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March 8, 2019

North Dakota Technician Champions National Certification

This article is part of a series featuring ASHP’s pharmacy technician members and their valuable contributions to the profession. Check out ASHP’s Pharmacy Technician Forum for more information about efforts to advance the pharmacy technician workforce, as well as ways for pharmacy technicians to become more involved in ASHP.


Diane Halvorson, CPh.T.

AS A YOUNG ADULT, Diane Halvorson, CPh.T., never intended to become a pharmacy technician. But now, more than 25 years later, she has a gratifying career and is an influential figure in the field. As Lead Pharmacy Technician at Vibra Hospital Pharmacy in Fargo, N.D., Halvorson is a staunch advocate for improving technician certification and education programs.

Successful Technician
Halvorson began working at a hospital pharmacy more than two decades ago. As a single mother, she needed to find a way to support her son. Halvorson was lucky enough to learn the pharmacy technician trade on the job. She didn’t have any experience, but back then the job of a pharmacy technician was “very basic,” she said. She mostly managed the prescription medication stock.

Over time, her boss (the pharmacy director) took notice of her attention to detail and ability to manage her time and work efficiently. “As pharmacy evolved, I evolved along with it,” she said. “I became a sponge and started attending conventions, conferences, and any continuing education I could to expand my knowledge. The support of my peers and leaders gave me the confidence to excel.” When she began serving on the North Dakota Board of Pharmacy in 2011, she realized it was time to become certified.

“I have taken every opportunity to gain the knowledge and understanding of pharmacy and have evolved into the person I am today,” she said

National Standards for Techs
As a member of ASHP and other national and state pharmacy organizations, Halvorson was appointed by the governor of North Dakota to serve a second term on the North Dakota State Board of Pharmacy, with a goal of implementing education and certification programs in the state. The position has provided a forum to speak out about the need for standardizing pharmacy technician training across the nation.

Currently, there is no standard training or certification on a national level to become a pharmacy technician. Education and certification requirements to earn a CPh.T. degree vary by state. Some states may require more training than others, additional exams, or recertification.

But standardization in the profession is needed now more than ever. Pharmacists are now working in more clinical roles, but prescriptions still need to be filled. “Pharmacy technicians should have the credentials and knowledge to fulfill this role safely and accurately,” said Halvorson.

Expanding Tech Education
Halvorson and many of her colleagues would like to see pharmacy technicians undergo the same rigors of training that pharmacists face. “I feel we should have a national standard that establishes a way to ensure all pharmacy technicians have a baseline knowledge when entering the profession,” said Halvorson. “While our education would not be as detailed as the pharmacist, our process should mirror the process of the pharmacist.” The process would include the completion of an exam that verifies the baseline knowledge, she added.

Halvorson is an advocate for improving technician certification and education programs.

Some of the strictest requirements in her field exist in her home state of North Dakota, where pharmacy technicians are required to receive their education from an ASHP/ACPE accredited program. They must take a national certification exam to demonstrate their knowledge of the field, and they may only earn their certification in the state after meeting those requirements.

Hospital pharmacies in North Dakota are also required to have a quality assurance program to track prescription errors. “If you have a near-miss or a mistake that reaches the patient, you need to document it,” said Halvorson. “Was this an isolated incident? Was there a product problem or process problem or personnel problem?”

Technician Advocacy
Donna Kisse, CPh.T., is a pharmacy technician who has gotten to know Halvorson through their service together in North Dakota’s Northland Association for Pharmacy Technicians. Kisse and other colleagues admire Halvorson for the advocacy work she’s taken on toward a goal of consistent, national certification requirements for pharmacy technicians.

“Since pharmacists are taking the lead in clinical patient care roles, pharmacy technicians must be leaders in supporting standardized qualifications to ensure pharmacies are safe, efficient, and have productive work environments,” said Kisse.

Halvorson became involved with ASHP through the Pharmacy Technicians Stakeholders Consensus Conference steering and advisory committee. “For me, being a member of ASHP has elevated my overall knowledge and fundamental understanding of the opportunities of expansion of the scope of practice that a pharmacy technician can achieve,” she said.

