Menu Icon Search
Close Search

Sound Off: Pharmacists as Providers

Created July 25, 2012 by Chivas Owle
Share


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

// Share //

// Recent Articles //

  • Do You Recognize the Classical Clinical Triad in This Emergency Case?

  • Posted May 26, 2017 by Figure 1
  • A 35-year-old female, G0P0, presents to the emergency department with lower abdominal pain and vaginal spotting. Her last menstrual period was nine weeks ago. She was treated for a chlamydial cervical infection in the past, and has never taken oral contraceptives. On abdominal examination, no mass is detected, however, there is moderate tenderness in the...VIEW >
  • You Can Buy That on Amazon?

  • Posted May 26, 2017 by The Short Coat Podcast
  • All work and no play…is not what we do. Sometimes you’re having so much fun that the time flies by and you forget that you have other important things to do.  That’s what happened on this week’s show, in which Dave brings Aditi Patel, Aline Sandouk, Kylie Miller and Irene Morcuende along for a trip...VIEW >
  • Considering Rejection: Lessons Learned From an ESL Classroom

  • Posted May 25, 2017 by Nicole Hawkins
  • I was seated on a child-sized plastic chair along a wall in the classroom when the teacher summoned me to the front of the room. She handed me a sheet of stickers and, in broken English that was heavily accented, indicated that my task was to watch the approximately twenty children in front of me...VIEW >
  • My Own Little Ice Age

  • Posted May 24, 2017 by Miguel Galán de Juanai
  • Reposted with permission from here. I can finally say I’m in my last year of medical school. It has been a bumpy ride, but only one clerkship, a research project and an OSCE separate me from graduating. I remember receiving my acceptance letter eight years ago. Thinking back to those days, neither vocation nor sentiment...VIEW >
  • What is Cirrhosis?

  • Posted May 23, 2017 by Open Osmosis
  • What is cirrhosis? Cirrhosis is a disease where the liver becomes scarred over time from chronic inflammation and liver cell damage. Cirrhosis can be caused by a variety of diseases, with alcohol abuse and viral hepatitis being some of the most common. This video discusses the cellular mechanism behind fibrotic tissue generation and the pathophysiology...VIEW >
  • Medical, +1 MORE
  • Q&A with Dr. Jennifer Villwock, ENT

  • Posted May 22, 2017 by Rafid Rahman
  • Dr. Jennifer A. Villwock is the current Rhinology and Skull Base Fellow at the University of Kansas Medical Center. After graduating in 2011 from the Michigan State College of Human Medicine, she completed her ENT residency at the State University of New York (SUNY) Upstate Medical University. Dr. Villwock is active in the American Academy...VIEW >
  • Premeds Can Be Science Podcasters, ft. Terel Jackson

  • Posted May 19, 2017 by The Short Coat Podcast
  • An unstated goal of ours is to show medical learners that podcasting is a beneficial experience for both listeners and hosts,  and we’re always banging on about the need for better science communicators. So Erin Pazaski, Levi Endelman, Kylie Miller, and Irene Morcuende were recently excited to get an email from Terel Jackson, an OSU premed who said...VIEW >

// Forums //