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.

Reflections on President Obama’s Substance Abuse Forum: A Perspective From Two Student Pharmacists

Contributed by: Jeremy Arthur (Class of 2017) and Randal Steele (Class of 2016)

To view a video interview published by WOWKTV, please click here.

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Randal Steele (Class of 2016), Jeremy Arthur (Class of 2017), and Dean Easton at the Substance Abuse Forum

The Community Forum with President Barack Obama held on Wednesday, October 21, 2015 at Charleston’s East End Resource Center was an incredible, once in a lifetime experience for us. We believe the discussion will provide impetus for further action towards addressing the prescription opiate and heroin abuse epidemic occurring not only in West Virginia but throughout the United States. Sadly, as reported by the Charleston Gazette-Mail (10/17/15), West Virginia leads the nation in overdose deaths. In the U.S., overdose deaths involving prescription pain relievers rose more than 300 percent from 1999 through 2011, leading the Centers for Disease Control and Prevention (CDC) to declare these deaths an epidemic. Deaths associated with heroin overdose have also increased significantly over the last three years.

While the discussion took place in WV, the forum presented a bipartisan recognition that this epidemic does not discriminate—both rural and urban communities deal with prescription drug and heroin abuse—no one is exempt. Specifically, President Obama indicated that substance abuse is not isolated to one community—it can impact anyone regardless of their socioeconomic background. The focus of the discussion was the President’s plan for prevention and recovery.

The President’s 2016 budget proposed critical investments to intensify efforts to reduce opioid misuse and abuse, including $133 million in new funding to support prevention and education activities. It also focuses on helping individuals sustain their recovery from opioid use disorders. For example, Medication-Assisted Treatment (MAT) is an important tool for the treatment of opioid use disorders, but is too often out of reach for vulnerable populations.  The President’s plan is to make these programs more accessible to those in recovery and those seeking recovery and treatment.

One facet of drug abuse discussed during Wednesday’s forum was the impact of the epidemic on America’s youth. The increase of prescription medication abuse in children and adolescents is likely due to the misconception that prescription medications are safer than illegal substances and therefore, less likely to cause abusive behaviors. Many individuals view prescription medications as “safer” simply because they are prescribed by healthcare professionals. Providing education to today’s youth is imperative in curbing the progression of the prescription medication abuse epidemic. Educating children from a very young age about the danger of prescription medication and illegal drug use is a key prevention strategy according to the President. He explained that children are “sponges” for knowledge.

Pharmacists can and should help with prevention and treatment strategies in a number of ways including education at the pharmacy counter. In fact, prevention through education is an area where student pharmacists and pharmacists can have a large impact. By promoting safe and effective medication use to children, we can dispel any myths that encourage experimentation that may lead to abuse in children and adolescents. Education specifically aimed at parents and adults should center on secure medication storage and proper disposal. Keeping medications out of the hands of children or adults who intend to misuse them is key in preventing diversion. Pharmacists and student pharmacists can aid in proper medication disposal by partnering with local law enforcement and other agencies that specialize in medication removal to ensure that unused/unwanted medications do not contribute to someone’s addiction.

While the pharmacist’s role in preventing this epidemic and assisting with patient recovery wasn’t acknowledged specifically at the community event, we know pharmacists are integral to discussion, education, prevention, treatment, and recovery. As we gain recognition as valued members of the healthcare team, our role will become more apparent, whether we are educating patients, coordinating care with physicians, or facilitating the sale of naloxone to help with opiate overdoses. With the awareness raised by the event, along with pharmacist’s expanding role, we hope to see rates of recovery finally outgrowing rates of substance abuse deaths and in turn, see healthier communities—both rural and urban.