The ASHP Pharmacy Technician Forum, which launched last year, has also been integral to her efforts. She currently serves on the forum’s Patient Care Quality Advisory Group committee.

Halvorson began her technician career more than two decades ago and currently serves as the Lead Pharmacy Technician at Vibra Hospital Pharmacy.

Reducing Prescription Errors
Halvorson hopes that all states will move toward following strict training guidelines like those in North Dakota. By not standardizing pharmacy technician training, Halvorson said the profession is putting the safety of patients in jeopardy. “The consumer believes that any person behind the pharmacy counter has education, that those people know what they’re doing, and that they have a minimum education.”

She recalled an incident that made headlines years ago. It involved Emily Jerry, a three-year-old girl in Ohio who died in 2006 as a result of a hospital pharmacy technician error. At the time of the toddler’s death, Ohio didn’t register pharmacy technicians or require any training or licensing to do the job. In 2009, Emily’s Act was signed into law. The legislation requires that pharmacy technicians be at least 18 years of age, register with the State Board of Pharmacy, and pass a Board-approved competency exam. It also includes requirements related to technician training.

“Humans make errors, and that’s why in a pharmacy you have a check and balance,” Halvorson said. That safety net wouldn’t exist without Halvorson and other passionate pharmacy technicians.

By Jessica Firger


# # #

August 6, 2013

Midwestern Glendale Students Dive into Drug Shortages Advocacy

From left, Mindy J. Burnworth, Nicole M. Wilson, and Benjamin J. Thompson display the drug shortages poster they created to educate others about this national problem.

ONGOING NATIONAL DRUG SHORTAGES that are negatively impacting pharmacists’ ability to care for patients can seem like an overwhelming problem to most practitioners.

But Benjamin J. Thompson and Nicole M. Wilson, students at Midwestern University College of Pharmacy, Glendale, Ariz., decided that they had a lot to contribute by educating fellow students, pharmacists, legislators, and other health care professionals about the issue.

They dove into the world of advocacy, partnering with mentor Mindy J. Burnworth, Pharm.D., BCPS, associate professor in the Department of Pharmacy Practice, to develop a poster on the issue.

Thompson and Wilson reached out to Burnworth during their first year of pharmacy school. Having settled into the routine of their studies, they were ready to expand their horizons in an area that interested them.

“We had gotten into the rhythm of tests and classes and were getting frustrated with not doing anything beyond that,” said Thompson. “We had talked about drug shortages and reached out to Burnworth through email with the idea of an introductory research project.”

From there, it was a matter of deciding on a project that would offer the students not only a chance to develop new skills, but provide a tool for advocacy.

“The poster format was short, sweet and concise, and it hit key points to discuss with pharmacists, physicians, and academicians,” Burnworth said.  “And, because legislation was being proposed in Congress at that time, the poster needed to include talking points to cover with legislators.”

Moving Through the Learning Curve

The team began by developing a timeline of tasks. All three conducted independent literature reviews, and together they narrowed their resources down to those that identified the impact of drug shortages on health care and highlighted legislation that proposed an early warning system as a way of addressing them.

Burnworth Melinda head shot

Mindy J. Burnworth, Pharm.D., BCPS

There was a learning curve in conducting the research, said Wilson. “We stumbled a little through trying to find the right articles and doing the literature search,” she said. “We needed to be detail-oriented, and because it was the first time we had done this, it took more time [than we expected].”

The poster took the form of a timeline that spanned from September 2010, when the Institute for Safe Medication Practice (ISMP) conducted a national survey of practitioners to assess the threat drug shortages pose to patient safety, to June 2012, when Congress reauthorized the Prescription Drug User Fee Act.

