ASHP InterSections ASHP InterSections

August 25, 2015

Creating an Army of Provider Status Advocates: One Member’s Story

Felicity Homsted, Pharm.D., BCPS

Felicity Homsted, Pharm.D., BCPS

AN UNEXPECTED EMAIL REQUEST this past June launched Felicity Homsted, Pharm.D., BCPS, on an unanticipated mission: to muster the support of Maine legislators for the Pharmacy and Medically Underserved Areas Enhancement Act.

If signed into law, the bill, now before congressional committees in the House and Senate, would grant pharmacists provider status in medically underserved areas and make them eligible for reimbursement under Medicare Part B.

“I didn’t hesitate. I just said, ‘Yes!’ and leveraged all of the relationships I’ve built over the years to get more people to push for provider status,” said Dr. Homsted, director of pharmacy at Penobscot Community Health Care in Bangor, Maine.

By the end of the day, she had called or emailed colleagues and administrators at more than a dozen health centers, health advocacy groups, and insurers; handwritten letters to Maine’s four-person congressional delegation; and quickly persuaded the CEO and CMO of her facility to do the same.

Within a week, Dr. Homsted had reached out to directors of pharmacy representing all of the health systems in the state. By the end of the second week, she added three presentations, a television interview, and more emails and calls. The entire PCHC pharmacy staff joined the efforts with technicians, pharmacists and residents all voicing their support. In under a month, she had confirmed that at least 50 support letters from all across the state had gone out to the Maine congressional delegation.

The results of her team’s hard work followed quickly. On July 7, Sen. Susan Collins signed on as a cosponsor of the Senate version of the bill S. 314. Sen. Angus King responded with a declaration of support for the bill.

Persistence Pays Off

The initial email appeal that Dr. Homsted received came from Joseph Hill, director of ASHP’s Government Relations Division. He knows he got far more than he bargained for.

“Felicity has been a pacesetter for the kinds of outreach we need from members to help us drive support for provider status,” said Hill. “The thing I find most inspiring about her advocacy is the persistence she demonstrated in reaching out to people and organizations. Felicity sets the gold standard for grass roots activity. If she can inspire others to do half of what she does, we will definitely get these bills across the finish line.”

Dr. Homsted tailored her pitch for every person she coaxed toward advocacy. “If I had just asked them, ‘Will you support us?’ many people – even many pharmacists wouldn’t understand why this is such a big deal,” she said. “But when I explain how provider status will help improve patient care and reduce healthcare costs on the individual level for their patients or organization, people really begin to understand the value of the legislation.”

Issues that matter-edits

Left, Robert Picone, host of the weekly public television show “Issues that Matter,” invited Dr. Homsted (right) to enlighten his viewers about provider status.

In the midst of Dr. Homsted’s advocacy blitz, another unexpected overture led to the most memorable moments of her campaign. Robert Picone, a board member of the Greater New England Chapter of the National Multiple Sclerosis Foundation and host of the weekly public television showIssues that Matter,” invited her as a guest on the program to enlighten viewers about provider status.

ASHP staff prepared Dr. Homsted for the interview by coaching her to ignore the cameras and take the time to consider each answer. They also recommended that she focus on a few simple, consistent messages and circle back to them at every opportunity; keep her answers succinct so that viewers understand what is at stake; and remember a few on-camera tips, including smiling slightly and avoiding clothing with patterns.

After the show appeared on YouTube, Dr. Homsted said she was amazed by how many people got in touch with her to find out what they could do to help. The most poignant response came from a good friend who texted, “I’ve never really understood what you do until I watched the show. Now I know how important your job is, and I want to thank you for all the things you’re doing to make healthcare better.”

Educating the Public about Pharmacists’ Roles

According to Dr. Homsted, consumers and legislators don’t fully understand the contemporary roles of pharmacists. “People are just beginning to appreciate that we add far more to the healthcare equation than just counting pills,” she noted, adding that educating the public as well as pharmacists about what provider status means is critical for passage of the legislation.

Dr. Homsted (second from far right) is supported in her provider status outreach efforts by her pharmacy residents and other members of her team at Penobscot Community Health Care in Bangor, Maine.

Dr. Homsted (second from far right) is supported in her provider status outreach efforts by her pharmacy residents, members of the Penobscot Community Health Care C-suite, and other members of her pharmacy team.

“Pharmacist provider status goes well beyond reimbursement; it is a mechanism to expedite pharmacist integration into care teams, ultimately improving care value, quality, safety and most importantly patient health.”

Dr. Homsted and her team’s advocacy efforts continue. She recently began enlisting universities and recruiting pharmacy students and residents (within and beyond Maine) to the ranks of active supporters.

“We want to create a small army of pharmacists who can go out and inform people about the importance of provider status,” she said. “I tell them to start with people they know well and with whom they can have an immediate impact, and then let those successes fuel more ambitious targets. Our goal is to get the entire Maine delegation to cosponsor the legislation. Anything else is unacceptable.”

