Obtaining Value Recognition and Compensation of Pharmacists Clinical Services

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Pharmacists Clinical Services: The Smart Spend That Pays

Members of the Pharmacy, Medical, Consumer and Legislative Communities:

Just over half of all Americans take at least 2 medications every day and nearly one-third take 4 or more medications. For the Medicare population, medication use is even higher — nearly half of Americans aged 65 and older take at least 4 medications each day. Anyone on a medication, particularly those patients with complex medical conditions, can benefit from pharmacists’ clinical services. Studies and practice-based experience have shown that when pharmacists are involved as members of the health care team, patient outcomes improve, patients report higher rates of satisfaction and overall health care costs are reduced.

As medication experts, pharmacists play a critical role in the provision of patient care services, in collaboration with physicians and other providers on the health care team. Pharmacists are capable of providing a range of services, such as medication monitoring, patient education, comprehensive medication reviews, coordination of medications in transitions of care, prevention and wellness and disease management. As outlined in the report Improving Patient and Health System Outcomes Through Advanced Pharmacy Practice: A Report to the Surgeon General 2011 pharmacists’ patient care services have grown beyond functions tied to medication product and delivery. Yet in many, if not most circumstances, pharmacists are not considered “providers” and thus are often left off the health care team. That is a major disservice to patients.

The Smart Spend That Pays
Pharmacists are using a variety of systems and models to implement patient care services. However, without a viable business model, these activities will continue to be difficult to initiate and unsustainable. Pharmacists are not recognized as health care providers by the Federal government. This singular fact creates a major barrier to access for patients in today’s fee-for-service health care environment. This not only affects payment from Medicare, but also from Medicaid and most private payers, who model their payment systems after those established by Medicare. Perhaps more importantly, the omission of pharmacists from the list of providers also creates a barrier to the integration of pharmacists into the innovative healthcare delivery models – medical homes, medical neighborhoods and accountable care organizations (ACO) – that are emanating from the Affordable Care Act (ACA).

Although current Medicare Part D law compensates pharmacies for limited services, including medication therapy management (MTM) for select patients, the program is restrictive and encompasses only a small set of the services pharmacists are capable of providing. Further, most of these services are provided by health plans (payers) rather than by pharmacists who have patient and physician relationships. Thus, physicians who rely on pharmacists to help manage medication use may see increased challenges without an ability to bill for those services under newly evolving systems.Without the proper recognition and financial incentives, patients and our health care provider teammates may not have access to our services.

To optimize our healthcare 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 the Social Security Act, and ultimately Medicare Part B, would help to improve patient outcomes and assist physicians and other providers in meeting patients’ complex health care needs. Recognition of pharmacists is “The Smart Spend That Pays.”

Achieving Value Recognition and Compensation
The recognition and valuation of pharmacists’ clinical services is the top strategic priority for APhA in 2013. Years before our 2012 House of Delegates put the Association on record as supporting “universal recognition of pharmacists as health care providers,” APhA worked toward creating and maintaining viable business models for pharmacists and their services. In January of last year, our Board of Trustees created a task force that is working closely with staff and consultants, as well other national and state pharmacy associations, to develop and implement a plan for taking this issue forward. While, we will seek to earn "provider status" under Medicare Part B, efforts will also be made to gain recognition for pharmacists’ services at the state and private levels. The ultimate goal remains ensuring patient access to pharmacists' clinical services and optimizing medication use.

As an association and as pharmacists, we are committed to working with the pharmacy community to achieve success on this issue. We’ve had an ongoing dialogue with pharmacy stakeholders to develop a cohesive approach to this effort and have stepped up efforts to align with our colleagues at the national pharmacy organizations. We believe a strategic coalition of pharmacy, consumer and other health care organizations is the right approach. We are implementing a comprehensive and cohesive plan that details the value of pharmacists’ services to the American people. We are pleased so many national and state organizations are doing the same, and we will work diligently to marshal our collective strength into one set of principles that everyone – pharmacy, medicine, consumers and legislators – can support.

Achieving value recognition and compensation for pharmacists’ clinical services will not be accomplished easily and it will not be immediate. The entire pharmacy community will have to come together with one strong and unwavering voice to show federal, state and private payers why we should be recognized and compensated for the clinical patient care we provide. We will need the participation of all pharmacists, to ensure consumers and our health care colleagues have access to our services. Pharmacists’ training and abilities must be applied to the achievement of higher quality at a lower cost in healthcare. Pharmacists must be ready to step forward and assume patient care accountability across the profession and within the new health care delivery system.

We encourage the active engagement by pharmacists to gain public attention and recognition of the value of pharmacists’ clinical services. As pharmacists, our responsibility and commitment to our patients and profession is to ensure patients have access to and value the clinical services we provide. More information about the issues and the new opportunities for pharmacists in the evolving healthcare system will be available at the APhA Annual Meeting & Exposition, March 1-4, 2013 in Los Angeles.

Best wishes for a Healthy and Happy New Year!

Thomas E. Menighan, BSPharm, MBA, ScD (Hon), FAPhA
Executive Vice President & CEO
American Pharmacists Association

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