ASHP InterSections ASHP InterSections

January 28, 2015

Provider Status Bill Reintroduced in Congress

 

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

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

HAPPY NEW YEAR! As we enter 2015 we can reflect on the success we had with last year’s introduction of pharmacists’ provider status legislation, H.R. 4190. This legislation, which enjoyed great support by both Republicans and Democrats, would amend the Social Security Act to recognize pharmacists as Medicare Part B providers working within their state scopes of practice in the large number of medically underserved areas—both urban and rural—throughout the United States.

I am happy to report that this important piece of legislation, now known as the “Pharmacy and Medically Underserved Areas Enhancement Act,” was reintroduced today by the original bipartisan sponsors. To add to that, we anticipate a companion bill will be introduced in the U.S. Senate by a bipartisan group of Republican and Democratic senators very soon. Now that’s the way to start the New Year off right!

ASHP and our members have taken a major leadership role in bringing this legislation to fruition and to helping advance it through Congress. The fact that all ASHP members provide exceptional care as generalists and specialists in hospitals, clinics, and other settings has made this effort possible, and it has clearly paid off.

These efforts by our stellar members who are already serving as patient care providers have been a shining example to Congress of what pharmacists can do to advance healthcare and improve patients’ lives. I am absolutely certain as I look to the future when provider status for pharmacists becomes the law of the land that ASHP members will lead the way in implementing the law and will serve as a source of inspiration to the entire healthcare community.

I would also like to recognize the efforts of our exceptional ASHP staff team that has worked tirelessly behind the scenes with Congress, CMS, and other stakeholders for more than a decade to lay the groundwork for this historic moment of opportunity. We couldn’t have gotten here without them! Regarding outreach and support from other stakeholders, the recent report by the National Governors Association expressed strong support for the expanding roles of pharmacists, including recognizing pharmacists as Medicare providers.

It is absolutely vital that every ASHP member continue to reach out to their members of Congress to express their support.

However, before we declare victory on behalf of our patients, we have a lot of work to do through 2015. It is absolutely vital that every ASHP member continue to reach out to their members of Congress to express their support and to ask them to co-sponsor (or thank them if they’re already co-sponsoring) this important legislation.

Further, we need you to form local coalitions with other patient and healthcare professional groups and colleagues you work with to get their support and to tell your stories as pharmacists and patient care providers through editorials and op-eds in your local newspapers, blogs, and social media outlets.

You can attend political rallies, fundraisers, and other events with your members of Congress and the Senate to ask them to support the legislation and to talk with them about how this legislation will help patients in your community and state. You can also support the ASHP PAC, which provides ASHP with the ability to support members of Congress who support your interests as pharmacists and patient care providers.

Most importantly, we want you to know that ASHP is here to support you every step of the way. Please visit ASHP’s advocacy center, and don’t hesitate to contact ASHP’s government affairs team.

ASHP continues to be a key leader in the Patient Access to Pharmacists’ Care Coalition (PAPCC), which currently includes almost every national pharmacy organization and a growing number of other influential stakeholders. The PAPCC will work to grow the national coalition, advocate to Congress, and create media campaigns in support of provider status.

I know you recognize the excitement and importance associated with this historic legislation, and the collective and individual role you will play in seeing the legislation get passed into law. I look forward to updating you again soon and to seeing all the great things you will be doing in your organizations, communities, and states now and in the coming months to support the legislation.

Thank you for all that you do on behalf of your patients and for being members of ASHP.

Sincerely,

Paul

January 19, 2015

Pharmacists Praise New Medicare Billing Opportunities

Filed under: ASHP News,Clinical,Feature Stories,Provider Status,Uncategorized — Tags: , , , , — jmilford @ 5:12 pm

RECENT UPDATES TO THE INCIDENT-TO BILLING REQUIREMENTS from the Centers for Medicare and Medicaid Services (CMS) have created new opportunities for medical practices to be reimbursed for pharmacists’ patient care services.

“Change is happening,” said Sandra Leal, medical director of pharmacy at El Rio Community Health Center in Tucson, Arizona. “What’s exciting is that there is more consideration from CMS to have pharmacists participate in teams and to . . . bill with the physician,” she said.

Sandra_LealLeal said the new billing opportunities arise from clarifications from CMS on work done by nonphysician healthcare providers and language in the agency’s 2015 update to the physician fee schedule.

