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Clinical Privileging Paves the Way for Expanded Pharmacy Services

This opinion column was authored by ASHP member and InterSections guest columnist Ryan Mills, Pharm.D., M.B.A, M.H.A., BCPS. Dr. Mills is the Pharmacy Manager at Novant Health Kernersville Medical Center and Novant Health Clemmons Medical Center in North Carolina. He is a passionate pharmacy leader who believes that bringing pharmacists to the forefront of patient care will have a significant impact on chronic disease management and population health issues.

Ryan Mills, Pharm.D., M.B.A, M.H.A., BCPS

HEALTH SYSTEMS TODAY STRUGGLE WITH RISING COSTS and lower reimbursement coupled with expectations for greater safety and quality of care. Failing to adapt to these changes and position your pharmacy enterprise for the future will result in fates similar to those of  Blockbuster and Kodak. As hospitals and health systems shift toward a value-based reimbursement model, we must promote a progressive pharmacy practice model with pharmacists working together with providers in collaborative practice agreements.

Leveraging Pharmacists’ Expertise

My colleague, Matthew Gibson, Pharm.D., M.S., BCPS, is the Clinical Pharmacy Manager for Ambulatory Services at Novant Health. He has many years of experience with implementing collaborative practice agreements, pharmacist credentialing, and expanding pharmacy services. His pharmacy team delivers the highest-quality clinical care to our patients throughout the continuum of care.

It takes more than interprofessional collaboration throughout the patient’s hospital stay to improve patient care. Pharmacists need to be officially recognized for their expertise. North Carolina state medical and pharmacy boards have recognized pharmacists as practitioners since 1998, under the designation of clinical pharmacist practitioners (CPPs). Like other midlevel providers, CPPs enter into collaborative practice agreements with physicians, whereby the physician grants authority to the pharmacist to provide specific patient care services. The North Carolina Board of Pharmacy requires a protocol agreement between the supervising physician and CPP. This agreement details the CPP’s scope regarding disease state, medication therapy, and monitoring privileges.

Know Your Medical Staff Bylaws

At Novant Health, Dr. Gibson has partnered with physician leadership to successfully add CPPs to the medical staff bylaws. This means CPPs are now considered advanced practice clinicians, which is the same designation as nurse practitioners and physicians assistants. At a high level, medical staff bylaws describe how the medical staff governs itself. The bylaws explain the rights of the medical staff, the qualifications for medical staff members and advanced practice clinicians, and the necessary steps in the appointment, reappointment, and clinical privileging processes.

Every health system has its own credentialing and privileging process. Our credentialing and privileging process occurs through our central verification and medical staff offices, which determined that our CPPs would complete the same rigor of credentialing, privileging, and oversight process as our medical providers.

North Carolina laws have established a quality assessment schedule for CPPs to meet with their supervising physician on a regular basis to review clinical performance. Since the training of pharmacists has rapidly progressed over the past 10 years resulting in a spectrum of clinical skill sets among pharmacists, we decided to adopt more stringent eligibility requirements than the state, such as Board of Pharmacy Specialties certification and two years’ clinical pharmacy experience.

Successful Use of CPPs

Novant Health first used CPPs in the acute care setting to support optimal medication management in the neurology service line and is in the process of expanding into other venues of care, such as medication reconciliation at admission and discharge, emergency department culture review, and high-risk chronic disease state management.

The role of the pharmacist has drastically changed over the years from dispensing and verifying orders to direct patient care in partnership with all other disciplines. Our pharmacists play a crucial role in ensuring that our patients receive the highest-quality care and safest experience possible every time.

One of the most cost-effective investments any health system can make is leveraging its pharmacists in collaborative practice agreements throughout every venue of care to deliver a remarkable experience.

By Ryan Mills, Pharm.D., M.B.A., M.H.A., BCPS