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Sound Off: Pharmacists as Providers

Created 07.25.12 by Chivas Owle
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Editor’s Note: This is the second installment of SDN’s new opinion column, “Sound Off.” If you are interested in submitting a column for publication, please visit the SDN Help Center to send a message to our Editor in Chief.

Recently pharmacists have been branching out further and further from the traditional dispensing role and gaining more and more acceptance as healthcare providers. Pharmacists have proven time and time again that we can positively impact patient outcomes on a cost effective basis. In spite of our recent advancements though there is one major hurdle that prevents pharmacists from living up to our full potential as healthcare providers – reimbursement. Until pharmacists are recognized in legislature as healthcare providers our ability to serve our patients to our full potential will be hindered.

One petition to have pharmacists recognized as providers, found at http://www.change.org/petitions/the-…care-providers, has this to say:

“Despite overwhelming evidence of the positive impact pharmacists can have on patient health, pharmacists are not recognized as healthcare providers under the Social Security Act and, therefore, cannot be paid by Medicare for therapy management and patient consultation services. The Social Security Act does recognize other healthcare professionals such as dieticians, nurse practitioners, physician assistants, nurse midwives, and clinical social workers. By changing the compensation structure allowed under Medicare, we can ensure that patients have access to the medication expertise of pharmacists. Studies have shown that when a pharmacist is directly involved in patient care, patients have fewer adverse drug reactions, experience improved outcomes, and healthcare costs are reduced. The perils of adverse effects from taking multiple medications affect all age groups. According to a recent survey, just over half of all Americans take at least 2 medications each day and nearly one-third take 4 or more medications each day. For the Medicare population, medication use is even higher — nearly half of Americans aged 65 and older take at least 4 medications each day. This is a critical safety issue!!”

Not every pharmacist agrees that this is the best use of political capital however. Thomas Menigham, BS Pharm, MBA, ScD, FAPhA, in an article recently published in Drug Topics, has this to say concerning the push to have pharmacists recognized as providers: “Just recently, in an important meeting with House committee staff, we heard the concern that provider status may not be the right fight at this time because of moves away from the pay-for-service and towards payments based on outcomes. If there is one mistake we want to avoid on Capitol Hill, it’s shooting behind the duck as it flies away!” He goes on to clarify, ”That said, under current rules there are situations for which provider status would add much to pharmacists’ economic toolbox. Pharmacists working in physician offices would have new billing options, and our members who work in those situations tell us that would help greatly in expanding MTM services…Given the creativity of our pharmacists in helping to solve America’s growing drug problem, I have no doubt that provider status would be an incredibly important advance in patient care”.

Dave Walker, RPh, on his blog, has this to say: “Pharmacists have been using the ‘waiting for reimbursement’ argument for providing MTM or consulting services for years. We could continue to wait like the profession has in the past. OR we can step up and BE THE HEALTHCARE PROVIDER now and show that we can provide valuable services to patients, physician practices, medical home providers, and any other applicable areas of healthcare.”

The Pennsylvania Superior Court agrees that pharmacists should be recognized as providers. The Superior Court has ruled pharmacists are considered health care providers for purposes of the Medical Records Act, overturning an Allegheny County Common Pleas judge who likened pharmacists more to yoga instructors than medical providers who have concrete doctor-patient relationships. The issue at hand was whether someone getting a prescription filled in a retail pharmacy should be considered a patient or a customer. The Pleas judge ruled that a person receiving services from a psychologist would describe himself as a patient, but a person receiving services from a licensed yoga instructor would not. He said the latter is more akin to the relationship between someone prescribed medication and the pharmacist who provides it. The Superior Court disagreed. “We specifically note that, as part of their health care duties, pharmacists are authorized to administer injectable medications, biologicals and immunizations,” Judge Jacqueline O. Shogan said for the state court. “Thus, the practice of pharmacy is not limited to filling prescriptions.” He also added, “First of all, we fail to see any ambiguity in the term ‘patient’. It is commonly understood that a person for whom a medication has been prescribed by a licensed health care provider is a patient. … However, we would not consider it erroneous to deem such an individual a patient of the dispensing pharmacist … as well as the prescribing health care provider.”

“The language utilized in the Pennsylvania Code, as well as the Pharmacy Act, reflects that the pharmacist is a health care provider and that the recipient of the prescription medication is a patient,” Judge Shogan said. She said the requirements that pharmacists maintain and review profiles of patients, provide counseling and maintain confidentiality support the conclusion that the records are medical records of a patient. “A pharmacist is not merely an intermediary between a vendor and consumer,” Judge Shogan said. “Rather, as noted above, a pharmacist is required to utilize his or her professional education, training and judgment to provide health care to patients.”

Eric Durbin, RPh has this to say: “The first issue that should have been addressed is recognition of pharmacists as medical providers. If pharmacists receive provider status and are able to bill for services rendered, the entire medication therapy management MTM practice model will take off. There are innovative minds in the pharmacy world that will revolutionize healthcare, but we need to be sure that the bills will be paid at the end of the day. Changing the practice model today with the hopes of reimbursement tomorrow isn’t going to cut it. We need to become recognized providers now.”

I urge every pharmacist reading this article to sign the petition today, to forward the link to everyone you know who has an interest in seeing pharmacists gain the status we need to bill for our services, and to encourage those people to do the same. Only by standing together and being politically active will the field of pharmacy be able to grow in the 21st century. We need you to let our leaders in Washington know how much of an impact we can have on patient care – sign the petition, write a letter, contribute to a campaign, do whatever you can to make a difference. Only with sustained efforts can we hope to make lasting changes!

Have you signed it yet?