The fee schedule, released this past November, allows physicians to bill Medicare for unsupervised after-hours services provided by nonphysicians under Medicare’s chronic care management (CCM) and transitional care management (TCM) programs. The person who provides these services incident to a physician’s care need not be a direct employee of the medical practice, according to CMS.

TCM and CCM services involve face-to-face care and comprehensive follow-up, including medication therapy management, within a specific time frame.

CMS began reimbursing medical practices for TCM services in 2013, and Leal said her clinic participates in this program. She said in November that no decision had yet been made about providing CCM services.

“Our compliance officer is actually reviewing the language right now to see if it makes sense for us to be able to  participate,” she said.

The 2015 fee schedule doesn’t state outright that physicians can bill for pharmacists’ TCM and CCM services provided incident to the physician’s care.

Instead, the fee schedule refers to physicians’ clinical staff and the time spent by those nonphysician healthcare professionals in providing TCM and CCM services.

But a March 2014 letter from CMS Administrator Marilyn Tavenner affirmed that pharmacists are among the nonphysician healthcare providers for whom incident-to billing is permissible [see June 15, 2014, AJHP News].

CMS regulations for 2014 also specified that nonphysician healthcare professionals must meet state requirements for licensure and work within their state’s scope of practice regulations in order to participate in incident-to billing.

Betsy Bryant Shilliday, associate professor of medicine at the University of North Carolina (UNC) School of Medicine in Chapel Hill and assistant medical director for the UNC internal medicine clinic, said the reference to state law has greatly benefited her clinic.

That’s because North Carolina has established the clinical pharmacist practitioner (CPP) credential, an advanced practice designation conferred by the state’s pharmacy and medical boards.

Under North Carolina state law, CPPs are “approved to provide drug therapy management, including controlled substances, under the direction of, or under the supervision of a licensed physician.”

A March 2014 letter from CMS Administrator Marilyn Tavenner affirmed that pharmacists are among the nonphysician healthcare providers for whom incident-to billing is permissible.

A March 2014 letter from CMS Administrator Marilyn Tavenner affirmed that pharmacists are among the nonphysician healthcare providers for whom incident-to billing is permissible.

Shilliday said her regional Medicare carrier—or Medicare administrative contractor (MAC), as the entities are officially designated—recently agreed that CPP-certified pharmacists qualify for incident-to billing using higher-level Current Procedural Terminology (CPT) codes.

Specifically, she said, physicians can bill using CPT codes 99211–99214 for pharmacists’ incident-to services.

“This was my Christmas present. I’m like a kid in a candy store now,” Shilliday said in November.

Shilliday recalled that about a decade ago, her Medicare carrier allowed higher-level incident-to billing by pharmacists. But that changed when a different carrier assumed responsibility for the region.

At that time, she said, pharmacists’ services were restricted to the minimal evaluation and management CPT code, 99211, regardless of the time spent with the patient and the complexity of the patient’s condition or the medical decision-making involved in the visit.

“We’d been going along that path, providing very complex care but getting reimbursed very little,” Shilliday said.

“So it’s been very hard for us to justify to practices to hire more pharmacists, because we’re expensive. And our reimbursement rates are very low, especially if we’re in a high Medicare population clinic.”

She said the new ruling from the MAC will provide a better return on the clinic’s investment in pharmacists’ services. Her compliance office is also attempting to justify billing at the highest level, 99215.

“However, we’re happy to bill up to a 99214. It’s huge, it’s over three times what we are able to bill for a [99211] visit,” she said.

Shilliday said that although the CPP credentialing process for North Carolina pharmacists helped sway the Medicare carrier’s approval of higher-level billing, pharmacists in states without a similar advanced practice designation might also be able to use higher-paying CPT codes.

We’re happy to bill up to a 99214. It’s huge, it’s over three times what we are able to bill for a [99211] visit.

“I would very much explore it in another state as well and see how they interpret it. Because each Medicare carrier can interpret it differently,” she said.

Shilliday said she and her colleagues are exploring whether the clinic meets CMS’s requirements to bill for TCM and CCM services. She said potential problems with billing for these services include the need to obtain a written agreement from patients to receive the care.

Medicare coinsurance and deductibles apply to TCM and CCM services, which could pose an obstacle to patients’ acceptance of the services.

Shilliday and Leal welcomed the new opportunities for reimbursement of pharmacists’ patient care services. But they emphasized that incident-to billing is not a substitute for the recognition of pharmacists as healthcare providers under the Social Security Act.

