A BILL To Elevate Pharmacists to Provider Status

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naplexnaplex

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IN THE SENATE OF THE UNITED STATES

DECEMBER 31, 2013

Ms. GUARINONI introduced the following bill;

A BILL
To Elevate Pharmacists to Provider Status

Reference
http://collegeyig.org/wp-content/uploads/2014/01/S-9-2014.pdf

We all pharmacists should support this bill. Do you support this bill ? please share your opinion here. If this bill is approved, will it change pharmacist scope and future?What do you think? Any idea..
 
Stuff like this has been coming and going in congress for many years and nothing has happened...nothing much new here.
 
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I seriously hope someday the law passes that pharmacists get provider status. I know in some states (Cali I think) it already has passed but I do wish we can get it from the federal gvt. It personally bothers me (and breaks my heart) that the AMA is sooo against giving provider status for pharmacists when other healthcare workers who receive less amount of education (certain healthcare workers who only go to school for 2 yrs) have provider status. It has been known for some time now that pharmacists are one of the most "under utilized" healthcare workers given the amount of vast knowledge we receive in pharmacy school.
With the shortage of physicians in this country, I do hope the gvt takes advantage of the education and knowledge pharmacists have and allow us to reach our full potential as healthcare workers.
 
I seriously hope someday the law passes that pharmacists get provider status. I know in some states (Cali I think) it already has passed but I do wish we can get it from the federal gvt. It personally bothers me (and breaks my heart) that the AMA is sooo against giving provider status for pharmacists when other healthcare workers who receive less amount of education (certain healthcare workers who only go to school for 2 yrs) have provider status. It has been known for some time now that pharmacists are one of the most "under utilized" healthcare workers given the amount of vast knowledge we receive in pharmacy school.
With the shortage of physicians in this country, I do hope the gvt takes advantage of the education and knowledge pharmacists have and allow us to reach our full potential as healthcare workers.

It's not about the length of school. It's about what the schooling is in. Those 2 year professions are trained to diagnose and have clinical experience doing so. Pharmacists aren't trained to examine and diagnose. Without that skill, you really cannot initiate any treatment because you can't get to the diagnosis. You could have 6 years of Pharm.D. work and that fact wouldn't change. Pharmacists are the drug experts and respected and utilized for that knowledge, but they are not diagnosticians.
 
It's not about the length of school. It's about what the schooling is in. Those 2 year professions are trained to diagnose and have clinical experience doing so. Pharmacists aren't trained to examine and diagnose. Without that skill, you really cannot initiate any treatment because you can't get to the diagnosis. You could have 6 years of Pharm.D. work and that fact wouldn't change. Pharmacists are the drug experts and respected and utilized for that knowledge, but they are not diagnosticians.

Provider status does not equate with providing initial diagnosis or therapy. Some PharmD programs do teach students how to perform examinations, basic physicals and other such things. My school does. We also do touch on diagnostics, not to the level of a medical grad or a mid-level grad (NP or PA) but we have to be competent in it in order to properly manage drug therapy and understand drug therapy. Then again, no pharmacy groups (at least of those I'm aware of) are pushing to expand pharmacy scope to include diagnostics or claiming that pharmacists are diagnostic experts and should be diagnosing. It's mainly geared towards collaborative practice and disease management as it pertains to the use of drugs (which is what pharmacists are the experts in). Provider status is largely just a title that allows for the billing of services to insurance companies. Many states recognize pharmacists as healthcare providers when it comes to liability and lawsuits at least. It's about further utilizing the skills and knowledge of the drug experts as it pertains to the utilization of drugs to treat diseases, not turning the drug experts into the diagnostician that is providing the initial diagnosis for conditions or even interpreting the lab tests to perform the diagnosis.

Also, the 6 year PharmD is the bare minimum and I would venture to say only a small percentage (not majority) of the overall pharmacy student population actually do a 0-6 program. I myself, along with the majority of my class, will have 8 years in with some schools requiring 3-4 years of work before being eligible to matriculate. There are some MD/DO programs that don't require a BS degree and accept exceptional undergrad students as well as foreign licensed physicians only having a masters level education. Regardless though, the professional coursework is 4 years. The minimum of 2 undergrad years just means someone doesn't need the extra filler classes and can get into some programs having only taken their pharm school pre-reqs. As far as competency to do the job goes, some practice models and institutions (like the VA) have pharmacists managing diseases actively with some states having more progressive practice models. A pharmacist is competent to do the job and many go on to have residency training before engaging in such jobs.
 
