CATALYST CORNER: March/April 2013

Achieving Recognition and Payment for Services

It seems a fitting topic for this column in the annual ComputerTalk Retail Buyers Guide to focus on a number of recent announcements within the pharmacy profession to move forward in advancing initiatives that will allow pharmacists to be recognized and receive payment for their services. Within the pharmacy community, the language used is often “provider status.” For pharmacists to practice “at the top of their license” in providing patient care services, the use of pharmacy technology is critical. While technology has long supported more efficient and safe dispensing, more recently, technology has been used to advance patient care services, including immunizations, adherence programs, and medication therapy management services, among others. Continued integration of pharmacy systems into the broader electronic health record and health information exchange infrastructure will be crucial to support the profession’s push for recognition.

The American Pharmacists Association (APhA) announced a major initiative to obtain recognition of pharmacists as providers in the healthcare system in January. So did the American Society of Health-System Pharmacists’ (ASHP) CEO Paul Abramowitz, who issued a statement saying provider status is a “top priority” for the organization. In the statement, Abramowitz noted, “It is essential to recognize pharmacists for the patient-care providers that they already are, along with other formally recognized providers, such as nurse practitioners, dietitians, psychologists, social workers, optometrists, nurse-midwives, dentists, and others. The data are conclusive: Pharmacists improve medication-use outcomes for patients when they are included on the patient-care team.” That announcement followed one by the American College of Clinical Pharmacy (ACCP) in November that their board of directors authorized an initiative to seek provider status for clinical pharmacists working in all practice settings. The Academy of Managed Care Pharmacy’s (AMCP) board of directors approved a position statement on “Non-Physician Provider Status for Pharmacists” in June 2012.

Call to Action 

The issue was front and center at the APhA2013 annual meeting, from the opening general session featuring Susan Dentzer, editor-in-chief of Health Affairs, who outlined opportunities for pharmacists presented by the Affordable Care Act, through eight additional related educational sessions on integrated care models/pharmacist opportunities and in remarks during the second general session by former Utah Governor and Secretary of Health and Human Services Michael Leavitt. Leavitt’s theme was contrasting compassion as a driver of policy decisions with the concept of global economic dispassion and how they are intersecting now. He cited many problems, including the national debt and growth in Medicare and Medicaid with an aging population, noting the need for change. He described the evolving health delivery model of accountable care organizations (ACOs). While community pharmacies are least frequently included in these risk-bearing payment arrangements, the ACO’s need to manage financial risk and meet quality requirements will drive ACO interest in pharmacy, he said. He issued a call to action, noting this was a “golden period” for pharmacists, but only for those who can change. 

That call to action was echoed at a pre-meeting conference, Provider Status for Pharmacists: Creating a National Action Plan, held in conjunction with APhA2013. Nearly 200 pharmacy leaders from national organizations, state associations, and academia gathered to discuss how to achieve integration of pharmacists into the evolving patient-centered, team-based healthcare system. The conference was led by APhA, the National Alliance of State Pharmacy Associations (NASPA), the University of Southern California (USC) School of Pharmacy, and the California Pharmacists Association (CPhA).

Dana Goldman, director, USC Leonard D. Schaeffer Center for Health Policy and Economics and adjunct professor at the USC School of Pharmacy and Price School of Public Policy, noted, “Prevention is key to controlling healthcare costs, and pharmacists can play an important role in managing this process.” Patients and healthcare providers often do not have access to the benefit of the patient care services pharmacists provide because the proper recognition and payment models are not in place. Studies and practice-based experience have shown that when pharmacists are involved in the provision of patient care services as members of the healthcare team, patient outcomes improve, patients report higher rates of satisfaction, and overall healthcare costs are reduced.

CPhA CEO Jon R. Roth noted, “With the Affordable Care Act and Medicaid expansion set for implementation nine short months from now, we must press forward with opportunities to ensure that the millions of people who will be receiving insurance coverage have avenues to achieve care. By affirming pharmacists as healthcare providers, it will ensure patients can receive a range of primary care services from highly trained and widely available pharmacists.”

The attending pharmacy leaders considered a slate of draft principles for the profession to seek recognition for pharmacists’ role as healthcare providers under one unified voice and message. These broad-based principles will serve to frame the profession’s efforts to seek increased access for patients to pharmacists’ patient care services.

APhA EVP and CEO Thomas E. Menighan said, “If we are successful [in achieving recognition], patients will be well served by pharmacists’ patient care services, and our services will be valued and covered. If we can speak with a common message and one voice as a profession, we will be much more effective at getting buy-in from policy makers and the public.” Becky Snead, EVP and CEO, NASPA, concluded the meeting by saying, “For success to be achieved, pharmacy representatives from local, regional, and national pharmacy organizations and stakeholders need to help shape the discussion.”

APhA announced in late January that its board of trustees has allocated $1.5 million toward a multimillion dollar, multiorganizational, multifaceted, long-range effort by APhA and the profession to gain recognition for pharmacists’ role as healthcare providers. It was clear from the sessions at APhA2013 that there are a number of avenues and models where pharmacists are contributing to current and evolving health delivery models. 

In an issue brief handed out at the meeting, APhA noted that it was “pleased so many national and state organizations are doing the same [working on the issue]” and that they would “work diligently to marshal our collective strength into one set of principles that everyone — pharmacy, medicine, consumers, and legislators — can support. Further, the brief says, “The ultimate goal is a consensus-based approach for advocacy and legislative efforts.” The profession’s ability to deliver an understandable, consistent, and coordinated message is crucial to achieving our overall objective — simply stated as “providing patients access to pharmacists’ clinical services and having pharmacists as recognized members of the healthcare team,” according to the brief.

APhA has created an issue-oriented space on its website at www.pharmacist.com/providerstatusrecognition. It also has the latest news on a petition that has collected over 35,000 signatures and that should prompt a White House response. 
I encourage pharmacy technology vendors to get up to speed on the issue and brainstorm ways their offerings could support the profession’s efforts. It’s clear from perusing the annual ComputerTalk Retail Buyers Guide that there are numerous technologies that can be brought to bear to help. 

In closing, I hope all readers will enjoy this annual buyers guide as much as I do. I use my copy frequently throughout the year, both as a reference and for recommendations to clients. Hats off to the ComputerTalk team for another fine guide. CT

Marsha K. Millonig, R.Ph., M.B.A., is president of Catalyst Enterprises, LLC, located in Eagan, Minn. The firm provides consulting, research, and writing services to help industry players provide services more efficiently and implement new services for future growth. The author can be reached at mmillonig@catalystenterprises.net.




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