Healthcare Provider Status for Pharmacists is Long Overdue

By: Donnie Calhoun, PD, RPh
As published in Drug Topics

Pharmacists are often underutilized because they are not recognized as health care providers under the Social Security Act. As a result pharmacists cannot be fully compensated by Medicare and Medicaid for all their capabilities, which if completely incorporated could improve patient health outcomes.

That's why it is heartening to read U.S. Surgeon General Regina Benjamin's letter supporting the conclusions of Improving Patient and Health System Outcomes through Advanced Pharmacy Practice—A Report to the U.S. Surgeon General, 2011. Benjamin agrees with the report's finding that "recognition of pharmacists as health care providers, clinicians and an essential part of the health care team is appropriate given the level of care they provide in many health care settings."

The Surgeon General makes the case for this designation by pointing out that pharmacists currently work with physicians and clinicians under collaborative practice agreements (CPAs) in 43 states and in federal health programs in "performing patient assessments and developing therapeutic plans; utilizing authorities to initiate, adjust or discontinue medications; ordering, interpreting and monitoring appropriate laboratory tests; providing care coordination and other healthcare services for wellness and prevention; and developing partnerships with the patients for ongoing and follow-up care."

As the nation's chief health advocate and doctor, the U.S. Surgeon General certainly crosses the independence and credibility threshold because her words carry weight. For example, the tobacco industry is still reeling from the fallout (i.e., major class action lawsuits, stringent regulations, reduction in the percentage of smokers, etc.) that occurred from the warning regarding the dangers associated with smoking from U.S. Surgeon General Luther Terry in 1964. Hopefully, history repeats itself in our case.

With this federally recognized designation, pharmacists could finally be recognized for the valuable work they do and for their dedication to their patients. When I engage independent community pharmacists on this issue, they welcome the additional responsibility and the extra scrutiny that recognition brings, because they know the tangible results they can deliver. For example, our members' patient-focused business model is ideally situated to put a big dent in the up to $290 billion a year that is wasted on care due to the improper use of medications. Independent community pharmacies can and should become active participants in new collaborative health care models such as accountable care organizations and medical homes. Our members can fill the need of an overstressed health care system by treating patients for their minor health care needs.

Independent community pharmacists already enjoy the trust of patients. For example, according to the annual honesty and ethical standards survey by Gallup, pharmacists came in second among all professions. That is not a one-time occurrence, but a long-standing trend. Pharmacists' standing in the 2012 survey marked an all-time high.

The National Community Pharmacists Association will work tirelessly over the next year with Congress, the states, payers, and other health care practitioners to ensure that they understand the value pharmacists bring to health care through examples such as what happened with the Asheville Project and with Smith Drug Company. In both instances pharmacists were incorporated into the health care team to help patients maximize their health outcomes. Not only were patients healthier, but the costs were reduced in comparison to previous years when the role of pharmacists weren't part of the unique, but effective approach. Not only are the results impressive, but they will serve a real world example to rebut the inevitable push-back.

The reason provider designation has proved elusive is a fear of the costs the health care system will incur. Any front-end costs will pale in comparison to the savings that will accrue on the back end. For example, the Congressional Budget Office recently released a report called Offsetting Effects of Prescription Drug Use on Medicare's Spending for Medical Services, which finds that proper prescription drug use can reduce overall health costs.

Having inundated the decision makers with the overwhelming evidence of why and how pharmacists can do more, we should finally see the long-overdue change to the Social Security Act that needs to occur by passing legislation in the U.S. Congress. Then finally, the cutting-edge contributions that pharmacists can provide will be tapped. Everyone will benefit as a result.

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