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May 23, 2014

Privileging Expands Pharmacists’ Role

Pharmacist privileging at Veterans Administration hospitals can extend past traditional pharmacist duties.

Pharmacist privileging at VA hospitals can extend past traditional medication management duties.

HOSPITALS THAT HAVE A STRONG CLINICAL PHARMACY PRESENCE are turning to their institutional privileging programs to expand the high-level patient care services that pharmacists can provide.

At The Johns Hopkins Hospital in Baltimore, a recently approved program will allow certain ward-based pharmacists to prescribe medications to inpatients.

“It’s about empowering some of our folks to practice at the top of their license and the top of what their knowledge base allows them to do,” said John J. Lewin III, division director of critical care and surgery pharmacy at Johns Hopkins. “That’s going to be good for patients in terms of efficiency, and accuracy, and care, and medication safety and its related outcomes.”

Lewin expects the pilot program to begin this summer in the hospital’s surgical ICU, where clinical pharmacists are fully integrated into the multiprofessional team and work there daily.

Writing Medication Orders

Under Maryland law, pharmacists can manage medication therapy by protocol, under the terms of a drug therapy management agreement between pharmacists and physicians.

“Our pharmacists do make the interventions now, but they’re not allowed to write medication orders,” Lewin said. Under the current system, any changes to the medication regimen must be performed by a resident, attending physician, or other prescriber.

John J. Lewin III

John J. Lewin III

“What we really heard from our physicians was, basically, ‘Why can’t you write the orders for this? You guys are the medication experts, and it would be good for patient care,” Lewin said.

He said allowing pharmacists to enter medication orders into the computer system will decrease the administrative burden on physicians and allow them to make better use of their time.

Ultimately, he said, about 20–30 unit-based pharmacists are expected to be granted prescribing authority. He said the expanded scope of practice will be available to clinical pharmacy specialists who have a Pharm.D. degree and postgraduate year 2 (PGY2) residency training or equivalent experience.

Lewin said hospital decision-makers concluded that modifying drug therapy is akin to prescribing, and that the hospital’s governing board should be responsible for assigning privileges to clinical pharmacists to encompass this work. The same process is used to permit physicians, nurse practitioners, and other qualified health care providers to order medications.

Lewin expects the pilot program to focus on renal dosage-adjustment protocols.

He said the protocols are designed to comply with state law and will allow pharmacists to use their professional judgment to make clinical decisions about drug therapy. He noted that different units will use different protocols that take into account the individual needs of the entire health care team and its patients.

Mirroring Physician Privileging

A similar privileging process is used at Fort Belvoir Community Hospital in Virginia, said U.S. Army Lieutenant Colonel Eric Maroyka, director of pharmacy for the joint services military treatment facility.

U.S. Army Lt. Col. Eric Maroyka

U.S. Army Lt. Col. Eric Maroyka

Maroyka said all hospital pharmacists are “core privileged” to perform routine tasks at the hospital. But about a dozen clinical pharmacy specialists with advanced training have been granted additional privileges that include the ability to prescribe medications in specific settings.

“We’re really mirroring what physicians and other midlevel practitioner providers do for their privileging,” Maroyka said.

For example, he said, one pharmacist in a patient-centered medical home setting specializes in diabetes care and is able to prescribe medications, monitor patients, and educate them about their drug therapy.

“She handles newly diagnosed diabetics and type 2 diabetics without complications,” Maroyka said. “If it’s more complex, like they need to be set up on [an insulin] pump or some other advanced regimen, then they would see the endocrinologist.”

Maroyka said credentials for supplemental privileges may include PGY2 residency training or the completion of a fellowship or other recognized educational activity.

For one pharmacist, he said, completion of the ASHP Research and Education Foundation’s three-part traineeship program in pain management and palliative care supported the attainment of advanced privileges to treat patients in need of such services.

The Council on Credentialing in Pharmacy, a coalition consisting of ASHP and nine other national pharmacy organizations, recognizes several groups that may credential or certify pharmacists in advanced practice areas. These include the Board of Pharmacy Specialties, the National Asthma Educator Certification Board, the American Heart Association, the National Certification Board for Diabetes Educators, the Commission for Certification in Geriatric Pharmacy, the American Academy of HIV Medicine, and the American Board of Applied Toxicology.

Click here to find resources that describe credentialing opportunities and related documentation.