Highlights included the 2010 Drug Shortages Summit co-convened by ASHP and other stakeholders, several bills proposed to address the issue, and President Barack Obama’s 2011 Executive Order directing the Food and Drug Administration and Department of Justice to take action to reduce and prevent drug shortages. In her role as mentor, Burnworth shared resources and examples of posters for the students to use as a guide, and she discussed the nitty-gritty of poster production—how to find a printer, what the costs would be, and how to schedule poster reproductions.

She also gave the students pointers on submitting their work for presentation at meetings and conferences. All told, the process took two months from first meeting to printed poster. A mock poster session with fellow students and faculty gave Thompson and Wilson the chance to perfect their presentation and prepare them for their discussions with health providers and legislators.

The two then presented the poster four times in 2012: at the university’s Research Day, the Arizona Pharmacy Association’s Health-System Academy and Annual meetings, and ASHP’s Midyear Clinical Meeting in Las Vegas.

“Our mission was to make pharmacists aware that there was already a drumbeat for reform, and encourage them to contact their legislators and advocate support for the specific legislative items that had already been proposed,” said Thompson. “I found that people seemed much more inclined to take action once they realized that a proposed solution was already in place, and most of the people we spoke with indicated that they were strongly considering taking the time to contact their legislators.”

Poster Sparks New Interest in Advocacy

One goal of the project was to educate Thompson and Wilson about political advocacy. The students followed four key steps wherein they identified the salient issue; identified local, state, and national legislators; communicated with their legislators via telephone, email, or in person; and tracked the status of their efforts by following relevant legislation through government websites. It’s a formula the students plan to use going forward.

“Finding an opportunity to get involved during our first year of school was especially rewarding as it enabled us to share our experiences with our classmates, and take on roles as leaders and educators when other students wanted advice for similar projects,” said Thompson, who indicated that he continue advocating for ways to address drug shortages and is considering branching out into other issues. Wilson intends to advocate for provider status for pharmacists and advancing the profession as a whole.

The content of the poster and the steps the students took fit well with ASHP’s grassroots advocacy, said Joseph M. Hill, ASHP’s Director of Federal Legislative Affairs.

“The timeline presents the continuum of policymaking at the federal level. It shows the slow, multiyear process. It’s almost a case study of how an issue moves through Congress,” he said.  “Overall, the students’ process could be used as a guide to work on other issues, not just in meeting with members of Congress, but other stakeholders with an interest in an issue.”

—By Terri D’Arrigo


July 30, 2013

Compounding Legislation: Your Voice Urgently Needed Now!

Filed under: Current Issue,From the CEO,Quality,Regulation — Tags: , , , , — jmilford @ 12:29 pm
Paul W. Abramowitz, Pharm.D., Sc.D. (Hon.), FASHP

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

It’s hard to believe that after the many deaths and illnesses associated with the alleged practices at the New England Compounding Center last Fall, the bipartisan Senate bill (S.959) that is designed to prevent a tragic repeat could be facing tremendous opposition.

ASHP strongly supports this legislation. Yet, it appears that opposition to the Senate bill is forming, because certain interests want to protect the status quo, which we believe could be at the expense of protecting patients from another compounding tragedy.

These special interests are also threatening to severely limit how pharmacists in hospitals and health systems serve and protect patients. ASHP supports the provision in the bill that exempts health systems from being designated as compounding manufacturers. Without this important exemption, many hospitals and health systems would have to register with the Food and Drug Administration (FDA) as compounding manufacturers, since anticipatory compounding is required for us to meet the needs of our sickest and most vulnerable patients.  Also, without the exemption, many hospitals would not be able to prepare compounded preparations and send them to their wholly owned outpatient clinics, surgery centers, smaller inpatient facilities, and medical office practices.   This is a critical distinction, based on the fact that hospitals and health systems are fully accountable for the comprehensive care of the patient – as compared to a compounding manufacturer that sells its products across state lines without a prescription or knowledge of the patient to a third party for administration.

