Provider Status and Pharmacists: What’s the Connection?

Healthcare delivery in the United States and around the world faces various challenges including increased cost, improving quality, and reduced access. More people have the benefit to receive care and live healthy lives, however, there is a shortage in the number of healthcare professionals available to provide their care. By 2025 there is a projected fall in the availability in the number of physicians in the United States based on the huge gap in the supply and demand in this field. Costs are rising because the few available physicians must work more to accommodate all patients. This creates a unique opportunity for pharmacists to provide care to patients, especially if they receive official national recognition as healthcare providers and given the right to expand the services allowed under their scope of practice.

Per the Department of Health and Human Services, it is projected that there will be about 368,000 active pharmacists in the United States by 2030. By then, the general population will increase in number as well, making the need for healthcare professionals rise even further. Pharmacists are among the most trusted healthcare professionals due to their availability and personal relationships with their patients. However, in the Social Security Act, pharmacists are not formally recognized as healthcare providers. Even though they work in a wide-reaching field ranging from clinical specialties, to community/retail pharmacies, geriatrics, ambulatory care, and industry and research, they have not been given the privilege to be fully accepted as providers, and thus, cannot bill Medicare Part B for their services. This is the reason why all pharmacists must support and advocate for the provider status movement which was initiated in March March 2014.

Another reason why pharmacists should be recognized as providers is their status as health care professionals with extensive, thorough, and specific knowledge about drugs. Pharmacists have increased availability to patients, especially those in rural/underserved areas, and often work extended hours. A patient can walk into a community pharmacy at any time of the day to ask questions regarding any health concerns, medications being taken, or anything pertaining to their health and have a trained professional there to assist them. This means that, at some levels, pharmacists spend more time with their patients than physicians. Pharmacists often see the same patients come to the store everyday just to have conversations, which allows them to become more familiar with the patients and develop personal relationships with them. These relationships create trust between both sides and trust happens to be to the number one value that health care professionals need for their patients to believe that they are receiving the best care possible. Physicians have limited time to spend with their patients, and their encounters are very limited, which is why developing personal relationships and higher levels of trust with their patients is more difficult than that of pharmacists.

It’s easy to see how pharmacists play an important role in providing efficient and high-quality patient care. Pharmacists have vast knowledge regarding drugs, and are valuable for drug therapy management. With the introduction of Point Of Care Testing (POCT), most pharmacists have the ability to provide primary basic care to patients even when visiting local community pharmacies. Therefore, it is necessary for pharmacists to be formally recognized as providers so they can reach their full potential as professionals and help more patients receive the adequate health care they deserve.

Contributed by Koffi Amegadje, NCPA Community Outreach Chair, Class of 2020

The Road to Pharmacist Provider Status

Contributed by: Anojinie Karunathilake, Class of 2017

P1070662Background of Pharmacy

Pharmacy practice has evolved from dispensing medications to a comprehensive clinical, consultative, educational and a more patient centered practice. The value of pharmacist services in collaborative drug therapy management is widely recognized. Pharmacists continue to hold highest ratings as the most trusted healthcare professionals in Gallup Poll. Given this recognition by patients, it is important that pharmacists continue to provide high quality patient care and increase services that are provided to patients, which can be further enhanced by pharmacists obtaining the provider status.

What is provider status?

‘Provider status’ at the federal level consists of a listing of healthcare professionals included in the Social Security Act (SSA) whose services are eligible for Medicare Part B reimbursement. These healthcare professionals include physicians, physician’s assistants, certified nurse practitioners, qualified psychologists, clinical social workers, certified nurse midwives and certified registered nurse anesthetists1.

Title XVIII of SSA that describes provider status does not recognize pharmacist services as eligible for reimbursement under Medicare.   In Medicare part B, pharmacists are omitted as listed providers which limits access to pharmacists services to Medicare beneficiaries2,3.

Legislation

HR 5924 (House of Representatives) and S. 3145 (Senate) are written to amend title XVIII of Social Security Act to provide coverage under Medicare program of pharmacist services. This act is also known as the ‘Pharmacy and Medically Underserved Areas Enhancement Act’

Role of the Pharmacist

Many Americans do not have access to primary healthcare and is expected to get worse as the Medicare enrollees are expected to grow in the future. According to Health Resources and Services Administration (HRSA)- U.S. Department of Health and Human Services, Medically Underserved Areas/Populations (MUA/MUP) is defined as “having too few primary care providers, high infant mortality, high poverty or a high elderly population”6. Many areas in West Virginia state are considered as medically underserved areas6. Pharmacists obtaining provider status will help patients in MUA gain access to pharmacists’ services, which increase their quality of life, health outcomes and cost-effectiveness.

According to a report brief published by Institute of Medicine, there are at least 1.5 million preventable adverse drug events (ADE) that occur in the U.S. every year7. These ADE are costly for patients as well as their employers, hospitals and insurance companies. Being a trusted healthcare professional with direct access to patients, pharmacists can provide educational services to reduce incidents of ADE.