Flexibility to Perform Advanced Functions

William Greene, chief pharmaceutical officer at St. Jude Children’s Research Hospital in Memphis, Tennessee, said 11 clinical pharmacists have been granted advanced privileges by the St. Jude governing board.

“These individuals have the authority to order and monitor laboratory tests and other items related to medication therapy and to adjust medication therapy [for] a broad number of medications,” Greene said.

He said most pharmacists practicing at this level have completed a PGY2 residency program and are board certified in oncology pharmacy. But he said the system includes enough flexibility to allow some highly qualified, experienced pharmacists who lack those credentials to perform advanced functions.

William Greene

William Greene

Greene said the decision to privilege pharmacists through the medical staffing process grew out of his concern that an auditor could potentially decide that clinical pharmacists were providing medication therapy services without a valid medication order.

The problem, he said, is that although Tennessee’s pharmacy practice act allows pharmacists and physicians to establish patient care relationships, the act doesn’t define collaborative drug therapy management.

Greene said that the hospital’s medical executive committee determined that clinical pharmacists are functioning as “midlevel practitioners” and should be credentialed and privileged as such. He noted that the determination coincided with the Centers for Medicare and Medicaid Services 2012 revision of its conditions of participation that allowed pharmacists to be considered part of a hospital’s medical staff.

“It was perfect timing,” Greene said.

ASHP’s Council on Education and Workforce Development recently recommended that the Society support the use of postlicensure credentialing, privileging, and competency assessment to establish qualifications for providing direct care to patients. The council agreed that credentialing programs should meet guiding principles established by the Council on Credentialing in Pharmacy.

ASHP’s House of Delegates, when it meets June 1 and 3 in Las Vegas, will consider these positions for adoption as an official ASHP policy.

–By Kate Traynor, reprinted with permission from AJHP
(volume 71, pages 686-687).

April 9, 2014

PCIP Helps Pharmacists Make Big Impact in ED

Filed under: Clinical,Current Issue,Feature Stories,Innovation,Managers,Quality,Uncategorized — Kathy Biesecker @ 3:58 pm

ASHP’s Patient Care Impact Program aims to create more ED pharmacist positions in hospitals across the country.

THE SPEED AND COMPLEXITY OF CARE for patients in emergency departments (EDs) is a well-known contributor to medication errors and adverse drug events (ADEs). Studies show that twice as many medication errors occur in EDs than in the inpatient setting.[1]

And of the approximately 110 million patients who receive ED care each year in the U.S., 35 percent experience ADEs. Seventy percent of those are thought to be preventable. [2]

In 2007, the Agency for Healthcare Research and Quality corroborated ASHP’s view that hospital emergency rooms around the country could benefit greatly from pharmacists’ medication knowledge and oversight. It provided funding for the ASHP Patient Care Impact Program (PCIP), a small but crucial six-month traineeship to help practitioners implement an emergency pharmacist role within their own institutions.

“Pharmacists in the ED have been shown to reduce preventable adverse drug events, improve medication reconciliation, and help reduce drug costs,” said Barbara Nussbaum, B.S.  Pharm., MEd, Ph.D., ASHP’s director of adult learning and education programs. “It’s a total win-win for the hospitals who implement a pharmacist position in the ED.”

A Challenging Environment

Up to 10 trainees are picked for the program each year. Nationally recognized expert emergency practitioner Daniel P. Hays, Pharm.D., BCPS, FASHP, specialist in poison information, Arizona Poison & Drug Information Center, Tucson, serves as the program mentor, advising PCIP participants on the clinical projects they have chosen.

The pharmacists then engage in brainstorming sessions and monthly teleconferences for status updates, group mentoring,  and problem solving, all while earning 25 hours of CE credit.

Daniel Hays, Pharm.D., BCPS, FASHP

Daniel Hays, Pharm.D., BCPS, FASHP

“My role is to act as a sounding board for trainees and to provide guidance in moving ED services forward within their institutions,” said Hays. “Implementing this kind of program is not easy, and I help the participants deal with unique challenges they face in the emergency-care environment.”

The high stakes and elevated tensions of an ED can be challenging for a pharmacist who is used to working in a centralized pharmacy, according to Hays. In a place where orders are processed stat, it’s not always clear how and where medication experts fit in.