This distinction between health systems and compounding manufacturers is based on very important differences:

  • Hospitals and health systems have well-established quality improvement, infection control, and risk management committees, as well as adverse event monitoring and reporting systems.
  • Health systems must comply with the Centers for Medicare & Medicaid Services (CMS) Hospital Conditions of Participation and are accredited by quality improvement organizations such as The Joint Commission and DNV Healthcare, both of whom have deemed status with CMS.
  • Hospitals and health systems have Pharmacy and Therapeutics Committees that control approved drug formularies.

We must protect the important work that pharmacists do in hospitals and health systems to take care of their patients.  In addition, hospital pharmacists and other providers must be assured that when they need to purchase compounded products from outside suppliers that they can expect to receive products that are safe and effective for their patients.  Therefore, we must enact into law urgently needed regulatory control over compounding manufacturers to prevent another tragedy.

You can make a difference. Your voice really matters to your elected Senators and Representatives in Congress!

ASHP has made it as easy as just a few clicks on your computer for your voice to be heard.

Go to ASHP’s advocacy page and make a difference for patient safety!

Tell your Senators that you want them to vote “YES” in support of S. 959.  This legislation creates a new category, “compounding manufacturer,” which will be regulated by the FDA. Hospitals and health systems are considered traditional compounders in the legislation and will remain under the purview of state boards of pharmacy and other accrediting bodies.

Tell your Representative that the House should take a similar approach to the legislation and give the FDA the tools it needs to prevent another tragedy.

Your support today can go a long way in getting this important legislation passed!

July 1, 2013

Moving Closer to Achieving Our Vision


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

In the last 20 years, the ASHP House of Delegates has debated and passed important proposals like support for the entry-level Pharm.D., universal health insurance, mandatory reporting of medication errors and “just culture,” collaborative practice, and the implementation of health information technology.

In recent years, the ASHP House of Delegates has approved policies that set future goals for residency training for all practitioners in direct patient care roles; defined the role of pharmacist prescribing in interprofessional patient care; called on federal officials to take action on compounding, drug shortages, REMS, and meaningful use standards; and pushed for standardized education, certification, registration, and licensure requirements for pharmacy technicians.

These policies touch every facet of pharmacy practice and have a profound impact on medication use in this country. ASHP’s professional policies offer a vision for the future of the profession in which pharmacists are essential members of every health care team and where medication use is optimal, safe and effective for all people, all of the time.

Last month, the ASHP House of Delegates approved more than 20 new professional policies during its session at the 2013 Summer Meeting in Minneapolis. Along with passing measures that support training in team-based patient care for student pharmacists and residents and the reclassification of hydrocodone combination products under the Controlled Substances Act, delegates also took strong positions on compounding safely and achieving provider status for pharmacists.

These actions are emblematic of the leadership that ASHP has taken on key medication-use issues throughout its history. ASHP’s professional policies provide a solid foundation for the Society to pursue transformative solutions to the issues that affect our ability to care for our patients.

In particular, the newly approved policies on compounding by health care professionals and pharmacist recognition as health care providers highlight this principle.


ASHP is actively engaged in federal efforts to close gaps in the regulatory oversight of pharmaceutical compounding activities. We’ve worked closely with members of Congress and congressional staff on legislation that we expect the Senate to vote on this month; namely, the Pharmaceutical Quality, Security, and Accountability Act. While this legislation addresses federal authority, our new policy focuses on the laws and regulations that govern traditional compounding that occurs in hospitals, clinics, and other areas within health systems. It advocates for the adoption of applicable standards of the United States Pharmacopeia by state legislatures and boards of pharmacy.

The laws and regulations governing compounding vary from state to state. It is essential for the safety of all patients that all pharmacies that compound medications, regardless of the setting, adhere to the very highest standards. A uniform standard will help to ensure that the medications our patients receive are safe and that they are not harmed by agents that are intended to help them.

Pharmacist Recognition as a Health Care Provider

Pharmacists are health care providers. You demonstrate that each day. But we have some work to do to fix antiquated federal and state laws that place unnecessary limits on patients having access to the care we provide.

