Posted on September 13, 2019 in: Professional Practice
By Lynette Moser, Pharm.D., associate clinical professor, Wayne State University, Detroit
The importance and process of credentialing and privileging pharmacists are crucial discussions as the profession of pharmacy prepares for provider status; be it through national, state or third party payer designations. In 1999, 10 professional pharmacy organizations formed the Council on Credentialing in Pharmacy (CCP) to create resources to assist organizations and individuals who choose to introduce credentialing and privileging for pharmacists in any health care setting.1 Their work resulted in a resource paper that was published in 2014.2
A pharmacist’s credentials validate the individual’s education through licensure, practice experience and specialty board examination. Training programs within an institution that culminate in a competency assessment may also be considered a credential. An institution will consider a variety of credentials in their “credentialing” process, which may then support the “privileging” of pharmacists and expanded pharmacy services. Privileging is the process by which an institution grants an individual the right to perform specific duties.
The Michigan Society of Health-System Pharmacists (MSHP) Committee for Professional and Legal Affairs has been charged with evaluating the status and providing recommendations for credentialing and privileging of pharmacists in Michigan. Current interpretation of the Michigan Public Health Code gives pharmacists broad latitude to provide patient care services. As we advocate for provider status, we want to assure that pharmacy practice in the state maintains a focus of providing care to patients with all disease states and includes all drug therapy. Credentialing and privileging efforts may have a focus on specific therapies and disease states. Credentialing and privileging can benefit pharmacy departments and pharmacists by assuring competency, enhancing the scope of practice for pharmacists and demonstrating pharmacists’ value in the patient care setting. Patients will benefit from increased access to care (particularly in the ambulatory setting) and improved quality and safety. Institutions should see a benefit from a reduction in uncompensated care encounters, improved billing using a broader range of billing codes and ongoing assurance of quality and competency by pharmacists care providers (as part of the credentialing process).
When a pharmacy department decides to establish a credentialing process, they first need to assure support of leaders within the health system. A concise, cogent argument for the process to the corporate suite should focus on improved quality, patient satisfaction and cost savings/increased reimbursement. Data are available in the primary literature to support these benefits and should be shared. However, there is limited data highlighting which aspects of the pharmacist’s clinical role are the most effective and cost-effective.3 Pharmacists and pharmacy departments should take every opportunity to document and publish their work to demonstrate improved quality and cost savings. This will provide support for expansion of pharmacy services on a broader scale.
After obtaining institutional support for credentialing and privileging, each institution must determine which clinical services to provide, what external credentials will be accepted and expected, and what internal processes to use to assure pharmacists competency to provide high quality patient care services.
Pharmacist credentialing and privileging provides a process to allow our pharmacists to optimize their services and further validates a pharmacist’s education, licensure, practical experience, and preparation for specialty care by the institution. This is the same process currently used for midlevel providers such as nurse practitioners or physician assistants. A credentialed and privileged pharmacist can be granted the authority to perform specific services that can be billed as a provider in addition to the facility visit. MSHP will be providing a document that may be used to make the argument for privileging and credentialing to the corporate suite; as well as a guidance document for the pharmacy department to use in implementation.
1. Council on Credentialing in Pharmacy. Guiding principles for post-licensure credentialing of pharmacists . http://www.pharmacycredentialing.org/Files/GuidingPrinciplesPharmacistCredentialing.pdf (accessed July 23, 2019).
2. Council on Credentialing in Pharmacy. Credentialing and privileging of pharmacists: A resource paper from the Council on Credentialing in Pharmacy 2014;71:1891-1900.
3. Dalton K, Byrne S. Role of the pharmacist in reducing healthcare costs: Current insights. Integr Pharm Res Pract 2017;6:37-46.