“Unfortunately, a pharmacist who is not trained in the unique environment of the ED will not last long,” he said. “There may be personality conflicts, and it’s a uniquely chaotic environment. The ED pharmacist needs to be able to function within and to integrate with the team while helping with all aspects of patient care.”

Trainees feel they have gleaned myriad benefits from the program. Rachana Patel, Pharm.D., pharmacy clinical manager, St. John Medical Center, Westlake, Ohio, and her PGY1 resident Steve Margevicius, have used what they learned to help embed a full-time pharmacist in St. John’s emergency department (ED).

Rachana Patel, Pharm.D.

Rachana Patel, Pharm.D.

“We are excited to have hired a pharmacist with several years of critical care experience, and I’ll be using my PCIP experience to help him bridge the pharmacy’s clinical activities throughout a patient’s entire stay in the hospital,” Patel said, adding that she was also able to add three full-time medication reconciliation technicians to the ED.

Tiffany Mitchem, Pharm.D., an emergency room (ER) pharmacist with Mobile Infirmary Health, Mobile, Ala., used the program to get the emergency care skills she needed in lieu of an intensive residency. Mitchem recently led an initiative to expand ER pharmacist’s services in her hospital to seven days a week.

“At Infirmary Health, unless pharmacists are physically in the ER, there is no pharmacist supervision of medication orders there. So, it’s really critical to get these services into the emergency care environment,” Mitchem said, adding that the PCIP program made her much more confident in her clinical abilities.

Saving Lives

Given the fact that 70 pharmacists have completed the program to date, it’s not a stretch to say that the PCIP saves lives.

Cody Maldonado, Pharm.D.

Cody Maldonado, Pharm.D.

During his PCIP traineeship, Cody Maldonado, Pharm.D., clinical emergency department pharmacist, Saint Vincent Healthcare, Billings, Mt., undertook a project to decrease mortality and improve outcomes in patients with septic shock.

“We found that the key to improving outcomes was faster detection and administration of antibiotics and fluids,” Maldonado said. “So, we implemented a ‘sepsis swarm’ that would alert the physician, pharmacist, charge nurse, and bedside nurse to the life-threatening situation. By having a pharmacist deliver the antibiotic directly to the patient’s bedside, we decreased average time from sepsis recognition to administration of antibiotics from over three hours to less than one hour.

“This multi-disciplinary alert has greatly improved awareness about sepsis, and I believe that it is part of the reason why our sepsis mortality has decreased by over 50 percent.”

Sharing Knowledge

The six-month traineeship concludes with a poster presentation given by each participant at ASHP’s Midyear Clinical Meeting. The information that trainees share with the thousands of pharmacists who attend ASHP’s Midyear serves to sensitize many more practitioners to the special aspects of emergency care.

PCIP participants present the findings of their ED projects at ASHP's Midyear Clinical Meeting.

PCIP participants present the findings of their ED projects at ASHP’s Midyear Clinical Meeting.

Nussbaum noted the success of a specific 2013 poster on antibiotic stewardship in the ED.

“Understanding the resistance patterns of patients who are coming in from outpatient settings is a hot issue because of the upswing in more dangerous bacterial strains,” she noted, adding that trainees are developing processes to use the most-effective medications in the ED setting.

Other participants appreciate the opportunity the PCIP provides them to present on a profession-wide “stage.”

“The PCIP advanced several career goals of mine, including my desire to publish more within my specialty and to present the results of our project at Midyear,” said Nicole Abolins, Pharm.D., emergency medicine clinical pharmacist with Novant Health Forsyth Medical Center, Winston Salem, N.C.

Abolins presented a poster at the 2013 Midyear on “Expanding emergency department pharmacy services by decentralizing existing pharmacy staff resources.”

The Payoff

Despite the challenges of practicing in an emergency environment, the payoffs can be big, according to Hays. Working directly with critically ill patients requires special skills but can be a real gift.

“When a pharmacist works in the ER, not only is he or she providing safe medication use, but he or she is a key part of the care team’s front line,” Hays said. “I tell my mentees, ‘Don’t be afraid to get a warm blanket for someone.’ And I’ve never heard an ER pharmacist say, ‘That’s not my job.’ ”

 –By Evan Mulvihill

[1] Santell JP, Hicks RW, Cousins DD. Medication errors in emergency department settings—5 year review. Presented at American Society of Health-System Pharmacists Summer Meeting; June 2004; Las Vegas, NV. Abstract.

