Provider Status Profile
Sonya Collins
Rob Maher, PharmD, and his bedside delivery transitions-of-care pharmacy team was asked to fill prescriptions for “Ruth,” an older adult patient who was awaiting discharge at a nearby hospital. When his team looked at her records, they noticed that she had been in and out of the hospital numerous times in the last year.
“The main reason,” said Maher, “was that she couldn’t get to her pharmacy to pick up her medications, and they didn’t offer delivery.” The lack of transportation meant that she frequently missed doctors’ appointments, too. Medical practices dropped Ruth from their rosters one after another. And, showing signs of mild cognitive impairment, Ruth was forgetting to take her medications, too.
Before this latest hospital discharge, Ruth was referred to Klingensmith’s Drug Store in West Kittanning, PA. Through the pharmacy’s transitions of care program, pharmacists check prior to discharge that patients can afford their medications; reconcile medication lists; offer adherence packaging and medication synchronization; and provide patients and their caregivers instructions on how to take the medications.
This is one example of how the pharmacies within the Pennsylvania Pharmacists Care Network (PPCN) are improving the health of their communities. PPCN is a part of CPESN USA, which functions like an accountable pharmacy organization. PPCN is a network of community pharmacies across Pennsylvania that is able to contract with payers, including state Medicaid programs and private payers to arrange reimbursement for these critical pharmacy services. This type of negotiation is necessary because pharmacists—unlike doctors, nurses, physician assistants, and other health care providers —are not considered providers through CMS. CMS is responsible for the billing codes and standards used specifically for Medicare and Medicaid services, but are often used as the standard for billing any health service in the United States.
“Payers are more and more supportive of pharmacists providing patient care,” said Stephanie McGrath, executive director of PPCN. “The real struggle is in creating the contracts because payers haven’t traditionally had contracts with community pharmacies.”
But they see the value in creating those contracts—in stories like Ruth’s.
Ruth received bedside delivery of her medications in adherence packaging before she was discharged from the hospital. A pharmacist instructed Ruth and her adult children in how to take the medications. Forty-eight hours after discharge, a pharmacist called Ruth at home to make sure she was taking her medications properly and that she wasn’t doubling up on anything she already had at home. The pharmacy synchronized her prescriptions so that she’d get all of them, delivered to her door, on the same day each month.
Since Klingensmith’s started providing Ruth these services, she hasn’t returned to the hospital.
“If you can pay a pharmacist a fee to prevent one hospitalization,” said Maher, “you can save thousands and thousands of dollars.”
Maher practices at both Klingensmith’s and his family’s Patton Pharmacy. Through Patton Pharmacy, also a PPCN member, Maher and other pharmacists meet with older adult patients at their primary care providers’ office. Working with the patients and their family caregivers and providing adherence packaging, Maher said, this pharmacy service allows older patients to stay in their homes longer than they might have otherwise.
“Since this is a rural area,” said Maher, “if we weren’t here, those patients would probably have to go to a nursing home.”
Because PPCN negotiates for its member pharmacies and works to secure contracts for them, Maher said he can focus on the work that led him to the pharmacy profession to begin with. “That allows pharmacists—who have always wanted to provide these services—and their pharmacies to partner together to show payers that there is a benefit to what pharmacists do.”
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.