‘Smart spend that pays’: APhA advances provider status initiative

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Profession-wide effort begins

APhA has announced a major effort to obtain recognition of pharmacists as providers in the health care system. A major component of that recognition is the listing of pharmacists as providers in the Social Security Act. Provider listing in the Social Security Act is an important component in the ultimate goal of providing consumers and other health care providers with access to our services. For patients to achieve the full benefit of their medications, pharmacists must be part of the team.

The American Society of Health-System Pharmacists (ASHP) released a similar statement from its CEO on January 2, following on the heels of an American College of Clinical Pharmacy (ACCP) board action last November and an Academy of Managed Care Pharmacy (AMCP) position statement approved by its board last June.  Other national pharmacy organizations have also expressed interest in participating in provider status efforts.

People on all medications, particularly those with complex medical conditions, benefit from pharmacists’ clinical services, APhA will tell Congress. “It’s the smart spend that pays” will be the tagline advocated by APhA, which will cite published literature and practice-based experience showing that when pharmacists get involved, overall health care costs go down and quality and patient safety improve.

To optimize our health care spending, Medicare must include pharmacists’ clinical services that are provided in collaboration with physicians and other providers on the health care team. Recognition of pharmacists’ clinical services in the non-physician part of Medicare Part B would help to improve patient outcomes and assist physicians and other providers in meeting complex health care needs of patients. Medicare Part B is not the only important user of the Social Security Act provider list, as accountable care organizations, state Medicaid programs, and other payers usually rely on the Social Security Act provider list to determine payment policies and services covered.

“It is time for pharmacists to be recognized for the value they bring to improved patient outcomes,” said Steven T. Simenson, BSPharm, FAPhA, FACA, FACVP, APhA President-elect and Chair of APhA’s Provider Status Task Force. “Pharmacist advocacy in legislative and private payer arenas is a critical component to achieve pharmacists being paid, as are all other providers, for their clinical decision making. This should apply to all of pharmacy practice, regardless of practice site.”

“We are pleased to see so many national and state organizations rising up to support provider status, and we will work diligently to marshal our collective strength into one set of principles that all our organizations can support,” said APhA Executive Vice President and CEO Thomas E. Menighan, BSPharm, MBA, ScD (Hon), FAPhA. A statement for the pharmacy, medical, consumer, and legislative communities was posted on the homepage of pharmacist.com.  The APhA Board of Trustees has allocated significant financial and human resources to work on this issue.

Although changing the law would literally take an act of Congress, the initiative isn’t just about a legislative fix. The profession is exploring all avenues, including working with the private sector and states.

For the past 2 years, APhA has been in dialogue with stakeholders within and outside of pharmacy regarding ways to advance recognition of pharmacists’ patient care services. Recent discussions among the health care reform pharmacy stakeholders have been taking place to come up with a comprehensive and cohesive plan for the profession.

Beyond the national pharmacy organizations, advocacy for provider status has included the U.S. Public Health Service pharmacy report to the Surgeon General a year ago; the Change.org petition started by Sandra Leal, PharmD, CDE, of El Rio Health Center in Tucson, AZ, on November 15, 2011; and just last week, a White House We the People petition, started by student pharmacist Steve Soman of St. John’s University College of Pharmacy and Health Sciences in Queens, NY. If the White House petition amasses 25,000 signatures by January 26, 2013, then the White House must issue an official response.  These are examples of the types of advocacy needed by a critical mass of the profession in order to attain the desired recognition.

Calling provider status a “top-priority strategic issue,” ASHP CEO Paul W. Abramowitz, PharmD, FASHP, explained ASHP’s involvement in the profession-wide push for provider status in his From the CEO column in ASHP InterSections, released January 2.

“Achieving provider status under section 1861 of the Social Security Act is important for the profession. It is essential to recognize pharmacists for the patient-care providers that they already are,” Abramowitz wrote. “Achieving provider status will not be easy. It will take a massive grassroots effort by individual pharmacy practitioners and affiliated state societies leading state-based coalitions. … Achieving provider status will also require a strong and cohesive national coalition of pharmacy organizations, consumer groups, and other health care organizations that understand the value pharmacists bring to the care of the American people.”

In November 2012, the ACCP Board of Regents authorized a new initiative to seek provider status for clinical pharmacists working in all practice settings. Its action is focused more narrowly than that of other national groups. “‘Qualified clinical pharmacists’ will possess credential(s) beyond entry level that are commensurate with the scope of services being proposed for coverage and that assure the clinical pharmacist’s ability to contribute to team-based, patient-centered care,” according to the December 2012 ACCP Report article on the initiative.

The Academy of Managed Care Pharmacy (AMCP) issued a position statement on Non-Physician Provider Status for Pharmacists that was approved by the AMCP Board of Directors in June 2012. Provider status would “allow pharmacists to be reimbursed directly from Medicare Part B for providing cognitive services to patients covered under the program,” according to the position statement. “Although current Medicare Part D law reimburses pharmacies for pharmacists providing some cognitive services, including medication therapy management (MTM) to a select subset of patients, the program is restrictive and encompasses only a small set of the services pharmacists are capable of undertaking.”

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