12/19/2015

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Provider Status…What’s in it

for Me?

Mohammed M. Abdulwahhab, Pharm.D.

PGY-1 Pharmacy Resident

Broward Health Medical Center

Disclosure

Mohammed Serves on the American Society of Health-System Pharmacists, Counsel on Pharmacy Management as a new practitioner

Objectives

� Explain the concept of Provider Status and its impact on pharmacy practice in Florida

� Discuss why pharmacists should get involved in the legislative process

� Detail upcoming state and federal legislative efforts

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Provider Status Definition

� Adding pharmacists to section 1842 and 1861 of the Social Security Act (SSA)

� Allow pharmacists to participate in Medicare Part B program and bill Medicare for pharmacy services

Within the state scope of practice

Medicare

� Part A (Hospital)

� Hospital visits, skilled nursing facilities, home health, and hospice care

� Part B (Medical Insurance)

� Physicians visits, preventative care, durable medical equipment, hospital outpatient services, lab tests, some home health, and ambulance care

� Part D (Prescription Insurance)

� Private company with government contracts

Provider vs Practitioner

Provider

� A person or a thing that provides a service

� Can include a person or an establishment

Practitioner

� A person who practices a profession

� Can only be a specialty trained person

http://www.studypharmacist.org/2015/01/17-pharmacist-jokes-you-will-love.html

Which category do pharmacists fall into?

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Limitations

� Based on each state’s scope of practice

� Applies for medically underserved areas only

� Utilizes Fee for Service Model

� Addresses Medicare reimbursements only

� No impact analysis form the Congressional Budget Office (CBO)

Health Care Providers

Under SSA, the following are considered Providers:

� Physicians

� Nurse practitioners

� Physician assistants

� Psychologists

� Social workers

� Speech language pathologists

� Audiologists

� Registered dietitians

Associations, A. P. (2013, Sep 13). Provider Status. Retrieved from APhA: https://www.pharmacist.com/sites/default/files/files/Provider%20Status%20FactSheet_Final.pdf

Possibilities

�California

� All Pharmacists

� Furnishing hormonal contraception, smoking cessation drug therapy, and medications that don’t require diagnosis for international travelers

� Order and interpret lab tests to manage efficacy and toxicity of drugs

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Possibilities

� Advance Practice Pharmacist

� Perform patient assessment

� Refer to other providers

� Engage in collaborative practices

� Credentialing (two of the following)

� Certification in the area of practice

� Completion of a residency program

� 1 year experience with Collaborative Practice Agreements

Possibilities

� North Carolina

� Must meet certain credentialing criteria

� Adjust pharmacotherapy

� Order lab tests

� The agreement must be specific to a patient and a diagnosis

� Washington State

� Insurance companies must include pharmacists for reimbursement

History

� Surgeon General Report in 2011

� For every dollar spent in Clinical Pharmacy Services (CPS) the average benefit was $10.7 with ROI averaging 1:5

Giberson S, Yoder S, Lee MP. Improving Patient and Health System Outcomes through Advanced

Pharmacy Practice. A Report to the U.S. Surgeon General. Office of the Chief Pharmacist. U.S. Public

Health Service. Dec 2011

ROI= Return on Investment

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History

� Dr. Regina Benjamin issued a signed letter of support for pharmacists to receive recognition and adequate compensation

History

� Jan 2013, APhA committed 1.5 million dollars to:

� Establish a coalition to draft legislative language

� Create a legislative advocacy plan

� Create communication and plan tools

� Initiate a non-bias report on pharmacists’ value in patient care

� Secure Score on Cost of this effort

APhA= American Pharmacists Association

History

� Numerous studies have shown the value of pharmacists in health care

� Limitation?

� Avalere Independent Contractor Report

� $350 savings per medication reconciliation conducted by a pharmacist

� Pharmacist medication management ROI 1.67

� Pharmacists on an anticoagulation team provide care based savings of $3,697 per patient Avelere. (2014). Exploring Pharmacists’ Role in a changing Healthcare Environment. 1-23.

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History

� Patient Access to Pharmacists’ Care Coalition (PAPCC) was formed in Jan 2014

� A group of over 30 organizations representing patients and pharmacists

� ASHP, APHA, ASCP, AACP, NCPA, Walgreens, CVS, Rite Aid, Cardinal Health, McKesson, Target, Walmart, and others

History

�Bad Blood

� ACCP launched its own campaign

� ACCP advocates for special training and education to qualify as a provider

ACCP= American College of Clinical Pharmacy https://www.accp.com/images/logos/paclogo.jpg

History

� ACCP Position

� A Pharm.D. degree (or B.S. in Pharmacy with evidence of equivalent pharmacotherapeutic knowledge and clinical experience) from an ACPE-accredited degree program of a US college or school of pharmacy

� A valid CDTM agreement with a physician or a physician group, and/or clinical privileges formally granted to the clinical pharmacist

� Evidence of completion of an accredited post-graduate residency program or an equivalent level of experience in the provision of direct patient care

� Board certification or eligibility for certification

Pharmacy, A. C. (2012). ACCP Launches New Initiative to Seek Provider Status for Clinical Pharmacists Working in All Practice Settings. Retrieved from ACCP: http://www.accp.com/announcements/providerstatus.aspx

Doesn’t This Sound Reasonable?CDTM= Collaborative Drug Therapy Management

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History

� H.R.4190 introduced in March 2014

� 68 Democrats and 55 republicans

� Failed to gain traction

http://i2.cdn.turner.com/cnnnext/dam/assets/130114152903-abc-schoolhouse-rock-just-a-bill-story-top.jpg

Current State

� H.R.592/ S.314

� Pharmacy and Medically Underserved Areas Enhancement Act

� Rep. Guthrie (R-KY), Rep. Butterfield (D-NC), Rep. Young (R-IN), and Rep. Kind (D-WI)

� Sen. Grassley (R-IA), Sen. Brown (D-OH), Sen. Casey (D-PA), and Sen. Kik (R-IL)

Current State

� Why only Medically Underserved?