Our new policy on pharmacist recognition as a health care provider makes a strong case for changing the status quo. It points to the pharmacist’s role as a medication expert who provides safe, accessible, high-quality, cost-effective care. The policy also highlights that, as health care providers, pharmacists improve access to patient care and bridge existing gaps in care.

Achieving recognition as providers for pharmacists is ASHP’s top advocacy priority. We are devoting substantial time and energy with our partner pharmacy organizations to push for changes in the Social Security Act that will recognize the valuable role we play in the health care system.

Please take a look at the summaries of these policies below, and review the other professional policies that were recently finalized by the ASHP House of Delegates:

Pharmacist Recognition as a Health Care Provider

To advocate for changes in federal (e.g., Social Security Act), state, and third-party payment programs to define pharmacists as health care providers; further, to affirm that pharmacists, as medication-use experts, provide safe, accessible, high-quality care that is cost effective, resulting in improved patient outcomes; further, to recognize that pharmacists, as health care providers, improve access to patient care and bridge existing gaps in health care; further, to collaborate with key stakeholders to describe the covered direct patient-care services provided by pharmacists; further, to pursue a standard mechanism for compensating pharmacists who provide these services.

Compounding by Health Professionals

To advocate that state laws and regulations that govern compounding by health professionals adopt the applicable standards of the United States Pharmacopeia.


I also encourage you to spend some time thinking about what you envision for the future of practice and what is needed to bring us closer to that goal. Share your thoughts with me in the comments section of this column or by sending an email to Members serve as the catalyst for our policy initiatives. Your input can help bring us even closer to achieving the vision we have for patient care.

November 5, 2012

Reflections on the NECC Compounding Tragedy

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

I, LIKE MOST OF YOU, CONTINUE TO FOLLOW the news out of Framingham, Mass., as more is learned about the operations at the New England Compounding Center (NECC).

What investigators are finding—unsatisfactory conditions, shipping of product before the results of sterility testing were known, and inattention to other known safeguards—deeply upsets me. These types of practices are totally unacceptable anywhere, at any time. The patients who relied on these medications deserved much better, and our sympathies go out to all of the affected patients and their families. But condolences cannot begin to replace their losses. Enhanced safeguards must be put into place so that this does not happen again.

Having said this, however, it’s important to note that I am also concerned that compounding by pharmacists—a practice that is essential to patient care—may be broadly called into question. Compounding and pharmacy are inextricably linked.

From preparing a topical cream to the complex processes involved in preparing sterile products, compounding happens every day in every hospital and health system. What happened at NECC does not reflect the professionalism and commitment to patients provided by pharmacists throughout the country. We cannot allow what happened there to shape the public perception of a critical element of patient care.

ASHP has a long history of pushing for the highest standards for compounding and sterile product preparation in hospitals. In the early 1990s, we began publishing practice recommendations in AJHP. We published the “ASHP Technical Assistance Bulletin on Quality Assurance for Pharmacy-Prepared Sterile Products (TAB)” in 1993. The TAB established the three-tier risk assessment structure that was later adapted by USP for use in the <797> standards for sterile compounding. Our guidelines on outsourcing sterile compounding services urge pharmacy departments to conduct due diligence when outsourcing compounding services.

It is essential for the safety of all patients that all pharmacies that compound medications, regardless of the setting, adhere to the very highest standards. In addition, state boards of pharmacy will need additional resources to provide strict oversight of compounding pharmacies and provide more transparency.  And when companies cross the line from compounding to manufacturing, there needs to be enhanced coordination between state boards and the U.S. Food and Drug Administration (FDA) to ensure that the necessary regulatory scrutiny is applied.

We know the important role that compounding plays in patient care, but we have a fair amount of work to do to restore the public’s trust after this tragic event. As hospital and health-system pharmacists, we have always taken the lead in medication safety in our practice settings, ensuring that our patients can always depend upon us. ASHP pledges to work diligently to restore that trust and to help prevent a tragic and unfortunate event like this from ever happening again.

