Provider Status Profile
Sonya Collins
Almost weekly, “Helen” seemed to land in the hospital. Her complaints were the same every time: She felt weak, lethargic, fatigued, and confused. But the MRIs and CT scans turned up nothing. While health care providers never pinpointed the problem during these hospital stays, Helen always felt better in a few days or so. Her symptoms resolved, she was discharged with the same instructions each time: Resume your regular medications at home.
A week later, she’d be in the hospital again—until she was referred to Jason Barca, PharmD. The clinical pharmacist at Bakersfield Family Medical Center in California, employed by Synergy Pharmacy Solutions, helps ensure that once patients are sent home from the hospital or emergency department, they stay home. Nearly one in five Medicare beneficiaries returns to the hospital within 30 days of discharge. Pharmacists can help with this costly problem—often related to complex medication regimens—but they don’t always have the opportunity.
CMS does not recognize pharmacists as health care providers. As a result, only pharmacists who meet certain requirements—and in just a handful of states, including California—can bill insurance for the clinical care they provide. Otherwise, health care facilities would have to absorb the cost of a pharmacist—if they see the value in hiring one.
“If pharmacists aren’t pulling in any money, they’ve got to make sure they prove themselves,” said Barca.
Solving a medication mystery
With Helen, Barca proved to be the only clinician who could solve the mystery of her frequently altered mental state. He took great pains to piece together a medication list for Helen. He knew that hospital providers always instructed her to continue on her home medications, but he didn’t know what those were. “She was a new patient, so we didn’t have a very good list,” Barca recalled. “Then I noticed that she’s got five different prescribers and three pharmacies.”
Once he compiled the list, he came up with eight central nervous system depressants, including an opioid, a benzodiazepine, and a muscle relaxant. Also on the list were several antidepressants, including gabapentin and a medication for bipolar disorder, several inhalers, and some 10 prescriptions for other chronic conditions. As for the opioid and the benzodiazepine, Barca wasn’t able to determine why the patient was taking them. Helen didn’t know, either.
“I was baffled that none of these providers and pharmacies seemed to be talking to each other,” Barca said.
Recipe for disaster
In what Barca describes as a heart-to-heart with Helen, he and a physician assistant explained that it was her many medications that were causing the weakness and confusion. The frequent hospital stays served as mini–drug holidays and relieved her symptoms until she started the meds again.
“We told her that this cocktail was a recipe for disaster, and one of these days she was going to overdose,” Barca said.
She came to agree with Barca that it would be best to stop taking some of the medications. The providers then contacted the various prescribers to let them know that they were taking over as Helen’s primary care providers and that they would be eliminating some of her medications. Helen stopped the opioid, the benzodiazepine, and the muscle relaxant.
“She hasn’t gone back to the hospital since,” said Barca.
Pharmacists should be recognized as providers
Since medications are the cornerstone of Western medicine, Barca doesn’t understand why pharmacists—the medication experts—don’t have universal recognition as health care providers who can bill for their services. They are often the only providers who can unravel patients’ complicated therapies.
“[Helen’s] case was 100% medication driven. And since pharmacists have the knowledge and training to do these comprehensive assessments and reviews of the medications that health care relies so heavily on, we should be recognized as providers.”
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.