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Provider status does not equate with providing initial diagnosis or therapy. Some PharmD programs do teach students how to perform examinations, basic physicals and other such things. My school does. We also do touch on diagnostics, not to the level of a medical grad or a mid-level grad (NP or PA) but we have to be competent in it in order to properly manage drug therapy and understand drug therapy. Then again, no pharmacy groups (at least of those I'm aware of) are not pushing to expand pharmacy scope to include diagnostics. It's mainly geared towards collaborative practice and disease management as it pertains to the use of drugs (which is what pharmacists are the experts in). Provider status is largely just a title that allows for the billing of services to insurance companies. Many states recognize pharmacists as healthcare providers when it comes to liability and lawsuits at least. It's about further utilizing the skills and knowledge of the drug experts as it pertains to the utilization of drugs to treat diseases, not turning the drug experts into the diagnostician that is providing the initial diagnosis for conditions or even interpreting the lab tests to perform the diagnosis.

How does bringing in another person who can't really examine the patient help? Your model seems to be that you'd see an "examiner" who'd make the diagnosis. Then in the collaborative practice you'd see the pharmacist who'd decide the drug therapy, but you can't just treat the numbers. It seems like you'd still need a doc/PA/NP to determine what's going on. The real question is, how would it be cheaper to have the med management and physical exam duties split to two people? Most providers can handle adjusting drug regimens at the time of examination with little added time. In highly specialized cases, yes, I could see the benefit of having a pharm.d. be the medication managing person, but in the vast majority of garden variety ailments, is there an added benefit in addition to the added cost?
 
How does bringing in another person who can't really examine the patient help? Your model seems to be that you'd see an "examiner" who'd make the diagnosis. Then in the collaborative practice you'd see the pharmacist who'd decide the drug therapy, but you can't just treat the numbers. It seems like you'd still need a doc/PA/NP to determine what's going on. The real question is, how would it be cheaper to have the med management and physical exam duties split to two people? Most providers can handle adjusting drug regimens at the time of examination with little added time. In highly specialized cases, yes, I could see the benefit of having a pharm.d. be the medication managing person, but in the vast majority of garden variety ailments, is there an added benefit in addition to the added cost?

The arguments that are being made are that there just aren't enough providers to meet the needs of the public, it would help offset the primary care shortage. There is a need for more providers and a need for improved quality of care as it relates to managing chronic illness. A physician will initially diagnose someone with HTN, diabetes, etc. And then upon follow ups the pharmacist will see them and manage their drug therapy under collaborative practice with the physician. Having a pharmacist provide disease management lightens physician load, allows them to focus more on diagnostics and more fully utilizes the skills of another healthcare practitioner specifically trained in that area. Here is a report to the surgeon general that was approved and basically outlines the benefits that pharmacists bring to healthcare with more advanced pharmacy practice: http://www.usphs.gov/corpslinks/pharmacy/sc_comms_sg_report.aspx

The argument is that it improves the quality of care, decreasing costs related to hospital admissions and ER visits due to poorly managed diseases where pharmacist expertise can optimize care and prevent these. There is evidence that more advanced practice models do good for patients and the system as a whole while decreasing costs overall and improving patient health. It's basically taking things that are already happening in settings like the VA and IHS and trying to expand it beyond federal institutions. The biggest issue is being able to be paid for these services.
 
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The arguments that are being made are that there just aren't enough providers to meet the needs of the public, it would help offset the primary care shortage. There is a need for more providers and a need for improved quality of care as it relates to managing chronic illness. A physician will initially diagnose someone with HTN, diabetes, etc. And then upon follow ups the pharmacist will see them and manage their drug therapy under collaborative practice with the physician. Having a pharmacist provide disease management lightens physician load, allows them to focus more on diagnostics and more fully utilizes the skills of another healthcare practitioner specifically trained in that area. Here is a report to the surgeon general that was approved and basically outlines the benefits that pharmacists bring to healthcare with more advanced pharmacy practice: http://www.usphs.gov/corpslinks/pharmacy/sc_comms_sg_report.aspx

The argument is that it improves the quality of care, decreasing costs related to hospital admissions and ER visits due to poorly managed diseases where pharmacist expertise can optimize care and prevent these. There is evidence that more advanced practice models do good for patients and the system as a whole while decreasing costs overall and improving patient health. It's basically taking things that are already happening in settings like the VA and IHS and trying to expand it beyond federal institutions. The biggest issue is being able to be paid for these services.

http://www.ncbi.nlm.nih.gov/pubmed/23307525

Some evidence shows it may not be worth it to have the pharmacist on board.
 