September 6, 2012

Innovations in Reimbursement

Betsy Bryant Shilliday, Pharm.D., CDE, CPP, right, speaks with a patient during the patient’s Annual Wellness Visit (AWV).

LAST APRIL, THE PHARMACY DIRECTOR of a large, multi-hospital health system in the Midwest phoned Gloria Sachdev, Pharm.D., clinical assistant professor of primary care at the Purdue University School of Pharmacy, West Lafayette, Ind.

Several administrators had bombarded the director with requests for additional clinical pharmacists. Faced with juggling the competing demands while securing adequate resources to support the costs—and with his organization in the midst of becoming an accountable care organization (ACO)—he turned to Dr. Sachdev, an authority on establishing sustainable clinical pharmacy models.

“No one had a firm idea of what services they needed, yet they all felt pressure to meet shifting quality-of-care measures,” said Dr. Sachdev. These included reducing 30-day readmission rates or boosting subpar performance measures which would be tied to how much money they could share from savings created by its ACO. And all of the petitioners knew that medication-related measures were intertwined with many of the health outcomes they wanted to influence.

“The question was wide open: Can pharmacists make an impact on some of these measures? The answer is yes,” said Dr. Sachdev.

Creating a Financially Sustainable Plan

After multiple meetings with the administrators and the pharmacy director, Dr. Sachdev helped the group identify what services each had in mind, which diseases and conditions needed the most attention, and the role pharmacists could play within the organization’s nascent accountable care model. Then, they hammered out a financially sustainable plan to expand pharmacist services.

Ultimately, two ambulatory care pharmacist positions were approved to focus on chronic disease management, transitions of care, and quality improvement. Both positions were designed to be billed “incident to” a physician’s care.

Gloria Sachdev, Pharm.D.

“Reimbursement for the pharmacists will cover a bit more than the cost of their services,” said to Dr. Sachdev. “It’s essentially a cost-neutral proposition.”  Getting the billing department involved and educating employees regarding billing opportunities for pharmacists early on was key to the group’s success.

When direct billing for pharmacist services isn’t available—which is usually the case in today’s health care environment—Dr. Sachdev noted that “in a pay-for-quality environment, if pharmacists can show that they can help a health system achieve quality measures of high priority, when the organization gets a large payment for attaining these measures, some of that money can be designated to pay the pharmacists’ salaries.”

“Pay-for-quality programs, such as ACOs, Patient-Centered Medical Homes (PCMHs), Medicare Part C (Medicare Advantage), etc., offer pharmacists new payment opportunities by implementing this indirect model of reimbursement,” she added.

Helping Patients Manage Their Medications

Elsewhere, pharmacists have put their own distinct imprint on direct patient care. The P3 (Patients, Pharmacists, Partnerships) program at the University of Maryland School of Pharmacy began as a diabetes management initiative, then broadened its scope considerably.

The P3 Program is a dynamic partnership that begins with the University of Maryland School of Pharmacy, and includes the Maryland Pharmacists Association, the American Pharmacists Association Foundation, the Maryland General Assembly, and the Maryland Department of Health and Mental Hygiene, Office of Chronic Disease Prevention.

The program contracts with six companies, including ASHP, to conduct medication management and preventive care for employees with chronic diseases such as diabetes, high blood pressure, and high cholesterol. Any employee covered under the employer’s health plan is eligible, and more than 400 are currently enrolled.

P3 pharmacists consult patients four to seven times annually. They assess each patient’s understanding of his or her illness and medication regime, emphasize the importance of medication adherence, and provide education about adverse effects and drug interactions. Pharmacists may also help patients set personal goals, coordinate referrals for lab tests and specialist visits, and administer pneumococcal and influenza vaccinations.

Consults occur at wellness clinics, at community pharmacies, or at an employer’s premises. All P3 pharmacists receive training in medication therapy management, chronic disease management, and self-management coaching and must have completed an Accredited Council for Pharmacy Education-level Diabetes Certficate program, be a certified diabetes educator, or be a Board-certified Pharmacotherapy Specialist.

