I knew this rotation was going to be challenging…

amanda-brenneke-photo“Mama always said life was like a box of chocolates. You never know what you’re gonna get.” I’m sure most of you know and recognize this famous quote from the film Forrest Gump. What I didn’t know about this quote is how it would exemplify my June advanced pharmacy practice rotation experience in Jefferson City. When choosing this site for one of my nine rotations, I thought this might be a chance to learn about association work, policy, and non-traditional pharmacy career paths. Little did I know that I would learn so much more in my short one-month experience, than I could have imagined. I value my time spent at this rotation because I do not think that I could have learned the majority of what I did here at any of my other scheduled sites or most of the other offered rotations.

My primary location for June was at G.L.O. and Associates, a pharmacy consulting business that works closely with the Missouri Pharmacy Association as well as Missouri Medicaid (MO Healthnet). I knew this rotation was going to be challenging and full of information when I was handed a three page document of mostly unfamiliar acronyms on the very first day. From there I was oriented to the tremendous load of projects that were underway, learning that juggling isn’t just for circus acts. As the days passed, I found myself immersed in various projects across the spectrum from reading legislature to helping implement new state wide projects. Through various conference calls and meetings I started to pick up the lingo (after asking the meaning of additional acronyms used of course) and began feeling more comfortable in this very foreign to me, government based world.

I was fortunate enough to be able to attend a couple of really insightful meetings including the Drug Prior Authorization Committee Meeting, Community Health Center Pharmacy Integration Meeting, and the Chronic Pain Management Show-Me Echo sessions. While at the Drug Prior Authorization Committee Meeting for Missouri Medicaid, I sat with the voting members of the committee and was able to observe first-hand how preferred drugs and drug edits are changed and adapted into policy. This meeting really showed me all of the thought and time put into those rejections that I am so use to getting at my retail pharmacy job and made me think about the big picture on a state level. The Community Health Center Pharmacy Integration Meeting was even more eye opening for me. Dr. Steven Chen a faculty pharmacist from the University of Southern California spoke about the ways he has been able to integrate pharmacy into health centers using a large grant. I also heard from Missouri health care providers about all of the ways they are currently utilizing pharmacists in their clinics. Finally, observing the Chronic Pain Management Echo was like watching a futuristic collaboration, except that it is happening right now! The Echo program uses telehealth technology so that participants can video chat in real time with one another. Providers from rural areas are able to participate using any electronic device (computer, tablet, cell phone) and collaborate with others as well as an expert panel associated with the University of Missouri.

Perhaps my favorite project to watch grow and assist with has been the Polypharmacy Risk Reduction Program, fondly referred to as PPRR. This program utilizes a group of dedicated Missouri pharmacists to review current Medicaid patients’ medications. Here’s how it works: high risk patients will be identified and assigned to participating pharmacists across the state; those pharmacists review claims data to access therapy and provide recommendations to the patient’s provider. Theoretically, this program will hopefully produce better out-comes for MO Healthnet patients as well as save tax payer money.

This rotation has been so rewarding for me and I plan to recommend it to younger students when I get back to Kansas City. I have gained a very valuable understanding of so many different aspects of pharmacy and many things that cannot be taught in school which I believe will be very important to understand in my pharmacy career. It has been a truly great month in Jefferson City and I am grateful to have spent a month with G.L.O. and Associates and the Missouri Pharmacy Association.

Amanda Brenneke
University of Missouri-Kansas City
2017 Pharm.D Candidate

Myth busters: Provider Status Legislation

Mario-CoronadoBy Mario Coronado, STLCOP Pharm.D. Candidate 2016

While this is not strictly a Missouri issue, I wanted to take some time with this blog to cover a few points on the current provider status legislation, HR 592 and S 314. This is the preeminent issue impacting pharmacists and pharmacy services today, and it is important that everyone understands the scope of what the bill is proposing.   Here are some common myths that I have been hearing:

  1. Provider status will only impact pharmacists in rural communities: This is my least favorite myth because it implies either that some pharmacists think it’s not worth the effort or that pharmacists in cities have different goals than pharmacists in rural communities. Most importantly, all pharmacists must have the same goal of providing patients with the best care possible, partly through expanded services; this legislation will allow financial support for those services through Medicare Part B reimbursement. Second, it’s just wrong. This bill allows Medicaid Part B reimbursement to pharmacists serving patients in any Medically Underserved Area (MUA) or Health Professional Shortage Area (HPSA). You can check your designation with this link, but to offer an example, my neighborhood in South St. Louis City is an HPSA1.
  2. Physicians are against pharmacists expanded services: Admittedly, this one is going to vary physician to physician, and I haven’t spoken with all of them, but my impression so far is that physicians appreciate pharmacists’ involvement. Notably, the American Medical Association does not oppose this legislation. And why would they? There is a known shortage of primary care physicians, and if a pharmacist is available to perform “services medically necessary to treat a condition or disease,”2 physicians will be able to see more patients. The health-care team is evolving rapidly to care for our expanding patient population. Our role in that team must evolve as well.
  3. Pharmacists are already performing these services OR Pharmacists won’t be performing these services anyway: These myths are two sides of the same coin, as HR 592/S314 does not expand the scope of services a pharmacist can provide. This comes down to the state level, which is an area for potential advocacy moving forward. We are lucky to live in Missouri which is expanding pharmacy services throughout MO HealthNet. MPA has worked extensively with the Pharmacist Service Expansion Project to give community pharmacies an avenue for reimbursement for the expanded services a pharmacist performs. The Diabetes Accreditation Standards-Practical Applications (DASPA) certification is just one example to ensure community pharmacists can receive the reimbursement they deserve for providing patient care beyond the traditional role of a pharmacist. The provider status bill would open up Medicare Part B reimbursement for pharmacists’ services. It will impact what clinical services we perform, rather, it will incentivize increased clinical services through reimbursement with federal dollars.
  4. Pharmacists provide different services than physicians or nurses, why should they be classified the same: Yes, doctors and nurses are providers under the Social Security Act that covers Medicaid Part B, but so are midwives, dieticians, social workers, and clergy. Clergy are considered healthcare providers and pharmacists are not. I’m not diminishing the importance of clergy, I’m just astounded that pharmacists are still not considered providers eligible for Part B reimbursement. HR 592/S 314 will finally place pharmacists among the list of providers like we belong. Again, the bill does not impact the scope of pharmacy practice, it just provides reimbursement for the services we perform.
  5. This will just increase the cost of healthcare: Technically, the jury is still out on this argument. The Congressional Budget Office “scores” every bill, meaning they estimate the potential cost it will have on the federal government. The Pharmacy and Medically Underserved Areas Enhancement Act has been submitted for a score, and this is currently pending. Rest assured though that expanded pharmacy services have been shown to decrease the overall cost of healthcare while improving quality. There are many legislators who have, appropriately, held off on co-sponsoring this legislation until a score has been posted. Hopefully a low score will bring a host of new co-sponsors that will help move this legislation forward through congress.
  6. My support won’t make a difference: This past October, the American Pharmacists Association with Pharmacists Provide Care led an advocacy effort to recruit more co-sponsors for this legislation, particularly within the House of Representatives. This important indicator of support jumped from 219 to 266 representatives promoting patient access to pharmacists’ services3. The bottom line is that everyone’s support adds up to make a great difference. Even without advocating to your legislators, ensuring that your community understands what services a pharmacist can provide is an important step towards ensuring that all patients have access to quality healthcare.

All pharmacists stand to benefit from this legislation, and it is important that we all understand the impact this will have on our profession. I urge everyone to voice their support for this bill and any initiatives that come up at the state and federal level that expand patient access to valuable pharmacy services.

 

References

  1. Find Shortage Area by Address. Health Resources and Services Administration Data Warehouse. Updated May 29, 2015. Accessed February 29 at http://datawarehouse.hrsa.gov/GeoAdvisor/ShortageDesignationAdvisor.aspx.
  2. What Part B Covers. Medicare.Gov. The Official U.S. Site for Medicare. The Centers for Medicare and Medicaid Services. Accessed February 29 at https://www.medicare.gov/what-medicare-covers/part-b/what-medicare-part-b-covers.html.
  3. Pharmacists Provide Care. American Pharmacists Association. Accessed February 29 at http://www.pharmacistsprovidecare.com/.

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