–By Steve Frandzel

Editor’s Note: Want to find out how to support ASHP’s provider status efforts in your state? Check out our advocacy toolkit with a variety of activities to get you started!





August 18, 2015

New Mexico Clinic Pharmacists Wield Extensive Prescribing Privileges

From left, PMG Pediatric Pharmacy Specialist Kari Bishop, Pharm.D., discusses improvements in the electronic health record system related to adult and pediatric heparin infusions with Pharmacy Anticoagulation Specialist Linda R. Kelly, Pharm.D., Ph.C., CACP.

From left, PMG Pediatric Pharmacy Specialist Kari Bishop, Pharm.D., discusses improvements in the EHR system related to adult and pediatric heparin infusions with Pharmacy Anticoagulation Specialist Linda R. Kelly, Pharm.D., PhC, CACP.

IF THEY TAKE A MOMENT to look, patients who fill prescriptions after visiting one of the ambulatory care clinics in Albuquerque’s Presbyterian Medical Group (PMG) will see that the name on the medication bottle belongs to a pharmacist.

“When I write a prescription, it’s not checked or approved by a physician because I’m recognized as a healthcare provider by my state and my health system,” said Robert Rangel, Pharm.D., BCPS, PhC, director of pharmacist clinicians and anticoagulation services with PMG, noting that state laws dictate the limits of collaborative practice.

“That changes the perception among patients and colleagues about pharmacists’ abilities to care for patients, and it means that we’re recognized as advanced practitioners.”

Independent Prescribing

Collaborative practice agreements (CPAs) under which pharmacists write prescriptions are no longer isolated experiments. But most require a physician or nurse practitioner to review and sign off on every order. That’s where PMG breaks new ground: Any of the 14 clinical pharmacists practicing in ambulatory care can independently prescribe any medication used in the scope of a primary care visit as well as manage a spectrum of common chronic disease states. Right now, that list includes diabetes, elevated lipid levels and cardiovascular disease, hypertension, asthma and COPD, and even psychiatric and thyroid conditions.

Robert Rangel, Pharm.D., BCPS, Ph.C.

Robert Rangel, Pharm.D., BCPS, Ph.C.

The current CPA emerged from an earlier version at PMG’s anti-coagulation clinic, where pharmacists had wide latitude to adjust warfarin regimens and counsel patients. Improved clinical outcomes, such as a reduction in thromboembolic events, opened the door to the current, far more expansive CPA. This new practice agreement covers 15 primary care clinics, two cardiology clinics in greater Albuquerque, and one rural clinic with plans to expand to other parts of New Mexico. All of the more than 100 PMG physicians participate in the agreement.

“We’ve seen again and again that when you put a pharmacist in a clinic, even if they’re doing something small to begin with, sooner or later they’ll be asked to do more,” said Dr. Rangel.

The effectiveness of PMG’s ambulatory care practice reveals what pharmacists could do for patients if they were granted healthcare provider status under Medicare Part B, according to Joseph M. Hill, ASHP director of federal legislative affairs.

“This story is so great because it reinforces our message that pharmacist-provided care expands patient access and is cost effective,” Hill said, noting that the collaborative nature of PMG’s CPA mirrors the evolution of new care delivery models.

Charting Improvements in Fundamental Quality Measures

Three years ago, PMG restructured its budget so that the medical group, not the pharmacy department, paid the salaries of the ambulatory care pharmacists. A year later, the chain of command shifted; now, PMG ambulatory care pharmacists report to the director of the medical group rather the pharmacy director. The impact was huge, recalled Dr. Rangel.

“We’d been working and living in the medical group’s clinic but following a different management hierarchy. We didn’t feel like we were really a part of the medical group, and they felt the same way about us. We were still outsiders,” said Dr. Rangel.

The administrative shake-up solidified the unit and led to a collegial, supportive environment. “It really sealed the deal,” said Dr. Rangel.

Pharmacists at PMG clinics help patients manage a variety of chronic conditions, including diabetes.

The CPA’s success resulted from a lot more than just managerial and financial reshuffling. Once clinical pharmacists entered the scene, across-the-board improvements in fundamental quality measures followed, such as tighter A1c control for diabetic patients and improved blood pressure and lipid levels for cardiovascular patients. “We see better numbers for all three of them when pharmacist clinicians work in ambulatory care,” said Dr. Rangel.

Though their colleagues are accustomed to the presence of pharmacists in the outpatient clinics, patients are still getting used to the idea. Many express surprise when a pharmacist walks into the exam room to chat. “The majority of patients still see pharmacists as just drug dispensers,” said Dr. Rangel. “We still have a long way to go to change that perception. However, we are getting the word out, and it is making a difference.”