Shilliday noted that her MAC’s previous refusal to allow higher-level billing for pharmacists’ incident-to services was based on the fact that CMS didn’t list pharmacists as recognized providers.

Leal explained that incident-to billing “only covers what the provider specifically asks for you to help with.”

If a physician refers a patient to a pharmacist for diabetes management, only those services are billable as incident to the physician’s service. This applies even if the pharmacist discovers during the encounter that the patient has uncontrolled hypertension or other problems and addresses those.

“You will [treat them], because that’s our clinical obligation. But for reimbursement purposes, you’re only able to do what the [physician] asks you to do,” Leal said.

Thus, to allow pharmacists broader opportunities to use their skills and be reimbursed for their work, “it’s very critical to get provider status,” Leal said.

 –By Kate Traynor, reprinted with permission from AJHP (Jan. 15, 2015; volume 72, pages 91-92)

January 16, 2015

New EHR Improves Outcomes at The University of Kansas Hospital

Filed under: Ambulatory Care,Clinical,Current Issue,Feature Stories,Managers,Quality — Tags: , , — jmilford @ 5:34 pm
clinical_pharmacy_2 Google

The new Clinical Efficiency System that is part of the EHR used by pharmacists at The University of Kansas Hospital ensures that clinicians see the most critical patients first.

CLINICAL PHARMACISTS BEGIN THEIR SHIFTS much the same way as most clinicians: They examine patients under their care and proceed from there.

But when faced with dozens of patients, each one with different needs and clinical complexities, which ones need immediate attention? Which can wait? Sorting out the choices subjectively is time-consuming and inefficient, and reduces the amount of time a pharmacist can spend with patients.

“We want our pharmacists to come in and, based on patients’ clinical acuity, examine their most critical patients first. Choosing patients alphabetically or by room number won’t achieve that,” said Samaneh T. Wilkinson, M.S., Pharm.D., Assistant Director of Pharmacy at The University of Kansas Hospital in Kansas City.

“Instead, we wanted to have the electronic health record (EHR) guide pharmacists based on a patient’s clinical needs, with the primary goals of improved efficiency, clinical consistency, and better patient outcomes.”

To that end, Dr. Wilkinson spearheaded implementation of the Clinical Efficiency System (CES), a complex software package developed by the hospital’s IT department and integrated with the hospital’s existing EHR.

Flow Sheets Provide a Snapshot of Patients

The system instantly provides pharmacists with a “snapshot” of each patient in real time, immediately registers updates as a patient’s condition changes or when he or she receives treatment, and alerts pharmacists when interventions may be needed. The CES comprises three principal components: flow sheets for daily documentation and clinician hand offs, a pharmacy scoring list, and a rounding navigator.

Samaneh T. Wilkinson, M.S., Pharm.D.

Samaneh T. Wilkinson, M.S., Pharm.D.

Flow sheets track pharmacist-managed therapies that require detailed documentation, including antimicrobial stewardship, anticoagulation monitoring, and venous thromboembolism (VTE) prophylaxis assessment.

Similar to a Microsoft Excel spreadsheet, flow sheets display rows labeled with key parameters and patient-specific data, and allow users to add notes. The display ensures that daily documentation is up to date during hand-offs between clinicians.

For example, a drop-down menu allows pharmacists to quickly assess a patient’s VTE risk. If necessary, the pharmacist can quickly relay the information to the patient-care team to initiate VTE prophylaxis. Flow sheets also include hyperlinks to other pertinent information, such as lab values and current anticoagulant therapy.

“The connectivity is very useful,” said Lucy Stun, Pharm.D., a critical care pharmacist at KUMC. “From the VTE flow sheet, I can easily see when the last TPA or aspirin was given, and what time the next dose of heparin can be given safely.”

The scoring list provides an overview of patients monitored by a particular pharmacist, guiding each clinician through his or her caseload based on clinical acuity as calculated by intricate algorithms.

This process, according to Dr. Wilkinson, reduces subjective determinations and the attendant time they require and ensures that pharmacists focus on patients most in need of their expertise. The scoring list, said Dr. Stun, “also creates a more efficient workflow because the pharmacist knows what major changes happened overnight and what they need to take care of first.”

Augmenting the scoring list is a rounding navigator that provides an in-depth review of each patient with a large amount of specific, pertinent clinical information, with more hyperlinks to reports, summaries, and documentation.

A Boon to Efficiency

According to Dr. Stun, the CES dramatically improves efficiency and streamlines workflow.

