Provider Status Profile
Sonya Collins
On a typical day at Westland Family Medicine, DeLinda McDaniel, BSPharm, meets with patients in person for medication therapy management (MTM), comprehensive medication management (CMM), and disease state management, and by phone with the medical assistants for chronic care management. McDaniel is a member of a multidisciplinary primary care team at a patient-centered medical home in Columbus. She works alongside a physician, a nurse practitioner, nurses, medical assistants, and a social worker. Among the patients she sees, McDaniel particularly enjoys working with her Somali patients with diabetes.
“When we explain to them that their former diet from Somalia, which was high in vegetables and fresh fish, is really much better for them than the Western diet that they have started eating here, they get a big smile on their face,” said McDaniel. “When they realize that if they can go back to their regular diet and adhere to their medication therapy, their A1Cs will start to go down, it’s fantastic.”
Sidelined during pandemic
McDaniel relishes the opportunity to show patients that she understands them and to educate them on how they can improve their health. But for the last few months, she hasn’t seen many patients at all. Since the COVID-19 pandemic reached the United States—a time when the country needs all its health care providers’ hands on deck—pharmacists have faced more barriers to caring for patients than ever before.
“Our practice is doing telehealth now, with very few office visits for acute disease care,” said McDaniel. “But those visits are with a nurse practitioner, physician assistant, or physician. I don’t do virtual visits, as the telehealth platform is not as conducive to MTM or CMM.”
CMS does not recognize pharmacists as health care providers. Nurse practitioners, physician assistants, and physicians, however, do earn the distinction. As such, pharmacists cannot bill Medicare directly for the patient care services they provide. Their services must be billed by the physician or other recognized provider as “incident to” a physician who is on site during the appointment, and conflicting interpretations of CMS payment policy often lead to inadequate payment for the types of services pharmacists provide.
“But patients aren’t coming in during COVID-19, so the physicians aren’t in the office,” McDaniel explained. “And if I did do a virtual visit, a major discount is taken, so it’s all a wash.”
This means that McDaniel has been sidelined during a global pandemic. “I feel as if my hands are tied,” she said.
Lack of access to pharmacists
Like many pharmacists, McDaniel prides herself on being accessible to her patients. She makes the time to stay with them until all their questions are answered and they’re clear on how to take their medications and make the necessary lifestyle changes to manage their condition. But now, McDaniel is frustrated that almost no one has access to her services..
“I’m only doing chronic care management through telephone visits because those were always phone visits,” McDaniel said. “Other than that, I’m not seeing patients right now.”
Barriers restricting access to pharmacists create a twofold problem during the pandemic. McDaniel’s regular patients lack complete access to their provider during a public health crisis. And the public, who need information about the prevention and spread of the coronavirus, lack full access to these providers who specialize in counseling and education.
“If we had the provider status to just educate—nothing to do with doing the tests, drawing blood, or anything else—pharmacy has a decades-long tradition of educating,” she said. “If we could just be involved in the education inside the hospital, outside the hospital, in any shape or form that we can—about masks, PPE, handwashing, sheltering in place—then we wouldn’t have so much trouble with people adhering to not only medication therapy, but to lifestyle changes that are necessary, as well.”
Provider status stories
Pharmacists are health care providers. In a series of profiles appearing in Pharmacy Today and on pharmacist.com, pharmacists explain how their patients would benefit from provider status. And as part of our campaign for provider status, APhA has asked pharmacists to share their story of how they provide care to their patients and how provider status will improve health care. These stories are collected on the APhA YouTube channel at https://www.youtube.com/user/aphapharmacists/playlists. If you would like to share your story, please visit PharmacistsProvideCare.com.