[2] Brennan TA, Leape LL, Laird NM, et al. Incidence of adverse events and negligence in hospitalized patients. Results of the Harvard Medical Practice Study I. N Eng J Med. 1991;324(6):370-376.

April 4, 2014

The Importance of Staying Current on New Guidelines

Filed under: Clinical,Current Issue,Residents,Students,Uncategorized,What Worked for Me — Kathy Biesecker @ 3:04 pm

Bryan P. White, Pharm.D.

AS A NEW PRACTITIONER at a 250-bed hospital, working the weekends can be intimidating. Fewer pharmacy staff work on weekends, and clinical and administrative support is only available via paging. The punctuality of a call back can vary widely.

On the weekends, you also receive many verbal orders and admissions from on-call physicians, a concern because increased error rates with verbal orders have been well documented.1 As an evening pharmacist, I often work two and half hours alone. Pharmacists must always be vigilant to ensure the best patient care, but the need to have heightened safeguards is even more important when you practice under low-staffing conditions.

Questioning a Verbal Order

Working in this environment builds your confidence, but the first year is difficult. Interventions can happen at any time. Late one Saturday night, I received a verbal order for “low-dose dopamine titrate to systolic blood pressure greater than 90 mm Hg” for a patient in the ICU.

Two blood cultures were also ordered by the same physician. I called the nurse to ascertain what was going on with the patient. The patient was hypotensive with mean arterial pressures less than 65 mm Hg and possible sepsis. Because new “Surviving Sepsis” guidelines2 indicate that norepinephrine was the vasopressor of choice, I wanted to ensure that the ordering physician had a specific reason for placing the patient on this particular regimen.

Interventions can be a great opportunity to educate fellow health care professionals about what pharmacists know and why we do what we do.

I paged the physician and discussed with him the current guidelines that show dopamine had higher mortality and supraventricular and ventricular arrhythmias when compared to dopamine. Because the guidelines had just come out, he was unaware of the new recommendations and thanked me for calling this to his attention. He went on to give me a new verbal order to change the patient to norepinephrine.

I walked up to the ICU and wrote the verbal orders to discontinue the dopamine drip and start a norepinephrine drip. I also spoke with the patient’s nurse and another nurse on the floor about the current “Surviving Sepsis” guideline recommendations on vasopressors.

An Opportunity to Build Relationships

The extensive time that it takes new knowledge to disseminate is well-documented in the literature. (It typically takes about 17 years before it becomes routine practice). Pharmacists can ensure they are doing what’s best for the patient by staying as up-to-date as possible on new clinical guidelines and recommendations. Being on the sharp edge of new information on medication use—and helping to disseminate that information to other members of the health care team—is critical to providing safe and effective treatment.

These types of interventions are not atypical, but I believe that they can be a great opportunity to educate fellow health care professionals about what pharmacists know and why we do what we do. It’s also important for new practitioners to develop confidence in discussing therapeutic changes with physicians. Interventions such as this one help to increase your rapport with practitioners, boost appreciation for a pharmacist’s role in patient care, and increase one’s own self-confidence in performing the critical duties of a pharmacist.

–By Bryan Pinckney White, Pharm.D., Staff Pharmacist, St. Francis Hospital, Columbus, GA

    1. Fijn R; Van den Bemt, P.M.L.A.; Chow, M.; De Blaey, C.J.; Jong‐Van den Berg, D.; & Brouwers, J.R.B.J. (2002). Hospital prescribing errors: Epidemiological assessment of predictors. British journal of clinical pharmacology, 53(3), 326-331.


  1. Dellinger, R.P.; Levy, M.; Rhodes, A.; Annane, D,; Gerlach, H.; Opal, S.M.;  Moreno, R. (2013). Surviving sepsis campaign: International guidelines for management of severe sepsis and septic shock, 2012. Intensive care medicine, 39(2), 165-228.



April 2, 2014

Patient Safety Award Highlights Best of the Best

University of Wisconsin Hospital and Clinics, Madison, won the 2011 award for its innovative anticoagulation stewardship program. Above, Philip Trapskin, Pharm.D., BCPS, confers with Anne Rose, Pharm.D.

NO ONE KNOWS MEDICATION SAFETY like a pharmacist, and the ASHP Research and Education Foundation’s Award for Excellence in Medication-Use Safety has showcased many of the best programs in the country since its launch a decade ago.

