I wrote this in response to an article on Politico.com. I thought I would post it here to generate discussion. I am 31 and about to graduate from pharmacy school and claim no superior knowledge of this subject...I just want to generate discussion and ideas. Thanks.
First, while pharmacists and pharmacies certainly need to be worried about reimbursement issues etc I think this issue often clouds the enormous opportunity pharmacists could offer patients, the US health care system in general, and our own profession. Community pharmacists are very accessible health care workers who, in the current dispensing model of pharmacy (IE the pharmacist's salary/wage is tied to a product) are vastly under utilized for the amount of education they receive. In general, a pharmacist's training/education includes, of course, the study of medications but also the study of diseases and disease state management. Many pharmacists even hold additional certifications that further strengthens training in areas such as diabetes management, asthma management, heart disease, etc. In other words, pharmacists can, could, and should be involved in chronic disease state management of patients. The Asheville Project, The Diabetes Ten City Challenge, and other community pharmacist led disease state management pilot programs have shown significant health benefits to patients along with reduced costs related to the disease. In other words, improved patient health and significant cost savings to payers. To be clear, the pharmacists didn't diagnose disease...that was still left to the physician and the physician is still the leader of the health care team. The pharmacists simply worked in a collaborative manner as part of the health team.
Approximately 150,000 pharmacists practice in the community setting accessible to patients. Why aren't pharmacists utilized in chronic disease state management and more involved in the health care team? Well, there are certainly many reasons. Perhaps the biggest reason is that a pharmacist cannot bill payers (IE medicare; insurance companies) for their cognitive services (ignoring MTM in Part D...I'm talking about disease state management). In the current model, the community pharmacist salary is tied to the sales of medications thus dispensing prescriptions (selling drugs) keeps the store open or investors happy. Thus, time away from dispensing is money lost in the true business sense. Doctors, nurse practitioners, PAs, clinical social workers can all bill insurance for their cognitive services. Pharmacists cannot. I can't think of another health care provider with our level knowledge and expertise that cannot bill payers for what we know or what we can/could do...
What I'm trying to get at is this: pharmacists are accessible and have the education/knowledge to participate in the health care team in a manner that helps maximize disease state management treatment while reducing costs for everyone. Research is showing this. However, a huge obstacle is being reimbursed for this activity. I don't mean this in the "me too" sense of trying to get pharmacists more money for the sake of more money. I see this as a win for patients, payers, and pharmacists.
To be clear on one more issue, I don't believe all community pharmacists are created equal. If pharmacists were ever recognized for their cognitive services in disease state management, I think the pharmacy profession would need to be tiered. In other words, in community pharmacy you could have traditional dispensing pharmacists and pharmacists that have further training (residency; board certification; etc) that would be able to bill payers.
Thanks.
PS I know there are pharmacy consultant groups that do LTC and such but I'm talking about a top-down model (IE Medicare and Third Parties reimburse) as opposed to individual contracts. Another thought I just had, if pharmacists could bill (IE generate a revenue stream for their services) you could see the mainstream development of pharmacy practice groups similar to physician groups. These practice groups could contract with clinics, LTC, etc. Anyway thanks.
First, while pharmacists and pharmacies certainly need to be worried about reimbursement issues etc I think this issue often clouds the enormous opportunity pharmacists could offer patients, the US health care system in general, and our own profession. Community pharmacists are very accessible health care workers who, in the current dispensing model of pharmacy (IE the pharmacist's salary/wage is tied to a product) are vastly under utilized for the amount of education they receive. In general, a pharmacist's training/education includes, of course, the study of medications but also the study of diseases and disease state management. Many pharmacists even hold additional certifications that further strengthens training in areas such as diabetes management, asthma management, heart disease, etc. In other words, pharmacists can, could, and should be involved in chronic disease state management of patients. The Asheville Project, The Diabetes Ten City Challenge, and other community pharmacist led disease state management pilot programs have shown significant health benefits to patients along with reduced costs related to the disease. In other words, improved patient health and significant cost savings to payers. To be clear, the pharmacists didn't diagnose disease...that was still left to the physician and the physician is still the leader of the health care team. The pharmacists simply worked in a collaborative manner as part of the health team.
Approximately 150,000 pharmacists practice in the community setting accessible to patients. Why aren't pharmacists utilized in chronic disease state management and more involved in the health care team? Well, there are certainly many reasons. Perhaps the biggest reason is that a pharmacist cannot bill payers (IE medicare; insurance companies) for their cognitive services (ignoring MTM in Part D...I'm talking about disease state management). In the current model, the community pharmacist salary is tied to the sales of medications thus dispensing prescriptions (selling drugs) keeps the store open or investors happy. Thus, time away from dispensing is money lost in the true business sense. Doctors, nurse practitioners, PAs, clinical social workers can all bill insurance for their cognitive services. Pharmacists cannot. I can't think of another health care provider with our level knowledge and expertise that cannot bill payers for what we know or what we can/could do...
What I'm trying to get at is this: pharmacists are accessible and have the education/knowledge to participate in the health care team in a manner that helps maximize disease state management treatment while reducing costs for everyone. Research is showing this. However, a huge obstacle is being reimbursed for this activity. I don't mean this in the "me too" sense of trying to get pharmacists more money for the sake of more money. I see this as a win for patients, payers, and pharmacists.
To be clear on one more issue, I don't believe all community pharmacists are created equal. If pharmacists were ever recognized for their cognitive services in disease state management, I think the pharmacy profession would need to be tiered. In other words, in community pharmacy you could have traditional dispensing pharmacists and pharmacists that have further training (residency; board certification; etc) that would be able to bill payers.
Thanks.
PS I know there are pharmacy consultant groups that do LTC and such but I'm talking about a top-down model (IE Medicare and Third Parties reimburse) as opposed to individual contracts. Another thought I just had, if pharmacists could bill (IE generate a revenue stream for their services) you could see the mainstream development of pharmacy practice groups similar to physician groups. These practice groups could contract with clinics, LTC, etc. Anyway thanks.
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