by Frank Zaran, R.Ph., clinical pharmacist specialist - drug informatics, Detroit Receiving Hospital and MSHP Immediate Past President
In MSHP President Jesse Hogue’s January article, “Changing Gears,” he selected pharmacist provider status, as his theme for the year. In announcing the theme, Jesse stated, “I believe that this issue is THE MOST IMPORTANT ISSUE for pharmacy that any of us will see in our professional lifetimes.” In her February article, “A long time ago, in a pharmacy far, far away: Provider status,” President-elect Dana Staat, takes off from Jesse’s firing of the starter’s gun and quickly accelerates into hyperspace. She identifies three areas of anxiety associated with our profession obtaining provider status and how to address them with the education of pharmacists, patients and other healthcare professionals.
But, the course to victory is not without some twists and turns. So, let’s get ready to down-shift as we enter the next corner and then stomp on the gas and ratchet up through the gears coming out of the turn.
Provider status alone will not change how we practice. It is merely the first step. Provider status will; however, allow us to be reimbursed by Medicare for the cognitive services we provide. This will lead to recognition by other insurers as providers and subsequently reimbursement from them, as well.
As pharmacists, we’ve long recognized that there are additional services that we could provide to benefit our patients except for the lack of resources which can be attributed to not being compensated for those services. Reimbursement for cognitive services will provide the necessary incentives to inpatient, outpatient, and ambulatory employers to expand pharmacy services that will ultimately benefit patients and reduce overall healthcare expenditures with regards to fewer adverse medication events, improved patient outcomes and reduced emergency room visits and hospital admissions.
As Jesse and Dana point out, we need to think about the opportunities that provider status offers to the practice of pharmacy to benefit our patients. Some examples can be found in recent legislation passed in California, Washington, Oregon and Ohio regarding collaborative practice and accountable care organizations. These include administration of drugs and biologics ordered by prescribers; provide consultation, training and education about drug therapy; disease management and prevention; prescriptive authority to renew certain types of medications; dispense self-administered hormonal contraceptives (per protocol); furnish CDC-recommended travel medications, provide prescription nicotine products for smoking cessation (per protocol); order and interpret laboratory tests for monitoring and managing drug therapy (in coordination with patient’s physician); perform patient assessments; and refer patients to other healthcare providers.
But, we shouldn’t stop there. Other possible practice areas may include diabetes, asthma, blood pressure management, geriatrics, pediatrics and psychiatry. Anywhere there’s a shortage of providers or difficulty in obtaining access to a physician is an opportunity for a collaborative pharmacy practice. In fact, at the VA ambulatory care practice, pharmacist specialists have prescriptive authority for many medications and are responsible for managing the drug therapy of their patients, who they see by appointment.
In Michigan, it’s already possible for pharmacists to enter into collaborative practices with physicians; however, provider status means that we can be directly reimbursed for these services. This may finally provide the financial incentive for pharmacies and health-systems to invest in providing these services, which can address this patient need and prevent unnecessary emergency room visits, hospitalizations and costs associated with delays in or management of drug therapy. Such services provide the financial incentives for CMS, insurers and even patients to pay for such services. For example, a physician-collaborated pilot program overseen by Michael Klepser, Pharm.D. of Ferris State University, has community pharmacists clinically assessing patients and when appropriate using rapid diagnostic tests to determine if a patient has the flu or strep. Based on their findings, patients may be treated with oseltamivir, an antibiotic or when necessary referred to their physician, an urgent care clinic or the emergency room. By the way, in this pilot project, patients are willing to pay for this service out of their own pockets, seeing that it was not only quicker than waiting to see a physician, but also cheaper.
Last July, CMS proposed a rule that would require that long-term care facilities reconcile all of a patient’s pre-discharge medications (prescription and OTC) with their post-discharge medications, as part of the discharge summary to be communicated to the primary care provider. We, in pharmacy, are more capable than any other healthcare profession to conduct this reconciliation; however, without provider status, we are not eligible to be paid for this service. The thing is, by leveraging the use of pharmacy technicians and technology, we can provide this service better and cheaper than other professions. In Michigan, some hospitals are already using pharmacy technicians in this role and in some cases, technicians are also handling third-party prior authorizations, a service that not only ensures that patients receive the medications they need upon discharge, but may also help to avoid delayed discharges or even prolonged hospital stays, as well as, potentially future (re-)admissions.
However, provider status means more than just being eligible for reimbursement. It's recognition of the role that pharmacists play in patient care. Recognition by not just CMS and subsequently other third party insurers, but also by other members of the healthcare team. It provides the opportunity for us to be seen as a partner (co-owner if you will), in our patients’ outcomes and not just a trustworthy member of the pit crew.
So let’s step on the gas and head for that checkered flag!