Who is care?? I say just let md do job and they are provider status, pharmacist are not should be provider. Evry body can say everythign but this no point, nothing change pharmacist are not provider, pharmacist just give out pill only... pharmacist are should not pretend to try to be provider.....
 
Who is care?? I say just let md do job and they are provider status, pharmacist are not should be provider. Evry body can say everythign but this no point, nothing change pharmacist are not provider, pharmacist just give out pill only... pharmacist are should not pretend to try to be provider.....
Are you a troll? Reading this hurt my brain.
 
It's not about the length of school. It's about what the schooling is in. Those 2 year professions are trained to diagnose and have clinical experience doing so. Pharmacists aren't trained to examine and diagnose. Without that skill, you really cannot initiate any treatment because you can't get to the diagnosis. You could have 6 years of Pharm.D. work and that fact wouldn't change. Pharmacists are the drug experts and respected and utilized for that knowledge, but they are not diagnosticians.
Pharmacy school does go into diagnostics and therapy (almost every pharmacy program does). We do not use about 25-30% of the knowledge we receive in school in the actual workforce.
 
Does the VA ring a bell to any of you guys? Pharmacists there already do lipid, diabetes, anti-coagulation, smoking cessation, HTN management, etc. Does a patient really have to see the doctor EVERY time to make medication changes?

Get lab work done on lipids --> go to doc (have him analyze lipid panel...wow so difficult to do...) adjust per ACA/AHA 2013 lipid guidelines.

Diabetes: Perform SMBGs at home --> go to doc ($), and doc analyses numbers (another extremely difficult task) --> adjust dose

HTN: go to doc ($) --> take BP --> adjust dose

Anticoag: Go to lab to get INR --> see doc ($)....oh man, INR comes back at 1.3 patient says he missed a dose. To top it off, he has a-fibb. Oh man, what to do? As a pharmacist, I wouldn't know.... --> doc adjusts dosing.

The list can go on...
 
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Pharmacy school does go into diagnostics and therapy (almost every pharmacy program does). We do not use about 25-30% of the knowledge we receive in school in the actual workforce.
I'd put the number around 75%.

MDs absolutely can handle what we can. It's just a waste of their time. In a rotation I did at the VA, we saw people to help manage smoking cessation therapy every two weeks. If a PharmD can touch base with patients regarding only disease states that are basically pharmacologically managed more often, why not? The surgeon general can run a Coumadin clinic, but he doesn't because talking to geriatrics about their spinach intake is below their pay grade.
 
Also, before it is suggested that pharmacists should be managing patients in the current retail model, I have "patients" I've never met and patients who probably don't exist. It's not built for that.
 
Does the VA ring a bell to any of you guys? Pharmacists there already do lipid, diabetes, anti-coagulation, smoking cessation, HTN management, etc. Does a patient really have to see the doctor EVERY time to make medication changes?

Get lab work done on lipids --> go to doc (have him analyze lipid panel...wow so difficult to do...) adjust per ACA/AHA 2013 lipid guidelines.

Diabetes: Perform SMBGs at home --> go to doc ($), and doc analyses numbers (another extremely difficult task) --> adjust dose

HTN: go to doc ($) --> take BP --> adjust dose

Anticoag: Go to lab to get INR --> see doc ($)....oh man, INR comes back at 1.3 patient says he missed a dose. To top it off, he has a-fibb. Oh man, what to do? As a pharmacist, I wouldn't know.... --> doc adjusts dosing.

The list can go on...

Inappropriate. I don't marginalize your job. Please do not do the same to ours.
 
Provider status does not equate with providing initial diagnosis or therapy. Some PharmD programs do teach students how to perform examinations, basic physicals and other such things. My school does. We also do touch on diagnostics, not to the level of a medical grad or a mid-level grad (NP or PA) but we have to be competent in it in order to properly manage drug therapy and understand drug therapy. Then again, no pharmacy groups (at least of those I'm aware of) are pushing to expand pharmacy scope to include diagnostics or claiming that pharmacists are diagnostic experts and should be diagnosing. It's mainly geared towards collaborative practice and disease management as it pertains to the use of drugs (which is what pharmacists are the experts in). Provider status is largely just a title that allows for the billing of services to insurance companies. Many states recognize pharmacists as healthcare providers when it comes to liability and lawsuits at least. It's about further utilizing the skills and knowledge of the drug experts as it pertains to the utilization of drugs to treat diseases, not turning the drug experts into the diagnostician that is providing the initial diagnosis for conditions or even interpreting the lab tests to perform the diagnosis.