“I can now glance at my color-coded screen and see what’s completed or what needs to be done based on the color coding—green, yellow or red,” she said.

“At the end of rounds, I always look at the screen to see what’s left to do. That may be checking if a patient has had DVT prophylaxis or if we’ve completed a medication reconciliation. It’s right in front of us.”

Dr. Stun said the system is particularly helpful in keeping the pharmacy team focused during rounds, when there are typically multiple, concurrent distractions.

Allie D. Woods, Pharm.D.

Allie D. Woods, Pharm.D.

“If someone on the care team asks me about a patient’s status, all I have to do is look at the screen to get a complete picture,” she said.

Allie D. Woods, Pharm.D., director of ASHP’s Section of Pharmacy Informatics and Technology, said the scope and results of the project are impressive.

“Hospital pharmacists are often responsible for dozens of patients every day. Setting priorities and deciding which patients to see and when can be very difficult, especially with all of the distractions that come up throughout the day,” she said.

“The scoring list alone helps pharmacists work more efficiently. They are able to triage patients more rapidly, and then adjust the amount of time they spend with patients based on their specific clinical needs. This system results in better patient care.”

Ensuring that Patients Know Pharmacists are on Their Care Team

The CES has also led to increased interaction between pharmacists and patients.

“It carves out more time during the day for face-to-face contact that previously might have been spent looking for information and evaluating a patient’s status,” said Dr. Wilkinson. “Our pharmacists can meet more patients and say ‘Hello, I’m your pharmacist. Do you have any questions about your medications? Can I clear up anything for you before you leave the hospital?’

“We want every patient who leaves our hospital to know that a pharmacist took care of them during their stay.”

Dr. Stun acknowledges that since CES implementation, she spends more time at bedside, particularly when conducting medication reconciliation or preparing patients for discharge.

“We used to just counsel patients who were taking high-risk medications,” she said. “Now we also counsel patients who have heart failure, COPD, pneumonia, or myocardial infarction, or if they have had an organ or bone marrow transplant.”

We want every patient who leaves our hospital to know that a pharmacist took care of them during their stay.

Success has also been quantified: Pharmacy admission history capture and pharmacist-supported discharges have increased by 96.4 percent and 85.6 percent, respectively. Dr. Wilkinson has determined that patients who were discharged after pharmacists educated them about their medications and conducted medication reconciliation are 30 percent less likely to be readmitted to the hospital within 30 days.

Readmission rates for patients with conditions that predispose them to repeat hospital stays (e.g., acute myocardial infarction, chronic heart failure, and COPD) also have fallen. During the last Joint Commission accreditation review, the reviewers noted the exceptional quality of the hospital’s medication reconciliation process. “The CES made that possible,” she said.

One unexpected, but welcome outcome, was a 30 percent jump (from 62 percent to 92 percent) in the number of positive responses to the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) question about patient perceptions of how well they were prepared to go home.

“Now, more than 90 percent of our patients feel adequately prepared for discharge. That was eye opening,” said Dr. Stun.

As with any major organizational change, the system planners encountered some resistance. Abundant training and a grace period were critical for overcoming anxiety associated with the change. After the initial roll-out, pharmacists had more than three months to become familiar with the system before its use became mandatory.

Now, the CES is an integral part of the culture for the hospital’s 54+ FTE staff pharmacists, and Dr. Wilkinson’s team is continually soliciting user feedback and looking for ways to improve it.

— By Steve Frandzel

January 9, 2015

Pharmacists in the C-Suite Offer New Perspectives on Patient Care

As pharmacists move into leadership positions, their ability to influence the conversation about the critical patient-care role of pharmacists is growing.

Pharmacists in executive leadership positions have unique opportunities to demonstrate pharmacists’ patient-care roles and medication expertise.

AS HOSPITAL AND HEALTH SYSTEM MERGERS and acquisitions increase, pharmacy directors have begun to step into executive positions that allow them to tap into their skills as leaders, team-builders, and strategic thinkers. They also bring a unique understanding of the importance of safe and effective medication use in patient care to their new jobs.

In some cases, pharmacists are moving up within their own hospitals into positions such as vice president, where they may or may not oversee pharmacy services, or they fill top spots such as president or chief executive officer.

In other cases, pharmacists move into positions where they serve as corporate pharmacy leaders for multi-hospital health systems.

