Provider Status: What it is, and why it matters.

John Oechsner, Pharm.D. Candidate 2014

John Oechsner, Pharm.D. Candidate 2014

If you were to take a walk down the street, stop a random person, and ask them what a pharmacist does, the most likely answer would be something along the lines of providing drugs.  “Pharmacists just count pills” is a popular phrase that most of you have probably heard.  Pharmacists are currently doing so much more than counting pills.   The practice of pharmacy is advancing at a rapid pace, and in some cases today’s pharmacist shares little with the public’s perception of one.  Pharmacists working in a health system or ambulatory setting may rarely, if ever, even see or touch the actual medications that their patients take.  Instead, their primary duty is cognitive functions, such as providing recommendations to physicians, educating patients on proper therapy, or optimizing patient care by initiating, modifying or discontinuing drug therapy under a collaborative practice agreement or protocol. Community pharmacists are doing more beyond the counter, including providing health screenings, educational classes, immunizations, comprehensive drug reviews, and disease state management to ensure effective treatments and outcomes.  As shown, pharmacists can provide much more than just a medication.

Unfortunately, although pharmacists are trained to provide many services and forms of health care to patients, pharmacists are not considered “providers” nor are pharmacists’ patient care services recognized under the Medicare Part B section of the Social Security Act (SSA).  This simple bit of wording has large implications for us as pharmacists and for the health and well-being of our patients.

What is provider status?
The real meaning of provider status is about ensuring that patients have access and coverage for valuable pharmacists’ patient care services. This can be achieved at the federal, state or private insurance level through various mechanisms. As noted above, “provider status” at the federal level refers to a listing in the SSA of those healthcare professionals whose services are eligible for Medicare Part B reimbursement.  As the American Pharmacists Association (APhA) notes, “the omission of pharmacists as listed providers limits Medicare beneficiaries’ access to pharmacists’ services in the outpatient setting.”  Though the law only pertains to Medicare Part B, it indirectly limits coverage by many state and private health plans, as they cite the lack of federal provider status as a reason for denying coverage.  The Affordable Care Act (ACA) emphasizes reducing the overall costs of healthcare and improving patient health outcomes.  Pharmacists’ patient care services go a long way toward accomplishing these goals, underlying the importance of obtaining provider status.

What would change with provider status?
In addition to designating pharmacists as providers within the California Pharmacy Practice Act, SB 493 also expanded the scope of practice for pharmacists in California.  Let’s take a quick look at the many new things pharmacists can do in the state of California with the passing of this law.  The California Pharmacists Association has assembled an extensive list as follows:

  • Designates pharmacists as healthcare providers who have the authority to provide health care services.
  • Authorizes all licensed pharmacists to:
    • Administer drugs and biologics when ordered by a prescriber. Previously, this was limited to oral and topical administration. SB 493 allows pharmacists to administer drugs via other methods, including by injection.
    • Furnish self-administered hormonal contraceptives pursuant to a statewide protocol.
    • Furnish travel medications recommended by the CDC not requiring a diagnosis.
    • Furnish prescription nicotine replacement products for smoking cessation pursuant to a statewide protocol.
    • Independently initiate and administer immunizations to patients three years of age and older.
    • Order and interpret tests for the purpose of monitoring and managing the efficacy and toxicity of drug therapies, in coordination with the patient’s prescriber.
  • Establishes an Advanced Practice Pharmacist (APP) recognition, and authorizes APPs to:
    • Perform patient assessments.
    • Order and interpret drug therapy-related tests in coordination with the patient’s primary care provider or diagnosing prescriber.
    • Refer patients to other healthcare providers.
    • Initiate, adjust, and discontinue drug therapy pursuant to an order by a patient’s treating prescriber and in accordance with established protocols.
    • Participate in the evaluation and management of diseases and health conditions in collaboration with other healthcare providers.

As shown, the expansion of pharmacists’ abilities under state law in California is quite vast.

How can I help?
Your Missouri Pharmacy Association is an excellent place to start.  Many resources are available for contacting and meeting your state and national legislators to advocate for pharmacists being part of the healthcare team as providers.  You can also share your experiences providing patient care services and how they affected patient outcomes.  Utilize any patients or other providers who are willing to provide a testimonial to your clinical services.  APhA has an excellent resource on the multiple other ways that you as a pharmacist can help with the federal effort at www.pharmacistsprovidecare.com.

Hopefully after reading this, the hot button issue of provider status is a little clearer and the importance is understood.  Pharmacists are an integral part of the healthcare team and provide valuable services to patients.  With provider status, these contributions can finally be recognized, acknowledged, and appreciated by patients and other providers alike.

John Oechsner
UMKC School of Pharmacy at MU
Pharm.D. Candidate 2014
MPA Rotation Student, May 2014

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