Also, the 6 year PharmD is the bare minimum and I would venture to say only a small percentage (not majority) of the overall pharmacy student population actually do a 0-6 program. I myself, along with the majority of my class, will have 8 years in with some schools requiring 3-4 years of work before being eligible to matriculate. There are some MD/DO programs that don't require a BS degree and accept exceptional undergrad students as well as foreign licensed physicians only having a masters level education. Regardless though, the professional coursework is 4 years. The minimum of 2 undergrad years just means someone doesn't need the extra filler classes and can get into some programs having only taken their pharm school pre-reqs. As far as competency to do the job goes, some practice models and institutions (like the VA) have pharmacists managing diseases actively with some states having more progressive practice models. A pharmacist is competent to do the job and many go on to have residency training before engaging in such jobs.

The majority of physicians complete 8 years of education. The accelerated programs you refer to are few and far between. I was in one of them 7 years. Don't forget a minimum of 3 years of residency as well for all physicians.
The VA is a well integrated program. May not work as well in an outpatient setting with more fractured care.
 
Does the VA ring a bell to any of you guys? Pharmacists there already do lipid, diabetes, anti-coagulation, smoking cessation, HTN management, etc. Does a patient really have to see the doctor EVERY time to make medication changes?

Get lab work done on lipids --> go to doc (have him analyze lipid panel...wow so difficult to do...) adjust per ACA/AHA 2013 lipid guidelines.

Diabetes: Perform SMBGs at home --> go to doc ($), and doc analyses numbers (another extremely difficult task) --> adjust dose

HTN: go to doc ($) --> take BP --> adjust dose

Anticoag: Go to lab to get INR --> see doc ($)....oh man, INR comes back at 1.3 patient says he missed a dose. To top it off, he has a-fibb. Oh man, what to do? As a pharmacist, I wouldn't know.... --> doc adjusts dosing.

The list can go on...

Just a different perspective (from a doc)

Is this patient someone who was previously controlled (htn, dm, afib on coumadin) and suddenly lost control? If so, why? Did the patient recently lose insurance coverage or is in the donut hole? Is there stress at home or at work? Is the patient depress?

Or is this patient someone who have never attempted lifestyle modification, takes his meds intermittently, and continues with unhealthy habits?

And since this patient is diabetic and has hypertension and afib (whether in good control or not), it's important to check for peripheral neuropathy, retinopathy (either from diabetes or hypertension), and also nephropathy. High risk for heart disease (not just CAD but CHF, ICMO, etc). Also at risk for OSA and/or obesity hypoventilation syndrome. Perhaps even secondary pulm htn.

There's more to just treating a disease than just looking at numbers - you have to treat the disease in the context of the patient.
 
Pharmacy school does go into diagnostics and therapy (almost every pharmacy program does). We do not use about 25-30% of the knowledge we receive in school in the actual workforce.

There's a huge difference between reading and talking about something and then actually practicing diagnosing (which requires laying hands on the patients). I've probably done a thousand cardiac, pulmonary, abdominal, etc exams at this point in my career and I'm no where near being an excellent diagnostician. I don't get how pharmacists are going to be able to even do the simplest of physical examinations without training or practice. And those who do have some training will be so far removed from it that it won't make much of a difference. You can't just treat the numbers without examining.
 
Sorry, but pharmacists are over their heads with this one. I'm going to relate a personal example that happened to me. After staying in a shady hotel (a particular one where construction workers liked to lodge) for 2 weeks to attend a class, by the second week my skin suddenly became itchy and what I panickingly thought was scabies. I called a relative of mine (ER) and sent a picture. They told me it wasn't scabies and recommended a certain cream. Went to the pharmacy, and the pharmacist looked at my face/neck, challenged the doc's prescription and recommended hydrocortisone cream and benadryl instead (?). Being that it was 2 AM and I wanted something fast, I agreed. The next day, my skin became worse after applying the hydrocortisone cream and the doc said what I had was BACTERIAL (impetigo) and therefore would not respond to hydrocortisone cream and that the pharmacist was being silly trying to PLAY DOCTOR. . . needless to say, I made the trip to another pharmacy, got my cream, skin got better over the next week, and I lost my respect for pharmacists.
 
There's a huge difference between reading and talking about something and then actually practicing diagnosing (which requires laying hands on the patients). I've probably done a thousand cardiac, pulmonary, abdominal, etc exams at this point in my career and I'm no where near being an excellent diagnostician. I don't get how pharmacists are going to be able to even do the simplest of physical examinations without training or practice. And those who do have some training will be so far removed from it that it won't make much of a difference. You can't just treat the numbers without examining.

