Provider Status Profile
Sonya Collins
“Thomas” was determined to do whatever it took to avoid having another heart attack. When Pilar Murphy, PharmD, met with him at the Perry County Health Department in Marion, AL, she found that, though he had a prescription for insulin, his type 2 diabetes was far from controlled.
The problem, she soon learned, was the syringes. No one had ever shown Thomas how to give himself insulin, so he just didn’t do it.
“Administering insulin isn’t easy for older patients,” said Murphy, who runs the Perry County Health Department’s Cardiovascular Risk Reduction Clinic. “The needles are tiny, the numbers on the syringe are teeny-tiny, and you may have arthritis or trouble seeing, so it’s difficult to draw the precise amount of insulin into that needle.”
Murphy asked Thomas to come to the clinic every week to have the insulin dose drawn up into the syringes so he could give himself his injections at home. While he was there each week, she reviewed his other medications, made sure he was taking them properly, and talked to him about lifestyle changes that could help control his diabetes and lower his risk for a second heart attack. Today, though Thomas no longer needs any diabetes medications, “he still comes in religiously,” Murphy said.
Not paid for years of care
Murphy is an associate professor of pharmacy practice at Samford University McWhorter School of Pharmacy in Birmingham. The university pays for her to take care of patients at several rural sites while teaching student pharmacists to do the same. Neither her patients nor their health insurance pay Murphy anything for the years of care that keeps so many of them alive and out of the hospital. Health insurance plans often do not cover pharmacists’ services because many payers follow CMS, which does not recognize pharmacists’ services for payment. As a result, relatively few patients have access to the kind of care that has saved Thomas’s life.
In the years that Murphy has been seeing Thomas, he has used diet, exercise, and correct use of his medications to halt the progress of his diabetes. He has given up soft drinks, cut sugar from his coffee, and—perhaps the biggest sacrifice for him—reduced his trips to Hardee’s for a fast-food meal. His A1C is now at goal, and he no longer takes diabetes medications.
“We have been able to educate and reeducate,” Murphy said. “And since I see him every week, as soon as that blood pressure starts to creep up a little, I stop and say, ‘Ok, what have you been eating lately?’ ”
Setting the crisis right
As a medication expert, it’s pharmacists’ job to make sure that patients get the full benefit of their medications, said Murphy. “How many people are going to the pharmacy to get their insulin filled and then never giving it to themselves?”
Prescription drugs account for 10 cents of every health-care dollar spent—about $450 billion a year totally. Yet, nonoptimized medication therapy, such as Thomas’s insulin therapy, costs the health care system an estimated $528 billion annually.
Pharmacists, Murphy said, could set this crisis right.
“We are not getting the most out of our pharmacists or our medications, and patients suffer for it,” said Murphy. “We need widescale availability of pharmacists’ services and a sustainable way to make that happen through recognized provider status and the ability to bill for services.”
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.