“This award is associated with projects that help to expand the role of pharmacists. It’s a model for showcasing pharmacists’ abilities to lead interprofessional teams to yield organization-wide, safety and quality initiatives,” said Stephen J. Allen, R.Ph., M.S., FASHP, the Foundation’s chief executive officer.

Supported by a grant from the Cardinal Health Foundation, the award provides $50,000 each year to a pharmacist-led multidisciplinary team for implementing significant institution-wide system improvements relating to medication use. Two finalists also receive $10,000 each.

Since the first award was given to OhioHealth in Columbus for its adoption of mechanisms to consistently identify adverse drug events and provide a platform for best practices across the system, the number of applications has climbed steadily to more than 30 per year, and the types of programs recognized have expanded from medication reconciliation to include a range of care areas such as post-discharge follow-up, anticoagulation stewardship, post-transplant care, diabetes care, and oncology.

As pharmacy practice and health care have evolved, the award has evolved with the work becoming sophisticated with significant impact and touching all areas of healthcare,” said Dianne Radigan, vice president of community relations at Cardinal Health.

Assessing Success

To win the award, a program or initiative must be able to provide evidence that it has improved medication-use safety and patient care. There must be quantifiable outcomes, and the applicant must be able to record specific, concrete ways that pharmacists and other members of a multidisciplinary team have worked together to produce the best patient outcomes.

Amassing the data provides an opportunity to assess the success of a program, said Teri B. Cardwell, R.Ph., Pharm.D., M.H.A., senior director of population health at Novant Health in Winston-Salem, N.C.  Novant won the award in 2008 for its outpatient medication reconciliation program for patients older than 65.

“It’s interesting to write it all down and see it in front of you,” Cardwell said. “We thought we were doing well, but when we got someone to run the numbers and look at the program more in depth, we learned just how much we’d done, and where we might want to go next.”

[The award] shows physicians and surgeons what a great resource they have in pharmacists and how pharmacists optimize care and help patients understand their medications.

Winning the award provided a boost to the team at the Medical University of South Carolina in Charleston, honored in 2010 for its initiative to decrease length of stay, preventable re-admissions, and adverse drug events for kidney transplant patients. The award brought the team recognition within their health system and landed them another award, this time from the hospital itself, to extend the initiative to other hospital services.

“Because this is a multidisciplinary process, the Award for Excellence in Medication Use Safety highlights to hospital leaders outside pharmacy how pharmacists can affect outcomes directly,” said Nicole A. Weimert-Pilch, Pharm.D., MSCR, BCPS, clinical specialist in solid organ transplantation and clinical assistant professor.

“It shows physicians and surgeons what a great resource they have in pharmacists and how pharmacists optimize care and help patients understand their medications. The process is worth the application in and of itself. Even if you don’t get nominated or win, it highlights your program to internal leaders.”

James Rudolph, M.D., M.S.

James Rudolph, M.D., M.S.

James Rudolph, M.D., M.S., chief of geriatrics at the Boston VA Healthcare System, can vouch for that. The Boston VA won in 2012 for its Pharmacological Intervention in Late Life (PILL) Service, in which pharmacists conduct medication reviews and follow-up calls with older adults, particularly those with cognitive impairment. Rudolph said that working with the team drove home for him how important pharmacists are to such efforts.

“It’s critical to have a pharmacist involved. PILL never would have taken off without one,” he said, noting that the award has enabled the program to expand its reach and work with other groups of patients.

Rudolph said that physicians can learn more from pharmacists than any other specialty or discipline. “We don’t get enough pharmacology training in med school. It’s a learning process when you start practicing, and it’s eye-opening when you take care of a patient who is on 15 meds and see how a pharmacist can improve care.”

Leading the Profession to New Heights

Anne Rose, Pharm.D., anticoagulation stewardship program coordinator at the University of Wisconsin Hospital and Clinics in Madison, which won in 2011, points to the value of the national recognition that comes with award.

Patient education is often key to programs that win the safety award.

Above, Erin Robinson, Pharm.D., CACP, with University of Wisconsin Hospitals and Clinics, counsels a patient.

“We had a great year after we won, going on the radio media tour and speaking about our programs and anticoagulation needs in general,” she said. “It’s more than the award itself. It’s being able to meet others doing similar things or who want to do what you do, so you can share it with them.”

