market our services is important. We can also publish even more articles about the value of a pharmacist and loudly disseminate the results to legislators, administrators and other healthcare providers. But maybe the problem is not so much our profession or the lack of data demonstrating our worth, but rather our healthcare system.
We are in the midst of a major change in healthcare in the US from a primarily fee-for-service model to a value-based model of reimbursement. Although this shift has started, fee-for-service continues to dominate (in fact, the push for provider status for pharmacists was established and is still based on a fee-for-service model). Because of this, our healthcare system remains physician-centered, service-heavy, costly, and arguably, lacking in quality. In this model, pharmacists are frequently left behind.
In a recent editorial in the New England Journal of Medicine Catalyst, Kaplan and Blackmore argue that physicians have both actively and passively resisted moving to a value-based model of reimbursement. Physician organizations have also lobbied against a change to value-based payments. Kaplan and Blackmore suggest that this stance is misguided based on ethical, professional and business reasons. However, because of this resistance, as well as other reasons, changing our reimbursement model remains slow. In fact in 2017, policy uncertainty in Washington related to value-based reimbursement led to a noticeable slowing of healthcare organizations implementing key changes necessary to move from fee-for-service to value-based care.4
A move to value-based care and reimbursement will be a boon for pharmacists. With our knowledge and skills, we will be one of the most important healthcare providers to ensure quality outcomes in the U.S. population. Our enhanced presence in hospitals (including the transitions of care process), ambulatory clinics, patient-centered medical homes and community pharmacies will improve outcomes and patient well-being (we have the data to back that up!). So, we need to be an integral part of this shift and not sit on the sidelines. On March 5, 2018, the new Secretary of Health and Human Services, Alex Azar, re-ignited the shift to value-based care by stating that “today’s healthcare system is simply not delivering outcomes commensurate with its cost.” He stressed one of the biggest challenges is that the U.S. healthcare system is “paying for procedures and sickness” instead of “outcomes and wellness.”5 Also, on March 22, 2018, four representatives in Congress launched the Health Care Innovation Caucus. These representatives noted that “...with the healthcare industry rapidly transforming from a volume-driven system to one that rewards value and outcomes, it is vital that we maintain this acceleration by encouraging a marketplace of multiple payment models.” Their main focus will be “...to explore and advance successful, innovative payment models as well as the technologies needed to support these models.”6
So yes, it is vitally important to demonstrate our value – every day. But, it’s just as important that we are an integral part of the ongoing shift to value-based care and reimbursement. This year as you consider ways that you can demonstrate and document the value of your services, consider also encouraging your representatives in Congress to actively support the move to value-based care and reimbursement. The recent efforts pharmacy has invested in obtaining provider status should, just as importantly, continue in this area.
1.Ravn-Nielsen LV, Duckert ML, Lund ML, et al. Effect of an In-Hospital Multifaceted Clinical Pharmacist Intervention on the Risk of Readmission: A Randomized Clinical Trial. JAMA Intern Med. 2018 Mar 1;178(3):375-382.
2. American Pharmacists Association. Pharmacist‐delivered Patient Care Services Evidence Examples. American Pharmacists Association website. http://www.pharmacist.com/sites/default/files/EvidenceforPharmacistsServices2000-2016.pdf. Accessed March 29, 2018.
3. Kaplan GS, Blackmore C. Time to Sink the Two-Canoe Argument. NEJM Catalyst website. https://catalyst.nejm.org/sink-two-canoe-payment-models/. Accessed March 29, 2018.
4. Belliveau, J. Slow and Steady Still the Motto for Value-Based Reimbursement. RevCycle Intelligence website. https://revcycleintelligence.com/news/slow-and-steady-still-the-motto-for-value-based-reimbursement. Accessed March 29, 2018.
5. Remarks on Value-Based Transformation to the Federation of American Hospitals. U.S. Department of Health and Human Services website. https://www.hhs.gov/about/leadership/secretary/speeches/2018-speeches/remarks-on-value-based-transformation-to-the-federation-of-american-hospitals.html. Accessed March 29, 2018.
6. Rep. Kelly Launches Bipartisan Health Care Innovation Caucus. U.S. Representative Mike Kelly website. https://kelly.house.gov/press-release/house-leaders-launch-bipartisan-health-care-innovation-caucus. Accessed March 29, 2018.