There's a lot of confusion happening in this thread. I'm by no means an expert on the issue, but I think it's important to define the term "provider" so that people are no longer arguing past each other, so to speak.

Provider status simply means that payers (private insurance companies, Medicaid, Medicare, etc.) recognize a profession's services as valuable and are willing to reimburse said professionals for conducting them. Note: it does not mean that all providers are equal. The services provided by providers are limited to those legally outlined in state practice acts. Ex. Insurance Company A is willing to pay a pharmacist to conduct a comprehensive medication review for my grandmother. My grandmother meets with a pharmacist, chats for a while about how her medications are working for her, what's she's taking, her concerns, etc., and the pharmacist writes to and/or calls her prescribers with his or her findings. In the eyes of Insurance Company A, pharmacists are providers. Does this have anything to do with physical assessment, diagnosis, prescriptive authority, or the like? No, no it doesn't.

Being a provider does NOT mean that one is capable of examining, diagnosing and managing a patient independently. That, instead, is the definition of what it means to be a physician, PA, NP, dentist, etc. What a provider is legally able to do is defined by state practice acts, and these are a topic for a different discussion.

So, to sum up, provider does not = physician, mid level, prescriber, diagnostician, etc. It is a designation for a professional who provides a valuable (read: reimbursable) service in the eyes of payers (not limited to physical assessment, diagnosis, prescriptive authority--remember, these are a separate topic, defined by state practice acts). Pharmacists and physicians can both be providers for doing the different jobs they have been trained to do.
 
Pharmacists can't even master MTM as a profession and now we want provider status? Not going to happen.
 
Sorry, but pharmacists are over their heads with this one. I'm going to relate a personal example that happened to me. After staying in a shady hotel (a particular one where construction workers liked to lodge) for 2 weeks to attend a class, by the second week my skin suddenly became itchy and what I panickingly thought was scabies. I called a relative of mine (ER) and sent a picture. They told me it wasn't scabies and recommended a certain cream. Went to the pharmacy, and the pharmacist looked at my face/neck, challenged the doc's prescription and recommended hydrocortisone cream and benadryl instead (?). Being that it was 2 AM and I wanted something fast, I agreed. The next day, my skin became worse after applying the hydrocortisone cream and the doc said what I had was BACTERIAL (impetigo) and therefore would not respond to hydrocortisone cream and that the pharmacist was being silly trying to PLAY DOCTOR. . . needless to say, I made the trip to another pharmacy, got my cream, skin got better over the next week, and I lost my respect for pharmacists.
Congrats. You found an idiot. Let's get this study published. Who has JAMA's phone number?
 
Sorry, but pharmacists are over their heads with this one. I'm going to relate a personal example that happened to me. After staying in a shady hotel (a particular one where construction workers liked to lodge) for 2 weeks to attend a class, by the second week my skin suddenly became itchy and what I panickingly thought was scabies. I called a relative of mine (ER) and sent a picture. They told me it wasn't scabies and recommended a certain cream. Went to the pharmacy, and the pharmacist looked at my face/neck, challenged the doc's prescription and recommended hydrocortisone cream and benadryl instead (?). Being that it was 2 AM and I wanted something fast, I agreed. The next day, my skin became worse after applying the hydrocortisone cream and the doc said what I had was BACTERIAL (impetigo) and therefore would not respond to hydrocortisone cream and that the pharmacist was being silly trying to PLAY DOCTOR. . . needless to say, I made the trip to another pharmacy, got my cream, skin got better over the next week, and I lost my respect for pharmacists.

My grandfather had a heart attack. Part of that was that he vomited and went unconcious. The doctor diagnosed him with epilepsy and treated him with medication for epilepsy while his heart condition didn't improve (they didn't even consider a heart attack). We lived 700 miles away and got the phone call that he was passing away. It wasn't until later that they found out it was a heart attack and not an epileptic seizure. I now trust n0 doctors because one almost killed my grandfather... (being sarcastic about not trusting doctors)

See how rational that is? N=1 does not a solid conclusion make. And FYI, pharmacists can prescribe OTCs and do treat according to guidelines for OTCs. A good pharmacist knows when to refer, but it's not "playing doctor" for them to make OTC recommendations which is completely within their scope. If they don't refer, go beyond what boundaries there are for self care/OTC care they can be held liable and brought to court over it. Also, if you did indeed have a real prescription from your ER friend I highly highly doubt that the pharmacist would refuse to fill a legit script in favor of an OTC. There are bad clinicians out there, bad physicians, NPs, PAs, pharmacists, nurses, etc. Taking 1 of them and basing your opinion on all of them based on that 1 really isn't all that rational.