Expanding Scopes of Practice for Hospital Pharmacists

Linda Kelly, Pharm.D., CACP, PhC, a pharmacy anticoagulation specialist, anticipates that a CPA will emerge on the inpatient side at PMG. “I practice to the limit of my professional license in the outpatient clinics because of the CPA, but we haven’t yet defined a comparable role for clinician pharmacists on the inpatient side,” she said.

Setting comparable scopes of practice for clinical pharmacists throughout the organization will blur the lines between inpatient and outpatient care and create a more patient-centered care model, Dr. Kelly asserts. It just makes sense, she explained, that patients receive the same level of care from pharmacists wherever they practice in the organization.

“I already conduct medication management and offer prescribing recommendations for inpatients, but I can’t write orders independently,” she said. “Expanding our role to include prescribing is a logical next step.”

Dr. Rangel cautions that pharmacists tread carefully – but confidently – when seeking to expand their roles within a health system. “We were fortunate because we had already established relationships and a solid track record in the anti-coagulation clinic,” he said. “If we had walked into a clinic and said, ‘We’re here to manage your patients with chronic diseases and write prescriptions,’ we’d have hit forceful push back.”

“It was a slow process. We used our experience in the anticoagulation clinic as our introduction, and that made the transition much easier.”

Dr. Rangel suggests starting small, finding a niche, and letting the momentum build naturally.

“If I were starting from scratch, I’d ask the medical group what they need and how we can help… maybe managing diabetic or hypertensive patients,” he said. “Often members of the care team welcome that kind of offer. And as trust builds, demand for your services will almost certainly grow.”

–By Steve Frandzel

August 13, 2015

Provider Status: Moving Forward, Major Push by Practitioners Still Needed

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

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

AS OF TODAY there are 185 co-sponsors in the House of Representatives and 28 in the Senate for the Pharmacy and Medically Underserved Areas Enhancement Act (H.R. 592 and S.314, respectively). As impressive as these accomplishments are, we are asking pharmacists working at the state and local levels to substantially increase their efforts in August to help increase the co-sponsors to at least 218 in the House and 50 in the Senate. The numbers 218 and 50 represent support by at least half of the House and Senate, respectively, and send a strong signal to congressional leadership that these are serious bills that demand action by committees and ultimately on the floors of both the House and Senate.

ASHP and our partners in the Patient Access to Pharmacists’ Care Coalition (PAPCC) have been highly successful in educating members of Congress and gaining the support of various other non-pharmacy stakeholders at the national level. However, a national effort alone will not result in the passage of legislation. Now is the time for every pharmacist and ASHP state affiliate to lead the charge at the state and local levels, and to tell the story of how these bills will increase access to healthcare for medically underserved patients in their communities.

To support the efforts of practitioners at the local level, ASHP has created easy-to-use tools for members to find which elected officials have or have not sponsored the legislation, as well as a simple way to send a letter of support. ASHP also has many tools on our website to help members engage in and lead various grassroots efforts. And last, but certainly not least, ASHP has an exceptional team of government relations and public relations professionals available to members and state affiliates to contact for advice and guidance.

In the spring of this year, ASHP contributed $1 million to a multimillion-dollar media campaign launched by the PAPCC that is targeting federal lawmakers in the Washington, D.C., area. This campaign has been extremely successful in creating awareness and understanding about the important roles pharmacists play, and how these bills will help improve patient access to the care pharmacists provide. Also, through the PAPCC, ASHP has helped support the hiring of consultants in key states where leaders of key congressional committees reside, with the goal of helping them understand how important these bills are to their constituents, communities, and states.

In September, ASHP will be holding a legislative day on Capitol Hill with nearly 100 ASHP members from all around the country. Further, ASHP has invited residents to another series of legislative days on Capitol Hill in late October and another with students in February. Pharmacy residents whose programs are visiting ASHP headquarters will extend their stay in the Washington, D.C., area to meet with congressional staff and members of Congress. Their visit will coincide with the annual celebration of Pharmacy Week and a Pharmacy Health Fair on Capitol Hill. We will also repeat our popular Student Advocate Training and Legislative Day on February 1-2. The conference will give student pharmacists an in-depth and hands-on look at the policy process and prepare them for meetings with congressional offices. Registration for the conference opens on September 1.

As you can see, the push for provider status at the national level is moving full steam ahead, and ASHP is supporting our members in every possible way. Passing provider status legislation will help our patients receive the care they need and deserve, and will enhance the capabilities of pharmacists to provide that care to them. Please take some time out of your busy schedules during August to reach out to your elected officials in the House and Senate, asking them to support H.R. 592 and S.314. Given that they are all back home in August, also consider attending a town hall meeting or political fundraiser, writing an editorial in your local newspaper, or working with your hospital or health systems leadership to invite them to see the patient care you are providing and how that could be enhanced through the passage of this legislation.

Lastly, thank you so much for being a member of ASHP. This is your organization, and we couldn’t do it without you! I hope you are enjoying your summer, and I look forward to seeing many of you at the 50th Annual ASHP Midyear Clinical Meeting in New Orleans in December.


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