Credentialing Pharmacists

As many pharmacists are aware, a major push by national pharmacy associations is to gain recognition as patient care providers within federal health care legislation. This is needed for our profession to further advance pharmacist responsibilities as providers and allow for consistent and fair reimbursement for medication management activities. The payment would be separate from the only consistent reimbursement that pharmacists currently receive—dispensing the drug product.

While there is broad consensus that this is a needed and positive step for the profession, there are many disagreements on what type of pharmacists should be able to do this. Should all pharmacists, no matter their training or practice location, be able to provide and receive reimbursement for patient care services? Or, should it be limited to those who have residency training, or board certification, or actively practice in a certain setting? Are these decisions best left up to state boards of pharmacy (which already have variability in continuing education hours needed for relicensure), or should a committee at the site manage the process?

A concept that is starting to get discussed more in pharmacy circles is the need for better credentialing. It is the idea that pharmacists would be allowed to only do certain things based on their training and skill set. While this idea is not new for the medical profession, it is not widely used in the pharmacy profession.

As we know, not all doctors are surgeons; only those who have been trained and credentialed are surgeons. Further, not all surgeons can operate on the heart—only cardiovascular surgeons can do so. There is a defined education and credentialing process to manage these practice differences.

In pharmacy, quite the opposite is true. All pharmacists’ licenses allow them to dispense medications, check chemotherapy, educate a patient on anticoagulants, and dose aminoglycosides. Every pharmacist might not feel comfortable doing these things, but all are eligible through pharmacy licensure.

As the pharmacy profession advances, many are hopeful that our scope of services becomes broader. Pharmacists are active in immunizing adults, conducting comprehensive medication reviews, and aiding in transitions of care. Future pharmacists could be involved in prescribing medications under protocol, ordering routine laboratory tests, and administering medications in clinics or hospitals.

If these opportunities do come true, should all pharmacists be allowed to do this? If not, how would a credentialing and privileging process be implemented that would allow it for those who are deemed competent, but prohibit it for those who are not?

As the profession continues to push for advanced roles of pharmacists, it needs to also provide technical guidance on how to implement a robust credentialing program with a hospital pharmacy department. Should board certification be enough to satisfy this, or should an annual peer review process be implemented? If so, how should the committee be organized, what type of information should be submitted, and how should it make and defend its decisions? I believe the profession should provide tangible solutions to this difficult process, as clear guidance is needed as laws expand to allow pharmacists to do more.

May our profession continue to advance so that a comprehensive credentialing and privileging program is needed in all hospital pharmacy departments across the country.

Stephen F. Eckel, PharmD, MHA, BCPS, FASHP, FAPhA, is associate director of pharmacy, University of North Carolina Hospitals and clinical associate professor, University of North Carolina Eshelman School of Pharmacy.

Stephen F. Eckel, PharmD, MHA, BCPS, FASHP, FAPhA, is assistant director of pharmacy, University of North Carolina Hospitals and clinical assistant professor, University of North Carolina Eshelman School of Pharmacy. - See more at: http://www.pharmacytimes.com/publications/health-system-edition/2013/May2013/The-Generic-Conundrum#sthash.BN39ErVX.dpuf

Stephen F. Eckel, PharmD, MHA, BCPS, FASHP, FAPhA, is assistant director of pharmacy, University of North Carolina Hospitals and clinical assistant professor, University of North Carolina Eshelman School of Pharmacy. - See more at: http://www.pharmacytimes.com/publications/health-system-edition/2013/May2013/The-Generic-Conundrum#sthash.BN39ErVX.dpuf

Stephen F. Eckel, PharmD, MHA, BCPS, FASHP, FAPhA, is assistant director of pharmacy, University of North Carolina Hospitals and clinical assistant professor, University of North Carolina Eshelman School of Pharmacy. - See more at: http://www.pharmacytimes.com/publications/health-system-edition/2013/May2013/The-Generic-Conundrum#sthash.BN39ErVX.dpuf