“We bill the employer every month based on the number of visits and pay the pharmacists who saw the patient,” said Dawn Shojai, Pharm.D., assistant director of P3.

The results are telling: Since January 2009, P3 participants have experienced statistically significant improvements in outcomes for all clinical endpoints, including hemoglobin A1c levels, blood pressure, and LDL cholesterol levels.

The numbers also compare favorably to national and statewide indicators, according to Dr. Shojai. For example, 83 percent of P3 participants had HbA1c levels under 8 percent, compared with 62.3 percent and 64 percent of patients enrolled in national and Maryland commercial plans, respectively, according to data from the 2011 HEDIS (Healthcare Effectiveness Data and Information Set). On average, employers saved about $1,500 per employee annually.

Dr. Shojai continues to push hard for recognition of P3 by Maryland’s Medicaid program, which she expects to occur eventually. “Most of the battles have been to convince people that paying for pharmacists, while expensive, will save money and lives,” she said.

Annual Wellness Visits: A New Kind of Patient Care

Farther south, pharmacists in North Carolina are mining a section of the Affordable Care Act (ACA) and hauling out a steady new revenue source. The ACA established Medicare coverage for annual wellness visits (AWV), but Medicare doesn’t stipulate who must conduct the visit except to say that the clinician must be a licensed health professional.

“This is a completely new avenue for pharmacists to generate revenue by seeing Medicare patients and earning direct reimbursement at a higher service level,” said Betsy Bryant Shilliday, Pharm.D., CDE, CPP, associate clinical professor at the University of North Carolina at Chapel Hill School of Medicine and Eshelman School of Pharmacy.

“Across the board, this is a different type of visit than pharmacists are used to providing. It’s a big deal,” she said. Patients seem to think so, too. Appointment slots fill up weeks in advance. “It’s a service patients want, and that means I am generating income, too,” Dr. Shilliday added.

Reimbursement varies by region, but rates are uniformly higher than for nurse visits, and the service isn’t subject to the usual 20 percent copayment, said Dr. Shilliday, who details the visit requirements on the Section of Ambulatory Care Practitioners portion of the ASHP website.

The practice of pharmacists conducting AWVs is not yet widespread, but Dr. Shilliday predicts steady growth as health systems realize that this represents a practical and profitable way to mitigate the shortage of primary care providers. Ultimately, it is up to pharmacists to identify these kinds of opportunities, according to Dr. Shilliday. “We need to step outside our comfort zone of practice to embrace innovative opportunities, expand our scope of practice, and assume new responsibilities” she said.

Bearing the Burden of Proof 

Mary Ann Kliethermes, Pharm.D., vice chair of ambulatory and associate professor at the Chicago College of Pharmacy, Midwestern University, in Downers Grove, Ill., agrees that in the current health care landscape, pharmacists bear the burden to prove their worth. Her own experience is a case in point. Dr. Kliethermes works part-time in an internal medicine office of a large, multi-site physician group in the Chicago suburbs. Until recently, her main responsibility had been counseling patients who were on anticoagulation therapy. She and the one other pharmacist in the office, however, envisioned much more.

Mary Ann Kliethermes, Pharm.D.

Over six months, they assembled a detailed business plan to broaden medication management services and projected the potential clinical and financial gains. They supported their case with data that showed, among other things, how pharmacist-directed medication management greatly reduced drug-related hospital readmission rates. By fortunate coincidence, the physician group had decided to adopt a patient-centered medical home model, necessitating a closer look at clinical outcomes. The result: Two pharmacists were added to their staff and a third is under consideration.

Their approach embraced the reality of the newer models to which health organizations must hew, and which tie reimbursement to quality and cost reduction, said Dr. Kliethermes, who co-edited, Building a Successful Ambulatory Care Practice, recently published by ASHP.

“We offered a total business package, justified our skills, and showed how we could help the practice meet its goals,” she said. “It is up to the health organization to decide how to allocate its resources, but it is up to pharmacists to show how they can improve outcomes.”


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