References:
Sandra Lee. (2012, July 25) “The President of the United States: Recognize pharmacists as health care providers!!!”. Retrieved from: http://www.change.org/petitions/the-president-of-the-united-states-recognize-pharmacists-as-health-care-providers
Gina Passarella. (2012, July 25) “Court: Pharmacists are health care providers”. Retrieved from: http://www.post-gazette.com/stories/…viders-629521/
Dave Walker. (2012, July 25) “Message to Pharmacists: Be the Healthcare Provider” Retrieved from: http://pharmarketing101.wordpress.co…care-provider/
Eric Durbin. (2012, July 25) “Pharmacists as providers?” Retrieved from: http://eric-rph.blogspot.com/2012/01…providers.html
Menighan, Thomas. “Provider status not the only path to payment for clinical services.” Drug Topics. May 2012. Retrieved from: http://drugtopics.modernmedicine.com/drugtopics/Associations/Provider-status-not-the-only-path-to-payment-for-c/ArticleStandard/Article/detail/772753?contextCategoryId=47443&ref=25

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Comments

  1. steve says:

    Thomas Menigham has too many titles after his name. that is all

  2. Mr. Bean says:

    Check this clown out:

    Robert Lee Page, II, PharmD, MSPH, FCCP, FASHP, FASCP, FAHA, BCPS, CGP

    Source: http://www.ucdenver.edu/academics/colleges/pharmacy/Departments/ClinicalPharmacy/DOCPFaculty/Pages/PageRobertLeeIIPharmD.aspx

    1. DrVino says:

      That’s why he teaches at a top school and does mega research and you count pills and Restock PantyHose (RPh)… “Price check” please!.. Pharmacy is the only profession that one professional critics another professional for being too advanced. You don’t see it in MDs, PAs, DOs, ODs. Retail pharmacists have a tradesman mentality.

  3. dockut says:

    Besides Clinical Pharmacists the rest of you should participate in the care of patients. This is especially true in regards to dispensing narcotics. I have asked 21 different compounding pharmacies to make a “blind pain cocktail” for my patients that have addiction or diversion issues interfering with their pain mgmt — ONLY ONE knew what I was talking about!. Look it up and be more than a pill pusher.

  4. Mr. Bean says:

    Pharmacists and DNPs want to be pseudo physicians? Why didn’t you guys just go to med school? It’s a simple solution. lol

  5. Chris says:

    Pharmacists do not have the depth and breadth of knowledge to function independently. Yes, they can treat conditions medically with drugs. But they don’t have any concept of clinical medicine. They can patch holes, but can’t fix the problem necessarily.

  6. David says:

    The article is discussing pharmacists being able to be listed as providers so they can bill Medicare for pharmacist services like MTM. No one is saying that pharmacists should be recognized as physicians or given full independent prescriptive authority. I support what they article is saying.

  7. Angela says:

    Pharmacists may be able to “patch holes”…but couldn’t it be said that with the medication education MDs receive that they are only able to find the hole? The Pharm D education is actually quite broad nowadays. Anyway, as David stated, pharmacists aren’t looking to be physicians. This isn’t about what’s best for pharmacists or MDs, it’s about what is best for the patients based on the education Pharmacists are receiving now.

    In response to dockut’s comment about pharmacists being more than pill pushers, I think that your statement is not only unprofessional, but also just rude. Not everyone will know everything, and just because you know that one compounded product does not make you smarter than those pharmacists. I imagine you don’t know half of the products they compound, and no one would expect you to. Get off your high horse–no one was attacking you or your profession.

  8. Kaustikos says:

    Hey,
    I just wanted to say that thanks to that site/petition, I’m receiving an awesome amount of spam mail. Well done.

    /sarcasm

  9. Landon says:

    I agree with David and Angela! Pharmacists do not want to practice medicine, it would just be nice to be able to bill for all the extra things they have to do on top of dispensing. I dont think thats greedy, I think thats very fair, when some professionals are able to bill $100 for just 15 minutes!
    And as far as dockut’s comment, i feel like your order was very vague. As a pharmacist following many laws, even more regarding narcotics, a pharmacist needs a little more clarity.
    Excited to see what comes of this!

  10. Jeanne Hyatt says:

    I would be very interested in knowing what you think about the difficulties that legitimate chronic pain patients are now having in regard to their prescriptions not being filled at their local, longtime pharmacy. I live in Florida and since January I have been having difficulties having my pain prescription filled whereas previously there was never a problem. It used to be that the pharmacy always had my prescription in stock and I could count on it being there every month. It used to be, in rare cases when it was out of stock, that the pharmacist would offer to call another pharmacy in their chain to see if they had the prescription in stock. It seems to me that because of new regulations to prevent drug abuse and diversion, the pharmacists are fearful, and rightly so, of losing their licenses by the DEA. But what should the legitimate pain patient do, short of doing the pharmacy crawl to upwards of 10+ pharmacies every month just to get their legal pain prescription filled? What should we do when we are being denied by our local pharmacies where we had been dispensed the same prescription for years and now are being told conflicting information such as the prescription is not in stock, etc. When we try to go to other pharmacies we are told that they do not have the ability to take us on as new patients? Now we are faced with the very real possibility of going into withdrawal every 28 days and live in fear of not being able to find our medications. I am a law-abiding senior citizen and have a good relationship with my pain management specialist who is board certified and has never, to my knowledge been in trouble with the law. Because of this very serious problem I have banded with a group of many, many others who are facing this exact situation. We are quite aware of the drug abuse and diversion problem and are trying to understand this new reality we face but we are the ones who are left to suffer. What advice do any of you have for us, if any?

  11. Sandra Leal, PharmD, CDE says:

    Great article!

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