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Achieving Provider Status for Pharmacists

Jan 02, 2013

Paul W. Abramowitz, Pharm.D., Sc.D. (Hon.), FASHP

ACHIEVING PROVIDER STATUS under Section 1861 of the Social Security Act is important for the profession. It is essential to recognize pharmacists for the patient-care providers that they already are, along with other formally recognized providers, such as nurse practitioners, dietitians, psychologists, social workers, optometrists, nurse-midwives, dentists, and others.

The data are conclusive: Pharmacists improve medication-use outcomes for patients when they are included on the patient-care team. A recent report by the office of the Chief Pharmacist of the United States Public Health Services makes a compelling case for using pharmacists more effectively in the care of patients. Therefore, a logical next step is making the services pharmacists provide eligible for recognition and payment by Medicare, Medicaid, and other third-party payers, including states and private health plans.

Pharmacists today are clinical practitioners who provide distinct direct patient-care services, serving as both pharmacy generalists and specialists. This fact is not in dispute. However, laws often lag far behind mainstream practice and technology. In today’s health care environment, where improving quality of care and decreasing costs are the focus of health care reform, there could not be a better time to recognize pharmacists as providers and as the medication-use experts on the interprofessional team.

Achieving provider status will not be easy. It will take a massive grassroots effort by individual pharmacy practitioners and affiliated state societies leading state-based coalitions. Federal legislators need to see, in their districts and states, pharmacists providing the patient-care services they seek for recognition and payment. Achieving provider status will also require a strong and cohesive national coalition of pharmacy organizations, consumer groups, and other health care organizations that understand the value pharmacists bring to the care of the American people.

During ASHP’s Legislative Day in September, ASHP members met with their representatives on Capitol Hill to discuss provider status, with the goal of setting the stage for a broad-based provider status campaign in 2013. Now and in the coming months the CEOs of the national pharmacy organizations are meeting to discuss how we can work together to pool our resources and collective energies to achieve success on this issue. I am absolutely certain that our organizations must work together to advocate for and achieve provider status. It is also important to recognize that achieving provider status will require a multi-year strategy that includes a strong and unwavering coalition at the state and national levels.

Stay tuned for updates on our progress on this top-priority strategic issue for ASHP. Please also start thinking about ways that you as future recognized providers are going to demonstrate to your elected officials in Washington, D.C., the great work you are doing to achieve optimal medication therapy outcomes for your patients and to decrease health care costs.

Best wishes for a Happy New Year!

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  • https://petitions.whitehouse.gov/petition/recognize-pharmacists-health-care-providers/3lkFWfvw Steve Soman

    I wanted to alert everyone to the petition on the Whitehouse.gov website for Pharmacists and provider status. The Petition can be found at: http://wh.gov/Q7lq

  • http://www.EssentialGuideToPrescriptionDrugs.com Dr. James Joseph Rybacki

    I couldn’t agree more on the importance of provider status and that a concerted, collaborative effort from National Pharmacy organization leadership is crucial. Many pharmacists are perfectly positioned to make pharmacoeconomic decisions, decrease length of hospital stay, decrease short-term recidivism and help ensure adherence/compliance.

  • Eric Kutscher

    I cannot agree more, our profession is no longer just an apothecary (a profession that just formulates and dispenses medications); we are the healthcare professional leaders who must commit to transforming the future of healthcare and hold ourselves responsible for helping each of our patients make the best use of medications.
    As Henri Manasse Jr. stated at the PPMI Summit in 2009, “If Pharmacists do not proactively move into more value-added clinical roles… I believe that there eventually could be business decisions beyond our control that diminishes the pharmacist’s role”
    Since the early 1970’s when ASHP and ACCP met in Kansas to clarify/define the roles of clinical pharmacy practice; the patient has been noted as the center of what we do. But often this important aspect of being a healthcare provider is overlooked by pharmacists. We as a profession need to remind ourselves that the patient is our #1 priority. Such that in order to be considered and recognized by others as “true” healthcare providers we must stop just looking at medical records/computers when making patient care recommendations/decisions, We must see (assess) each patient, just like every other healthcare provider does and yes in the hospital I expect that we should see each of our patients in person daily. We can no longer stand back and say we are understaffed to provide direct patient care; we need to commit 100% to doing what is right for our patients.
    Remember those who execute win! I am passionate about what we provide (do) for our patients and I am continuing to fight for our professions future. But I must ask this of all my colleagues…. What do you believe in? Since people only buy into an idea or product when they know why you do something, not what you tell them you do. http://www.ted.com/talks/simon_sinek_how_great_leaders_inspire_action.html

  • Mohamed D.

    The days of sit-down advocacy are clearly coming to an end. Social media is quickly becoming one of the most powerful and efficient ways to pursue a cause. Let’s get the white house petition (see link below) to 25,000 signatures and get this issue sorted, once and for all! Please sign the petition if you have not done so already:
    https://petitions.whitehouse.gov/petition/recognize-pharmacists-health-care-providers/3lkFWfvw?utm_source=wh.gov&utm_medium=shorturl&utm_campaign=shorturl

  • Ernest Dole

    I strongly agree with Dr Abramowitz’s statement, “Achieving provider status will also require a strong and cohesive national coalition of pharmacy organizations….” To date this has NOT happened and in fact, some national pharmacy organizatons have actively opposed previous attempts at achieving provider status for advanced practice pharmacists. I would hope that those pharmacy organizations that, in the past, have blocked attempts at achieving provider status, have arrived at a more enlightened viewpoint. And if those pharmacy organizations that in the past have blocked attempts for us to achieve provider status have not arrived at a more enlightened viewpoint, I would hope that those who are members in those organizations would hold them accountable

  • Ernest Dole

    I strongly agree with Dr Abramowitz’s statement, “Achieving provider status will also require a strong and cohesive national coalition of pharmacy organizations….” To date this has NOT happened and in fact, some national pharmacy organizatons have actively opposed previous attempts at achieving provider status for advanced practice pharmacists. I would hope that those pharmacy organizations that, in the past, have blocked attempts at achieving provider status, have arrived at a more enlightened viewpoint. I would also hope that the members of those organizations would hold their organzations accountable

  • William E. Smith

    I agree with the objective – provider status for pharmacists. This has been a goal with significant effort by many pharmacy organizations for several years. To achieve provider status will require more support than national pharmacy member organizations and individual pharmacists. Support from chain pharmacy, in particular at least one of the big three is needed. Recognition within pharmacy, including institutional pharmacy, is the fact that a majority of licensed pharmacies and licensed pharmacists practice in chain pharmacies. In addition, the message to gain recognized provider status will need to be accepted by the federal government at a time of increasing pressure to reduce health care costs. I think it could be helpful to develop scenarios that would tell the stories of patient care results from pharmacist clinical services and in a different manner than what the profession has used up to this date.