Provider Status Profile
Sonya Collins
“Shirley” visited the urgent care clinic at Caring Health, a federally qualified health center (FQHC) in Springfield, MA, almost monthly for UTIs. Every time, the health care provider on staff diagnosed the problem, gave her antibiotics, and sent her home. The infections cleared up with antibiotics, but another infection always followed closely behind.
On Shirley’s most recent trip to the clinic, she once again had UTI symptoms as well as extremely high blood sugar. The provider asked Kathy B. Doane, PharmD, to consult with the patient. The pharmacist, who is also a registered dietitian, specializes in diabetes management.
Medication review solves mystery
Doane reviewed Shirley’s medications and found she was taking empagliflozin—a sodium-glucose cotransporter-2 (SGLT2) inhibitor for type 2 diabetes. “One thing about this class of medications is they can raise risk for UTIs,” Doane said. What’s more, the medication wasn’t controlling the patient’s diabetes.
“No one had looked into this before. They had diagnosed and treated the UTI, but they hadn’t addressed anything else,” Doane said.
On review of Shirley’s chart, Doane found her A1C was 11%. In addition to antibiotics, Doane recommended changing Shirley to a more effective diabetes medication that didn’t come with the same risks.
“When I saw her for follow-up after a couple of weeks, her UTI had resolved, but also her diabetes was improving,” said Doane. “She hasn’t come back with another UTI since.”
Doane’s medication expertise helped Shirley avoid future infections and prevented additional use of antibiotics—a serious public health concern. The medication switch also thwarted potential complications of Shirley’s diabetes, possibly saving thousands of health care dollars and preserving Shirley’s health. In their encounter, Doane also won Shirley’s trust. The patient now comes in for routine diabetes management visits and participates in the clinic’s fitness and nutrition program. These are cost-effective ways to drastically improve Shirley’s diabetes and cut her health care costs. Shirley’s A1C is now 6.5%.
All in a day’s work
Though patients clearly benefit from her care, Doane cannot bill insurance for the valuable services she provides because CMS does not recognize pharmacists as health care providers. Instead, Doane’s salary is contingent on the health center receiving sufficient grants and federal funding while physicians, nurses, and physician assistants bill payers directly for patient care.
“We are the experts in pharmacotherapy,” Doane says. “We help patients and the health care system cut costs by eliminating unnecessary medications and unnecessary hospital visits.”
For Doane, it’s all in a day’s work to reduce a patient’s medication regimen from 20-plus daily medications to just 5 to 10. “When we reduce pill burden, we avoid dangerous drug interactions and adverse events.”
Shirley is one of an estimated 34 million U.S. adults who have diabetes, many of whom would benefit from extra clinical support. Doane is one of some 300,000 U.S. pharmacists who are qualified to manage diabetes but whose hands are tied by federal bureaucracy.
“If we were recognized as health care providers, we could make these services available and accessible for any patient, but when we cannot bill for our services, that’s hard to 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.