� Most affected portion by the primary care provider shortage

� Lessons from other professions

� Limits opposition

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Medically Undeserved Areas in the United States

Current State

� Why only targeting Medicare?

� Private insurances usually follow Medicare

� There are no stipulations stating that private insurances can’t pay pharmacists for cognitive services

� Prove the value, and then expand

Current State

� As of 12/17/2015

� 259 Representatives co-sponsored the bill

� Florida has 16 co-sponsors out of a possible 27

� 39 senators have co-sponsored the bill

� Florida has 0 co-sponsors

� The American Medical Association (AMA) has not objected to the bill content

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Assessment Question

� True/False

Pharmacy Provider Status will impact pharmacy services in an inpatient, ambulatory, and community setting

Impact

� Decreases medication related problems

� Improves patient access

� Decreases healthcare costs

� Able to bill for services that are currently complimentary

� Allows for sustainable business model

� Allows pharmacists to practice at the top of their license

Assessment Question

� True/False:

If implemented all pharmacists will be allowed to bill Medicare Part B for services provided to all patients that can benefit from pharmacy services

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Legislative Efforts

Federal

� Provider Status

� USP 800

� Drug Supply Chain and Security Act

� Pain medication access and diversion

� 340B

State

� Last year

� Expansion of pharmacy immunizations

� Minimum Allowable Cost (MAC) pricing

Pharmacists added to laboratory bill !!!

Upcoming Legislative Efforts in Florida

� Not filed yet

� Increase maintenance refill medication authority to 30 day supply without prescriber authorization

� Senate bill 780 and House bill 583

� Does not allow patient’s health insurance policy to limit certain chronic medications to mail order only

Upcoming Legislative Efforts in Florida

� SB 692 and HB 547 Patient Access to Pharmacist Care

� Allow for consultant pharmacists (CPh) to perform

� Patient health and wellness assessments

� Patient counseling

� Referrals related to medication and health care services

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Upcoming Legislative Efforts in Florida

� SB 692/ HB 547

� Allow CPh to order diagnostic tests

� Extend lab orders to a Pharm.D. with training

� Initiate, modify, discontinue, and administer drugs within the framework of a drug management therapy order or protocol with one or more health care providers

Upcoming Legislative Efforts in Florida

�SB 692/ HB 547

� The bill provides that a health insurer or health benefit plan may pay or reimbursefor a pharmacist’s patient care services separate and apart from the payment for prescription medications, if the services provided are within the pharmacist’s lawful scope of practice

Assessment Question

� True/ False:

Federal Pharmacy Provider Status will allow for an expansion of pharmacy scope of practice

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Pharmacists Pay for Services

Information provided by National Alliance of State Pharmacy Associations

What Can You Do?

� Contact your Legislators

� Donate to Political Action Committees (PAC)

� Be involved!!!

� You can change

The Profession

What Can You Do?

� Run for office

http://sav-cdn.com/sites/default/files/imagecache/superphoto/13342523_1.jpg

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Reality of Provider Status

� Dependent on state scope of practice

� Pay for pharmacists or the pharmacy?

� Increased workload

� Rate of pay

� Malpractice issues

� Complacency

States with Advanced Practice

� Arizona

� North Dakota

� Nebraska

� Tennessee

� Wisconsin

� Maryland

� New York

� North Dakota

Conclusion

� Federal Provider Status is the framework for state efforts

� Opportunity for business expansion

� It’s a recognition that is long overdue

� Be involved in the political process

� Donate to your PAC

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Pharmacist Role on Health Care Team

References

� California Pharmacists Association. Get Involved: Pharmacist Provider Status. Available at: http://www.cpha.com/Advocacy/Pharmacist-Provider-Status.

� American Pharmacists Association. State Advocacy Fact Sheet. Available at: http://www.pharmacist.com/pharmacists-patient-care-services-state-advocacy-fact-sheets. Accessibility verified June 12, 2014

� American Pharmacists Association. Provider Status: What Pharmacists Need to Know. September 2013. Available at: http://www.pharmacist.com/provider-status-what-pharmacists-need-

know-now.

� American Society of Health-System Pharmacists. Issue Summaries: Recognition of Pharmacists as Non-Physician Providers. Available at: http://www.ashp.org/menu/Advocacy/StateAdvocacy/Provider-Status.

� Florida Pharmacy Association. Legislative Action Center. Available at http://www.capwiz.com/pharmview/issues/bills/?state=FL

Provider Status…What’s in it for Me?

Mohammed M. Abdulwahhab, Pharm.D.

PGY-1 Pharmacy Resident

Broward Health Medical Center

Questions? “It Is Safer to Search in the Maze Than Remain in The cheeseless Situation” Spencer Johnson