She said the publicity can only help the profession as a whole. “It goes to show how far we have come and how we are branching out. Hopefully, being able to show how we can provide care, lead medication management programs, and work beyond traditional pharmacy roles will help us attain provider status.”

Advancing the pharmacy profession comes back to the increasing sophistication of pharmacist-led programs, said Daniel D. Degnan, III, Pharm.D., M.S., CPPS, senior project manager at Purdue University’s Center for Medication Safety Advancement in

 “We see programs from all over the country that are on the cutting edge of medication safety. There is a diversity of projects, but also of the types of organizations that apply, from large systems that cover big geographic areas to smaller, more traditional hospitals.”

These programs demonstrate leadership, Degnan added. “When we do site visits, we see people who are passionate about pharmacy and medication safety. These are typically great pharmacists who are active in their professional associations.”

That kind of enthusiasm is crucial to driving change in the profession, said Allen, noting that the award reflects a key goal of ASHP’s Pharmacy Practice Model Initiative.

“We want to help systems across the country expand pharmacist responsibilities and broaden pharmacists’ direct patient care, so they are not in the basement, but working with physicians and nurses,” he noted.

“You can’t change pharmacy practice without leaders, and by recognizing the impact pharmacists have on coordinating quality, process, and project improvement design, this award is a wonderful showcase for the many ways in which pharmacists can lead improvements in patient care.”

By Terri D’Arrigo

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March 21, 2014

Update on the Joseph A. Oddis Building

Filed under: Current Issue,From the CEO,Uncategorized — Kathy Biesecker @ 10:59 am


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

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

ASHP headquarters has been in Bethesda for 48 years and in our current building at 7272 Wisconsin Avenue for 22 years. It has served as a welcoming home for members and staff providing us with quality office space to host members and guests, and to conduct meetings and events.

7272 Wisconsin Avenue has provided convenient access to Metro, easy access from all three of the region’s major airports, and proximity to an array of local restaurants and hotels to host our members when they are in town. The building has been a valuable asset to ASHP that has grown in value and continues to provide ASHP with revenues through lease of both retail and office space.

One year ago we conducted a ceremony naming the building the Joseph A. Oddis Building in honor of Dr. Joseph A. Oddis, who served as ASHP’s Chief Executive Officer for 37 years, and whose vision and leadership led to ASHP acquiring the building in 1992. Since moving to this location, both ASHP and Bethesda have grown. The building sits atop the south end of the Bethesda Metro station and plans have been in place since the building was constructed to develop and build a new southern entrance to the Bethesda Metro station and add a new light rail service connected to the Metro, called the Purple Line.

This new rail line would connect Bethesda with points further east, and would be built on an old railroad right of way that currently houses the Capital Crescent Bicycle trail–a popular hiker-biker trail.  Recently, design studies revealed that it would not be feasible to construct the new stations and maintain a bicycle trail within the existing tunnel under our building, and that space limitation would limit design options for the transit stations.

As a result, ASHP was approached by the County regarding our willingness to explore the sale of the building to permit redevelopment of the site. To incentivize ASHP, the County is currently engaged in rezoning of several blocks here in Bethesda and exploring other incentives.

Previously, the plan had been to use the existing tunnel under our building for the Purple Line and to reroute the hiker-biker trail. The County approached us with a plan to combine the two under the building and build a larger metro station that would require demolition of the building. This is now the County’s preferred option, and we are therefore currently exploring it.

This option may present ASHP with a unique opportunity to obtain new and more modern offices to serve our future needs at an alternate location in downtown Bethesda. We have hired a law firm specializing in commercial real estate and an additional team of expert consultants who are working with staff to assess this opportunity and determine if such an arrangement would be in ASHP’s best interests. No decisions have been made at this point, and negotiations with developers and with county and state officials are continuing.

Dr. Oddis’ wisdom and vision years ago have provided ASHP not only with a quality home for more than 20 years, but with a valuable asset that has grown in value and places ASHP in a unique position to plan for our future.

I will let you know how things proceed. Thank you for your support of ASHP.

March 19, 2014

Provider Status Coming to Medically Underserved Areas?

A BILL INTRODUCED in the House of Representatives on March 11 would allow the Medicare program to reimburse pharmacists for pharmacist services in medically underserved communities.