A Perfect Fit for Pharmacists’ Skills

Pharmacists are well-suited to leadership positions for several reasons, said David Chen, B.S.Pharm., M.B.A., ASHP’s senior director, Section of Pharmacy Practice Managers.

“At the hospital level, pharmacy directors are trained care providers who also have unique skill sets as astute financial and business managers because of the expense and complexity of the technologies and departments they manage,” he said.

“Their clinical experience helps them get recognized among other health professionals providing the opportunity to move into leadership positions beyond solely the pharmacy department.”

At the multi-hospital level, mergers and acquisitions result in a need for system-wide oversight of pharmacy and medication-related activities, Chen added.

“There is a need for leaders who can identify the changes necessary as health systems grow in size and complexity and coordination of medication management services across many entities and patient care settings becomes critical. We need leaders who can determine where pharmacy fits into that equation,” he added.

Pharmacists should be prepared to take advantage of opportunities created by mergers, said Roy Guharoy, Pharm.D., chief pharmacy officer at Ascension Health, a non-profit system with 138 hospitals and over 1,500 clinics spread across 22 states and the District of Columbia.

“Today, everyone is open to hearing about how to improve patient care, and pharmacists can make a huge difference in that,” he noted. “If we come forward with good plans and show positive outcomes, it’s not hard for pharmacists to attract the attention needed to step into high-level roles.”

The Case for Pharmacists in Leadership

Moving into the C-suite offers a unique opportunity to promote changes that not only improve patient care, but benefit the profession of pharmacy.

kk 0814

Karl Kappeler, M.S., R.Ph., FASHP

When administrators at Nationwide Children’s Hospital in Columbus, Ohio, spoke with Karl Kappeler, M.S., R.Ph., FASHP, then director of pharmacy, about becoming vice president of operations and professional services, a position that is largely responsible for surgical practice, he said he wouldn’t take the job unless he could somehow keep the pharmacy in his chain of command.

Given his 15-year track record at the hospital, the administrators agreed to his request, and Kappeler was able to hire a new pharmacy director who reports directly to him. Keeping pharmacy under his umbrella has two key advantages, Kappeler said.

“I anticipate an opportunity to foster pharmacist and surgeon relationships for better continuity of care for patients,” he noted. “But also, I’ll be better able to keep administrators aware that the pharmacy has a huge impact on patient clinical outcomes and hospital finances.”

A C-suite pharmacist’s experience in the day-to-day challenges of patient care can be useful in clarifying for other executives how pharmacy can assist in times of crisis or change, said Bonnie Levin, Pharm.D., M.B.A.

Levin is assistant vice president of pharmacy services at MedStar Health, a system comprising more than 120 entities in the Baltimore-Washington, D.C. region, including 10 hospitals and nine retail pharmacies.

Bob Ripley, Pharm.D., BCPS

Bob Ripley, Pharm.D., BCPS

“Having worked through drug shortages or developed programs to help reduce readmissions, you can make the case for how pharmacists can play an innovative role in addressing those issues,” Levin said. “The important work gets done when pharmacists collaborate with other clinicians, and at the executive level, we can form teams that include pharmacy.”

Bob Ripley, Pharm.D., BCPS, vice president and chief pharmacy officer at Trinity Health in Livonia, Mich., agrees. Trinity Health is a national health system with 86 hospitals and 128 continuing care facilities and home health and hospice programs spanning 21 states.

“I think one of the most important things I do is to see problems not only from the pharmacist’s point of view, but from the perspective of patients, nurses, physicians, and other providers,” Ripley said. “Once I see the problems from those different angles, and the people who work with me see I’m not only looking at it just from a pharmacist’s point of view, that takes down walls. Then, we can begin to see how pharmacists can assist with a solution.”

Attitude Adjustment

As exciting as the C-suite can be, it’s not without its challenges. Moving out of direct patient care requires a change in mindset that newly minted executives sometimes find jarring.

“As with any other promotion, you can’t continue to behave like you did in your previous position,” said Tom Woller, M.S., FASHP, senior vice president of pharmacy services at Aurora Health Care, a system of 15 hospitals, 159 clinic sites, and 70 retail pharmacies in Wisconsin.

Tom Woller, M.S., FASHP

Tom Woller, M.S., FASHP

“One big adjustment is in understanding when you should jump in vs. when you should step back and provide guidance.”