The majority of physicians complete 8 years of education. The accelerated programs you refer to are few and far between. I was in one of them 7 years. Don't forget a minimum of 3 years of residency as well for all physicians.
The VA is a well integrated program. May not work as well in an outpatient setting with more fractured care.

My main point wasn't to downplay physician education, they get more years of education and experience than anyone else due to residencies and specialized training. My point was addressing the notion that 6 year PharmDs are the norm or are even the most common. It's the bare minimum. Even so though, to be a clinical pharmacist nearly all positions today require a 1-2 year residency on top of the PharmD. It's not as long as physician training, but it's not 6 years out of high school and then jumping in to managing patients. Either way, the only way to do this would be under a CPA and any physician feeling uncomfortable can chose to not initiate the CPA.
 
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My main point wasn't to downplay physician education, they get more years of education and experience than anyone else due to residencies and specialized training. My point was addressing the notion that 6 year PharmDs are the norm or are even the most common. It's the bare minimum. Even so though, to be a clinical pharmacist nearly all positions today require a 1-2 year residency on top of the PharmD. It's not as long as physician training, but it's not 6 years out of high school and then jumping in to managing patients. Either way, the only way to do this would be under a CPA and any physician feeling uncomfortable can chose to not initiate the CPA.

It's not about the number of years or hours of training. It is all about the type of training.
 
There's a lot of confusion happening in this thread. I'm by no means an expert on the issue, but I think it's important to define the term "provider" so that people are no longer arguing past each other, so to speak.

Provider status simply means that payers (private insurance companies, Medicaid, Medicare, etc.) recognize a profession's services as valuable and are willing to reimburse said professionals for conducting them. Note: it does not mean that all providers are equal. The services provided by providers are limited to those legally outlined in state practice acts. Ex. Insurance Company A is willing to pay a pharmacist to conduct a comprehensive medication review for my grandmother. My grandmother meets with a pharmacist, chats for a while about how her medications are working for her, what's she's taking, her concerns, etc., and the pharmacist writes to and/or calls her prescribers with his or her findings. In the eyes of Insurance Company A, pharmacists are providers. Does this have anything to do with physical assessment, diagnosis, prescriptive authority, or the like? No, no it doesn't.

Being a provider does NOT mean that one is capable of examining, diagnosing and managing a patient independently. That, instead, is the definition of what it means to be a physician, PA, NP, dentist, etc. What a provider is legally able to do is defined by state practice acts, and these are a topic for a different discussion.

So, to sum up, provider does not = physician, mid level, prescriber, diagnostician, etc. It is a designation for a professional who provides a valuable (read: reimbursable) service in the eyes of payers (not limited to physical assessment, diagnosis, prescriptive authority--remember, these are a separate topic, defined by state practice acts). Pharmacists and physicians can both be providers for doing the different jobs they have been trained to do.
To add a title of " Provider " can be confusing to public just like doctor nurse which is not a nurse nor a doctor. I find this title is unnessary . If pharmacists want to reimburse the services they provide , instead of adding a confusing title, they should work on the billing services ,negotiate with insurance companies ..etc.
 
Sorry, but pharmacists are over their heads with this one. I'm going to relate a personal example that happened to me. After staying in a shady hotel (a particular one where construction workers liked to lodge) for 2 weeks to attend a class, by the second week my skin suddenly became itchy and what I panickingly thought was scabies. I called a relative of mine (ER) and sent a picture. They told me it wasn't scabies and recommended a certain cream. Went to the pharmacy, and the pharmacist looked at my face/neck, challenged the doc's prescription and recommended hydrocortisone cream and benadryl instead (?). Being that it was 2 AM and I wanted something fast, I agreed. The next day, my skin became worse after applying the hydrocortisone cream and the doc said what I had was BACTERIAL (impetigo) and therefore would not respond to hydrocortisone cream and that the pharmacist was being silly trying to PLAY DOCTOR. . . needless to say, I made the trip to another pharmacy, got my cream, skin got better over the next week, and I lost my respect for pharmacists.