According to the Rural Assistance Center, medically underserved areas occur in almost every state in the country. H.R. 4190 would offer provider status in those areas and areas which experience health care provider workforce shortages.

According to the Rural Assistance Center, medically underserved areas occur in almost every state in the country. H.R. 4190 would authorize Medicare payments to pharmacists who offer pharmacists’ services in those areas.

The Medicare program, which provides health insurance for the disabled and persons 65 years of age or older, currently does not provide a mechanism to directly reimburse pharmacists for their services.

Representatives Brett Guthrie (R-Kentucky), G.K. Butterfield (D-North Carolina), and Todd Young (R-Indiana) jointly stated that their “common-sense bill” creates a means by which pharmacists can receive reimbursement for providing services permitted by state law to Medicare beneficiaries in medically underserved areas.

All three congressmen represent districts in which more than half the counties have been federally designated as medically underserved areas.

Pharmacotherapy Specialist Tim R. Brown cares for patients in a medically underserved area, Summit Service Area, commonly known as Akron, Ohio.

“This particular bill becoming a law would allow me to stand on my own as a provider—still working with that same physician and still working ‘incident to’ but being recognized as someone that’s a part of the team,” he said. “And that would be a huge step.”

Brown, who practices at Akron General Medical Center’s Center for Family Medicine, said he currently bills his chronic disease state management services under a collaborating physician’s name as incident to physician professional services in the physician’s office.

He estimated his payer mix as 60 percent Medicare and 40 percent private pay.

Ohio has allowed such pharmacist–physician–patient collaborative practice agreements since 1999.

Studies show that patients in all settings clearly benefit from the medication expertise of pharmacists.

The bill, if enacted into law, would also strengthen the health care team, Brown said.

“By giving provider status to pharmacists,” he said, “that [bill] strengthens our role as a part of the patient-centered medical home model team that many people are working within currently.”

Sandra Leal, director of clinical pharmacy at El Rio Community Health Center in Tucson, Arizona, cares for patients in the medically underserved Pima Service Area.

In fact, the health center targets the medically underserved population, she said.

Although El Rio has what Leal described as a good mix of payers, she lamented that the center does not receive compensation for some of the services the pharmacists provide patients. Or, if the center does receive compensation, the amount represents a level of service lower than what was actually provided to the patient.

For example, when Leal and other El Rio pharmacists manage the diabetes therapy of a patient with Medicare Part B coverage, “we have to override our level of care to a lower code because we’re not recognized for the full service that we provide.”

She said compensation for the actual service level the pharmacists provide would help the center’s clinical pharmacy program become more sustainable and widespread.

“There’s a significant demand for patient visits, for access,” Leal said. “We had a lot of people that joined the health care system [in 2014] with new insurance. And right now we have pharmacists at some of our sites but not all of the different satellites.”

The primary reason, she said, is lack of a means to permanently finance the full-time-equivalent positions. El Rio applies for and receives grants and funds, but those have end dates.

“I’m glad to see some new legislation out there” to recognize pharmacists as providers, Leal said.

This [bill] is a really great opportunity to give patients the access they deserve.

Although Gloria P. Sachdev, in her current position, does not work with a medically underserved population, she expressed support for the legislation.

Having “provider status” in Medicare Part B is “critically important to our sustainable business model” for clinical pharmacist services in ambulatory care settings, said Sachdev, a clinical assistant professor at the Purdue University College of Pharmacy.

“I’ll certainly be contacting my congressman and my senators . . . to support this bill,” she said, adding that she is “just waiting for someone to say, Do it” and also for the exact language of the bill to be available.

The bill by Guthrie is modeled after the concepts advocated by the Patient Access to Pharmacists’ Care Coalition, in which ASHP plays a “significant leadership role,” said Kasey K. Thompson, the Society’s vice president for policy, planning, and communications.

“This [bill] is a really great opportunity to give patients the access they deserve” to pharmacist-provided patient care services, he said.

By amending the portion of the Social Security Act concerning the Medicare program, Thompson said, the bill would allow pharmacists to bill for Medicare Part B practitioner services.

The type and scope of those services remain under the purview of the state in which a pharmacist provides them, he said.

Guthrie’s bill pertains to all state-licensed pharmacists, Thompson said, and ASHP and the coalition support that position—all pharmacists are providers.

–By Cheryl A. Thompson, reprinted with permission from the ASHP News Center (first published March 14, 2014)

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