Pharmacists Make Progress Toward Attaining Provider Status

The topic of pharmacist provider status kept coming up at the American Society of Health-System Pharmacists (ASHP) Midyear Clinical Meeting in Orlando on Monday, December 9, 2013. The organization’s president, Gerald Meyer, PharmD, discussed it in the opening session, and Michael Lee, PharmD, gave an overview of recent efforts to achieve it in an afternoon session.

Since the beginning of the year, a coalition of pharmacy associations including ASHP has been working toward amendment of the Social Security Act to define pharmacists as patient-care providers eligible for reimbursement under Medicare. During the opening session, Dr. Meyer reported that the coalition has made substantial progress. “We are very close to agreeing upon a legislative proposal built on a set of mutually agreed upon provider status principles,” he said. “We will then work in a broad-based coalition to coordinate an aggressive legislative campaign.”

In his presentation, Dr. Lee, who is chief of pharmacy services at the Claremore Indian Hospital in Oklahoma and vice-chair of the Indian Health Service National Pharmacy and Therapeutics Committee, pointed out that pharmacists are the most accessible health care providers in the US health care system, handling 270 million patient visits per week. In addition, he noted, chronic conditions of the sort that pharmacists have a demonstrated ability to help manage place a tremendous burden on the health care system. Patients with these conditions account for 81% of all hospital admissions, 91% of all prescriptions filled, and 99% of all Medicare spending, Dr. Lee said. “Chronic conditions are certainly an opportunity for us to become involved with the system,” he said.

Dr. Lee was co-author of a 2011 report to then­—surgeon general Regina Benjamin, MD, titled “Improving Patient and Health System Outcomes through Advanced Pharmacy Practice,” that convinced Dr. Benjamin that pharmacists should be recognized as health care providers. “We are health care providers,” said Dr. Lee. “We’re not recognized at this point in time, but each of you are health care providers.”

As to why pharmacists have not previously attained provider status, Dr. Lee noted that the profession is very complex, with multiple practice types and subspecialties and at least 12 national organizations representing its interests. In addition, a number of alliances within the profession have been formed, which means that there are a large number of stakeholders just within the pharmacy profession.

Turf battles with other groups of health care providers have also posed obstacles to attaining provider status, Dr. Lee noted, though he urged pharmacists not to use them as an excuse for pessimism. “Turf battles are there. I certainly recognize that,” he said. “However, I’m a guy that doesn’t like the word ‘can’t.’ … So it drives me crazy when I hear, ‘Well, we can’t do this because of these turf battles.’”

Dr. Lee suggested that perhaps 5% to 15% of physicians actively push back against the notion of pharmacists as health care providers and another 30% or so are actively supportive of the idea. The rest of the physicians, whose opinions are unformed, he argued, may be susceptible to the arguments of those who are opposed. For this reason, Dr. Lee noted, it is important for pharmacists to enlist supportive physicians as part of the movement to attain provider status.

A United States Public Health Service (USPHS) survey of physicians who work with nationally certified USPHS pharmacists, Dr. Lee pointed out, found that the physicians had a 96% satisfaction rate with the pharmacists they worked with. “We understand of course there is some bias associated with that,” said Dr. Lee. “However, would you ask someone who had never been on a baseball field how they enjoy baseball? To truly be able to speak about the game, you have to have been in the game. And those physicians are in those games every day. They work with these [pharmacists] on a daily basis and they see the improvement that we have in our heart failure clinic, for example.”

Pharmacists are closer than they have ever been to attaining provider status, said Dr. Lee. As signs that “the stars are very close to alignment,” he pointed out that Rear Admiral Scott Giberson, RPh, MPH, the lead author of the report to the surgeon general, is currently the acting deputy surgeon general; a Centers for Medicare & Medicaid Services final rule has broadened the concept of “medical staff” to include pharmacists; pharmacists who agree to serve needy communities are now eligible for student loan repayment along with physicians, dentists, and nurse practitioners; and there have been successful online petitions to win provider status for pharmacists.

There have been positive moves at the state level, as well. Dr. Lee pointed out that in California, pharmacists used the physician shortage and anticipated impact of national health care reform to successfully lobby for passage of legislation calling for pharmacist provider status. In Washington state, the state attorney general’s office issued an opinion that pharmacists are health care providers, which is being used as a tool in lobbying for passage of legislation.

In closing, Dr. Lee urged pharmacists to take the cause of attaining provider status into their own hands. He said they should emphasize the patient care services provided by pharmacists, reach out to supportive physicians, and be prepared to talk about the campaign constantly. “Be ready, be willing, be able to discuss with anyone and whoever, whenever,” said Dr. Lee. “Develop an elevator speech. … Keep it short, hit the high points. Have some quick stats. … You never know who is going to be on an elevator next to you, on a flight next to you. Be prepared: Have that elevator speech ready to go.”

At the end of the session, an audience member asked Dr. Lee whether it wouldn’t make more sense to try to attain provider status just for primary care pharmacists and hospital pharmacists, whom physicians instinctively recognize as providers. Dr. Lee responded that it is important to include retail pharmacists as well, as they are key to presenting pharmacists as highly accessible health care providers. “I think the focus has to be on levels of care,” said Dr. Lee. “In the retail sector, you’re going to see different levels of opportunity in how [pharmacists] can practice as compared to that critical care pharmacist, that inpatient pharmacist, or that heart failure pharmacist that you have on staff.”

Kasey Thompson, PharmD, ASHP’s vice president for policy, planning, and communications, who was present at the session, also addressed this question, noting that it was important to have all parts of the pharmacy profession working together to win provider status. “The collaboration has never been stronger,” he said. “And really, the strength is that we have 12 groups—that’s a strong coalition.”