For former pharmacy directors stepping into executive roles in which they will oversee pharmacy operations in several hospitals, delegating can take some getting used to, said Woller, who is also chair of ASHP’s Section of Pharmacy Practice Managers’ Advisory Group on Multi-Hospital Health-Systems.

“You know what needs to be done in pharmacy, but you need to learn to step away and let the good people you’ve hired do the work you’ve hired them to do,” he said, adding that being a member of the C-Suite helps him to advocate for pharmacy.
“It’s anyone’s job in a leadership position, formal or otherwise, to look at how to improve patient care, but the percentage of time spent advocating for how pharmacy contributes to better care is increased” at this level, he said.

Pharmacists taking on high-ranking leadership positions for one hospital may not experience the same internal struggle, but that’s in part because they’re diving into a pool of culture shock. And with so much to learn, they simply won’t have the time think about micromanaging, said Michael Sanborn, M.S., R.Ph., FACHE, president and CEO of Baylor Medical Center at Carrollton in Texas.

“The biggest area that was completely foreign to me was physician contracting and its associated legal aspects. As a pharmacy director, you aren’t exposed to that,” said Sanborn.

“It’s a totally different set of responsibilities when you expand into the realm of influence outside of pharmacy. You don’t have a choice but to be an effective delegator.”

Pharmacists may also have to engage in some silo-breaking, especially when it comes to initiatives involving medication management, said Guharoy.

“There are gaps in the continuum of care in health systems around the country. Physicians do their jobs, pharmacists do their jobs, but no one is managing the whole process.”

It can be an uphill battle, he added. “Typically, healthcare is very traditional, so changing the culture is a big challenge. You have to figure out ways to address it, but it starts with having good credibility. If you have leadership qualities and clinical skills, you have a tremendous opportunity to improve patient care.”

Multiple Paths to Upward Mobility

Pharmacists can take any number of paths en route to a corner office. Kappeler was the director of pharmacy at Nationwide Children’s, and the vice presidency was a straight promotion. Levin held positions in clinical pharmacy, informatics, and then administration. Woller knew in pharmacy school that he wanted to go into administration, so he pursued an administrative residency as the best route to becoming a director of pharmacy and went from there.

Whenever Sanborn saw an opportunity to serve in another department as an interim director, he took it. In fact, immediately prior to his current position, he served as the corporate vice president of cardiovascular services for all Baylor entities, ultimately going from a multi-hospital role to a single-hospital role.

Ripley began his career as a staff pharmacist, and with each successive position, his role grew in breadth and depth until administrators were coming to him with openings.

Regardless of their individual paths, these experts agree that pharmacists who wish to enter the executive track should focus on relationship-building.

“You’ll have to be extremely comfortable interacting with large and small groups made up of all kinds of personalities, so the more you do that early in your career, the more comfortable you’ll be with it later,” said Sanborn.

That means face-time, said Kappeler. “My relationships are not through electronics, but in-person communication. Younger pharmacists will be used to communicating electronically via texting or other modes, so they need to be mindful of the importance of speaking face-to-face, or those same relationships won’t be forged.”

The Value of Networks

“This is where ASHP is vital to us,” said Woller. “You can start developing networks through ASHP early in your career, people whom you can bounce ideas off of or have discussions with about projects or initiatives you think are worthwhile.”
Levin stressed that once a pharmacist is in the C-suite, influence depends on presence as much as expertise.

Roy Guharoy, Pharm. D.

Roy Guharoy, Pharm.D.

“Showing up is half the battle. It’s important to be visible to the other ‘Cs,’ like the chief financial officer or the chief medical officer and show them that you’re a problem-solver and a strategic thinker,” Levin said.

Guharoy agrees, urging pharmacists to align themselves with leadership within their organizations.

“I’ve seen situations in which there may be a great partnership among physicians and clinicians, but the CEO’s, CMO’s, and others in the C-suite are completely disconnected,” he said, reminding clinicians that the C-suite is filled with decision makers.

Levin added that there is strength in numbers.

“At this level in a health system, it’s more of a strategic focus, and the planning that I get to do with pharmacy directors gives them a voice,” she said. “It’s one thing if one pharmacy [in the system] needs a piece of technology, but if 10 sites are saying it, that is more powerful.”

Kappeler knows that along with the visibility of the position comes a responsibility to his profession.

“I want to do well and demonstrate that pharmacists are highly capable, engaged, knowledgeable within the organization and leadership,” he said. “I want to do a good job so that everybody sees a pharmacist doing a good job.”

–By Terri D’Arrigo

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