Nobody's expecting that retail pharmacists will gain provider status. It makes much more sense for a physician to diagnose the patient and have a clinical pharmacist consult with the doctor and order the meds. Anyone who works in a hospital probably knows that physicians have too much on their plates. If there are no protocols in place, troughs will be ordered at the wrong time, renal dosing will be incorrect, patients will stay on IV when they should be PO, and the list goes on. There's a physician assistant that has ordered meds for the wrong patient and just generally seems to be a mess because she's got too much to deal with. Doctors that are used to sitting in rounds with a clinical pharmacist will always consult them about anything drug-related. It takes them a while to realize it but clinical pharmacists know more about drugs than they do. I would imagine that primary care physicians would be even less knowledgeable, particularly the older ones that still think that atenolol and Tradjenta (true story) should be first line for all patients.
 
To add a title of " Provider " can be confusing to public just like doctor nurse which is not a nurse nor a doctor. I find this title is unnessary . If pharmacists want to reimburse the services they provide , instead of adding a confusing title, they should work on the billing services ,negotiate with insurance companies ..etc.
I could be off on this, but part of the issue, to my knowledge, is with the reimbursement through Medicare. Basically, pharmacists would like the ability to bill for their services through federal programs. In that respect, the title of provider is needed due to the language with which the laws are written.

I don't think anybody plans to use the term provider in the patient world, as it's really somewhat irrelevant there. It's about billing for services through the government.
 
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Just a different perspective (from a doc)

Is this patient someone who was previously controlled (htn, dm, afib on coumadin) and suddenly lost control? If so, why? Did the patient recently lose insurance coverage or is in the donut hole? Is there stress at home or at work? Is the patient depress?

Or is this patient someone who have never attempted lifestyle modification, takes his meds intermittently, and continues with unhealthy habits?

And since this patient is diabetic and has hypertension and afib (whether in good control or not), it's important to check for peripheral neuropathy, retinopathy (either from diabetes or hypertension), and also nephropathy. High risk for heart disease (not just CAD but CHF, ICMO, etc). Also at risk for OSA and/or obesity hypoventilation syndrome. Perhaps even secondary pulm htn.

There's more to just treating a disease than just looking at numbers - you have to treat the disease in the context of the patient.
We do talk about many of these issues in school. Motivational interviewing to determine root cause of issues is really stressed, at least in my program. We also talk about lifestyle modification, medication compliance, and practice checking for neuropathy. We've talked about how often patients should be seeing their eye doctors and also monitoring labs for patients with diabetes. We talk about the increased risk of heart disease as well.

I would never suggest that seeing a pharmacist could be a replacement for medical visits with a doctor -- that is not even remotely our scope of practice. I would suggest for patients with difficult medication regimens, a pharmacist can be a helpful addition to a medical team to help ensure patients are getting indicated, effective, safe, and convenient medication therapy.
 
So is there much of a chance that this bill will pass? When will we know if it does/doesn't?
 
NO. Pharmacists will make terrible providers. And am on my way to being one, but I want to be a drug expert. First, the pharmacy proffesion has allowed a sharp increase in pharmacy schools, some being run in mall-like structures - targeting employers like walmart. They are focussed on the $100,000 pay instead of producing critical thinking professionals. I have worked with pharmacists at KMART, WALMART, Hospitals, and to put it politely…they are very uninspiring. ACPE and the proffesion will need to check what they are graduating before asking for this big responsibility. Let them manage MTM first.
 
NO. Pharmacists will make terrible providers. And am on my way to being one, but I want to be a drug expert. First, the pharmacy proffesion has allowed a sharp increase in pharmacy schools, some being run in mall-like structures - targeting employers like walmart. They are focussed on the $100,000 pay instead of producing critical thinking professionals. I have worked with pharmacists at KMART, WALMART, Hospitals, and to put it politely…they are very uninspiring. ACPE and the proffesion will need to check what they are graduating before asking for this big responsibility. Let them manage MTM first.

Pharmacists are already "providers" in many settings. This is just a designation in the insurance code, not a federal increase in a scope of practice. There are pharmacists that have clinical services, perform consultations and some that manage disease under medical orders/CPA and are providers. Pharmacists being "providers" does not mean they will become diagnosticians replacing physicians. It means that they can be paid for the clinical work that they can do and have been doing already.
 
So what's the status of this bill? Is a vote/decision expected to be made within the next few weeks/months?
 
I have contacted legislators to explain the weaknesses that the proffesion needs to tackle and answer adequately before asking for this responsibility. I pray and hope that it is defeated. I support doctors/NPs/PAs against it.
 
I have contacted legislators to explain the weaknesses that the proffesion needs to tackle and answer adequately before asking for this responsibility. I pray and hope that it is defeated. I support doctors/NPs/PAs against it.

Cool story, bro. Glad you looked at it from all the angles and decided on behalf of the profession that it's an unwise project to pursue.
 