Medication adherence also is an area where a pharmacist can make a significant impact. Poor medication adherence estimated to cost around $100 billion a year in the U.S., is a reason for 33-69% of all medication-related hospital admissions8. Especially, almost 50% of patients with chronic diseases do not take their medication properly9.   By increasing pharmacist services through provider status, pharmacists can help improve patients’ medication adherence as well as disease management.

Current Situation

Many pharmacy organizations and several chain pharmacies have been instrumental in advocating for the provider status for pharmacists. Many are involved in writing letters to their representatives in Congress encouraging them to support provider status bill. Currently, a majority of U.S. House have co-sponsored H.R. 59210.

With the momentum building and many more supporters joining to advocate for H.R. 592/S. 314, hopefully pharmacists’ contributions towards healthcare teams and patient services will be recognized as an integral part of healthcare in the near future.

References

  1. APhA. Provider Status: What pharmacists need to know now. 2013. http://www.pharmacist.com/provider-status-what-pharmacists-need-know-now. Accessed January 6, 2016.
  2. ASHP. A bill to amedn title XVIII of the Social Security Act to provide for coverage under the Medicare program of pharmacist services. 2015. http://www.cqrcengage.com/ashp/app/bill/487919. Accessed January 5, 2016.
  3. O’Brien JM. How nurse practitioners obtained provider status: Lessons for pharmacists. Am J Heal Pharm. 2003;60:2301-2307. http://www.medscape.com/viewarticle/464663.
  4. Congress.org. HR 592- Pharmacy and Medically Underserved Areas Enhancement Act. 2015. https://www.congress.gov/bill/114th-congress/house-bill/592/text?q={“search”:[“HR+592”]}. Accessed January 6, 2016.
  5. Congress.org. S.314 – Pharmacy and Medically Underserved Areas Enhancement Act. 2015. https://www.congress.gov/bill/114th-congress/senate-bill/314/text?q={“search”:[“S.+314”]}. Accessed January 6, 2016.
  6. HRSA DHHS. MUA Find. http://datawarehouse.hrsa.gov/tools/analyzers/muafind.aspx. Accessed February 14, 2016.
  7. Medicine I of. Preventing Medication Errors: Report Brief. 2006. https://iom.nationalacademies.org/~/media/Files/Report Files/2006/Preventing-Medication-Errors-Quality-Chasm-Series/medicationerrorsnew.pdf. Accessed January 6, 2016.
  8. Osterberg L, Blaschke T. Adherence to medication. N Engl J Med. 2005;353:487-497. doi:10.1056/NEJMra050100.
  9. APhA. Improving Patient Care. 2015. http://www.pharmacist.com/sites/default/files/files/Making the Case (2015).pdf. Accessed January 7, 2016.
  10. APhA. An Update from Tom Menighan, CEO of APhA. 2015. http://echo4.bluehornet.com/hostedemail/email.htm?CID=31858955709&ch=59FBFD48BBC77F7D250F6152F0853DFB&h=101a58de85df02e6330c32f53b58b43c&ei=7dMpdFyNK. Accessed January 7, 2016.

Students Visit Capitol Hill

When applying to a pharmacy school, students must consider the plethora of opportunities the school can offer them. “What can this school offer to me? Why UCSOP instead of another school?” One of the reasons the University of Charleston School of Pharmacy is often chosen is because of its focus on a small, tight-knit community as well as its efforts in advocacy. Students are encouraged to advocate for their profession, and help push health care forward,  locally and nationally.

Katie Oliver and Brian Hancock on Capitol Hill

Katie Oliver and Brian Hancock on Capitol Hill

Proactive students, like Katie Oliver (P2) and Brian Hancock (P2), make the most of these opportunities. When offered the chance to travel to Washington, D.C., the two jumped at the possibility to meet with congressmen and women. The goal was to educate Senators and Representatives on the benefits of granting pharmacists “provider status,” which would expand a pharmacist’s role and allow them to be paid for various new services. Katie’s reflection of the event gives upcoming students an idea of what a student-pharmacist can accomplish.

Katie: “I was recently given the opportunity to visit Capitol Hill in Washington D.C. where I met with several congressman in order to advocate for Pharmacist Provider Status. I was provided the opportunity through Student Society of Health-System Pharmacists, a national student pharmacist organization that is available for membership at the University of Charleston.

I am grateful to have had this experience because it taught me the importance of advocating on behalf of the profession of pharmacy. Throughout my visit I was able to have a personal meeting with four United States congressmen regarding provider status for pharmacists in medically under served areas, a topic that could drastically change health care as well as pharmacist-patient interactions.  The congressmen were very responsive and interested in our views, most importantly how Provider Status for pharmacists would impact the lives of our patients.

After our visit to Capitol Hill, numerous additional congressmen signed on as cosponsors to the corresponding Provider Status bill. The experience revealed to me that many congressmen unfortunately do not have a background in health care. This is why it is imperative that we advocate on behalf of our profession and patients. I would strongly encourage any student or potential student to become involved in advocacy events. Change can be seen based on a few citizens’ actions.”

Thank you to Katie Oliver for helping with this post! Keep up the good work!

Contributed by Peter Relvas UC SOP Pharmacy Student & Graduate Intern, Office of Professional and Student Affairs.