Tuesday, January 10, 2012

Pharmacists as providers?

This past weekend marked the six-month anniversary of my transition from retail to hospital pharmacy. It seems like only yesterday that I was behind the pharmacy counter, while it also seems like forever since I’ve been in a community pharmacy.

One thing that immediately jumps out at me on the difference between the two settings is the manner in which I am treated as a pharmacist. In the retail setting, physicians and nurses (or receptionists or whoever the physician allows to represent them on the phone) didn’t seem to respect the knowledge of the pharmacist. I felt that I was viewed as a nuisance. Not so in the hospital setting. On a daily basis I am asked for my input on decisions relating to the care of my patients. A vast majority of the time my recommendations are accepted and implemented.

It didn’t take long for me to realize that hospital and community pharmacy are worlds apart with regards to the practice of pharmacy. I follow what is happening in the retail sector through blog posts and Twitter updates, but for the most part the issues in retail have no bearing on my practice in the hospital setting. And by the same token the issues that hospital pharmacists face don’t mean a whole lot to the folks out in the retail trenches.

The profession is clearly divided and it’s no surprise that pharmacy isn’t represented that well by the national organizations. There isn’t an issue that all of us can get on board with in order to have a united voice. So you end up having several different organizations (NCPA, ASHP, ASCP, etc…) representing their individual interests, trying to talk over each other and in the end nobody’s voice is heard.

The American Pharmacist Association, in my opinion, should be the organization that should be able to speak for all pharmacists. If you pay attention to the opinions expressed on the social media, pharmacists don’t feel that the APhA is doing much, if anything, to address the issues that pharmacists are facing.

The APhA has totally bought-in to the medication therapy management (MTM) practice model. Over the past 18 to 24 months, various articles have tried to sell MTM as the pharmacist’s component of accountable care organizations, patient-centered medical homes, and collaborative practice arrangements. While I believe that MTM-style services are where pharmacy should be heading, I believe that the so-called leaders of the profession missed a key component of the equation when they decided to go all-in on MTM.


Sure, some Medicare Part D plans are reimbursing pharmacists for MTM services, such as comprehensive medication reviews. But these are limited to the patients who are selected by the insurers. Rather than accept the practice model no-questions-asked, how about taking a step back to get all of our ducks in a row? How about getting us recognized as providers so that MTM services are reimbursable from all insurers and can be offered to all patients instead of the select few Medicare Part D-ers.

The first issue that should have been addressed is recognition of pharmacists as medical providers. If pharmacists receive provider status and are able to bill for services rendered, the entire MTM practice model will take off. There are innovative minds in the pharmacy world that will revolutionize healthcare, but we need to be sure that the bills will be paid at the end of the day. Changing the practice model today with the hopes of reimbursement tomorrow isn’t going to cut it. We need to become recognized providers now. There is a petition floating around out there to try to get pharmacists recognized as providers. If you haven’t done so already, I suggest that you check it out.

Provider status is the issue that covers a majority of the practice settings for pharmacists and could unite the profession into a strong voice. Over a year ago I wrote on how different practice settings could benefit from being recognized as providers*. Community pharmacists could bill professional fees for DURs, OTC consults, and even calls to insurers (nowhere in my state’s pharmacy practice act does it state that pharmacists must call insurance companies). For each service that we provide, we should bill. The days of counting on dispensing fees to cover the costs of these services are long gone. Pharmacists need to be reimbursed for the professional services that are provided.

On the hospital and consultant side, pharmacists could charge for consults and interventions that occur daily. These are documented at many facilities; we just need to develop a charge sheet to be able to submit to the insurers and Medicare. Services such as anticoagulation clinics, diabetes/asthma/COPD-education, and nutrition education would be areas where pharmacists could make a huge difference if the reimbursements were there.

I don’t know what it’s going to take for pharmacists to unite as one voice. It might be the APhA taking the lead and pushing for recognition as providers. It could be retail pharmacists saying enough is enough and forming a union to get issues addressed.

Whatever the practice setting, I think that we all can agree that we need to be paid fairly for what we do as professionals. Recognition as providers is the first step towards achieving that goal.

*Previous posts of mine that address this issue


SailaSeaofCheese said...

I enjoyed reading this post. I agree that this topic is one that pharmacists could come together to support.

There is little about day to day job that I have in common with colleagues in retail but this topic is something I think we all can agree on. I have worked both settings and I agree with you Eric, in hospital I feel my opinion is respected and in retail....

I still do love the independent community pharmacy setting, although it has been awhile since I have worked in it.

Glad to hear you are enjoying the new setting! Do you work for non-profit, profit, academic, specialty, federal or state hospital?

Mike said...

I agree about the worlds being completely different. I never really knew there was a problem getting any Adderall of any sorts. It isn't something we use. However, my retail brethren probably are unaware of all the injectable shortages we are dealing with; morphine, valium, ativan, dilaudid, versed, and numerous chemos.

Anonymous said...

You have hit the nail on the head. If you go see a doctor he bills. MTM as currently structured is just another task for limited patients and money. Billing for calls to the insurance would be a dream come true. Either we get paid for wasting our valuable time or the patient, not wanting to pay/bill insurance would do it on their own. Either way is ok by me.

Pharmaciststeve said...

The APHA was the driving force behind us being paid a "professional fee" during the late 60's.. just as the PBM's were getting traction.
I don't think that that has worked so well for the profession...but .. that is just my opinion... If the APHA gets involved in this.. hopefully history will not repeat.

Bob Diamond said...

Having worked both sides, retail and hospital, I can support your observation that pharmacists' knowledge is much more respected in a hospital setting. The pay in a hospital is generally less but the hours tend to be much better.

SJ said...

I couldn't agree more on what you said in this blog. I run the facebook page for the petition. Is there a way to post the link?


Sandra Leal PharmD, CDE said...

Hi Eric,

I love your blog. I am the pharmacist that started the petition and thank you for supporting it!!