Pharmacists are already "providers" in many settings. This is just a designation in the insurance code, not a federal increase in a scope of practice. There are pharmacists that have clinical services, perform consultations and some that manage disease under medical orders/CPA and are providers. Pharmacists being "providers" does not mean they will become diagnosticians replacing physicians. It means that they can be paid for the clinical work that they can do and have been doing already.

So in other words you want to increase the financial burden on the Medicare/Medicaid system thus increasing costs for patients? Now it's no wonder why our congressmen do not support this.
 
So in other words ye want to increase t' financial burden on t' Medicare/Medicaid system thus increasin' costs for patients? Now it be no wonder why our congressmen do not support this.
The idea is that overall it saves the health system money by improving care and reducing costs related to improper medication usage. Also, if pharmacist services prove to be a benefit to the healthcare system why not consider making cuts elsewhere to fund it if for some reason it isn't a cost savings measure (contrary to what studies say). Regardless, shouldn't pharmacists be paid for clinical services they provide like any other provider?
 
Cool story, bro. Glad you looked at it from all the angles and decided on behalf of the profession that it's an unwise project to pursue.
Well if Pharmacists just want to sit behind counters counting pills, hiding behind proffesional insurance instead of helping put back the care in Health - we have these twits and twats without critical thinking being pushed through the education system with an eye on the $100,000 paycheck…but can't dispense….mmh? Don't even know how to talk to patients?

I am against this being passed. All these mall-pharmay schools mushrooming all over should be put in check first or we will be giving pharmacists a licence to kill.
 
Well if Pharmacists just want to sit behind counters counting pills, hiding behind proffesional insurance instead of helping put back the care in Health - we have these twits and twats without critical thinking being pushed through the education system with an eye on the $100,000 paycheck…but can't dispense….mmh? Don't even know how to talk to patients?

I am against this being passed. All these mall-pharmay schools mushrooming all over should be put in check first or we will be giving pharmacists a licence to kill.

Critically observing this... It's about the ability to bill and be paid for services that are already being provided. People are against it without actually knowing what it is. What it is NOT is making pharmacists physicians, what it IS is recognizing them as providers so that they can bill for services they are already performing or can perform.
 
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The idea is that overall it saves the health system money by improving care and reducing costs related to improper medication usage. Also, if pharmacist services prove to be a benefit to the healthcare system why not consider making cuts elsewhere to fund it if for some reason it isn't a cost savings measure (contrary to what studies say). Regardless, shouldn't pharmacists be paid for clinical services they provide like any other provider?

Jackass.

Pharmacists don't provide clinical services worthy of reimbursement under Medicare regulations. Why pay a pharmacist to do MTM when a midlevel practitioner can do the same job AND has prescribing authority?
 
Jackass.

Pharmacists don't provide clinical services worthy of reimbursement under Medicare regulations. Why pay a pharmacist to do MTM when a midlevel practitioner can do the same job AND has prescribing authority?
If they could, we wouldn't have to.
 
Honestly, the fact that this idea has been championed almost entirely by pharmacy students is pretty evident in how ready the profession is to handle it. I'm not ready for a world where CVS/WAG/RAD has new metrics where they can try to combine billables with profitability, and the headache of liability that comes from personal interest in "acquiring more scripts/switching to more profitable scripts" - for the community pharmacist, this pretty much is a "allow us to do MTM properly" which 95% of current retail pharmacists don't WANT to do, because there isn't enough time in the day to look at it.

If we're saying that it's more than MTM, then it's going to lead into trying to put the chains in a VA-like system, which is a disaster. Would this be a good thing for hospital pharmacists? Sure, it would give them incentive to hire on more clinical pharms since they get a monetary benefit from what is provided. But you're deluding yourself if you think that any change that benefits the scope of pharmacists is going to exclude your chains from being able to bill things, since they are approximately a billion times more influential in these things than APhA and the like could ever contemplate being.
 
Critically observing this... It's about the ability to bill and be paid for services that are already being provided. People are against it without actually knowing what it is. What it is NOT is making pharmacists physicians, what it IS is recognizing them as providers so that they can bill for services they are already performing or can perform.
Are they not being paid…handsomely too? This is the excuse some predators are using to set up shop and produce human robots…promising them that they will be providers (expanded roles), when in reality, it will be a duplication of roles. Eventually will kill the proffesion altogether.
 
Pharmacists have a unique role. Define that and guard it jealously. Stop latching onto this other side shows that pollute the career. I still want to have time to come up with something in my pharmacy instead of doing what NP, MD, and PA should be doing.