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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