Provider Status Bills in House and Senate

[Digsbe]

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http://www.pharmacist.com/CEOBlog/h...ave-better-access-health-care-and-pharmacists

Evidently 2 bills, one in the House and the other in the Senate have been introduced. From what I understand it basically allows pharmacists to be designated as healthcare providers under Medicare in medically undeserved areas only meaning in this areas pharmacists can bill for more clinical services provided. I know APhA has been pushing hard for it, but I was wondering what everyone thinks this may do for pharmacy, job opportunities, demand for more clinical pharmacists providing services and the possibility that such things will become more mainstream under other insurance plans or possibly applied nationally one day? All assuming it passes.

 

[gwarm01]

What do they mean by medically underserved areas only? We would only be able to provide those services in rural areas then? Seems like a half-measure.

 

[MountainPharmD]

I have a question...what does this mean?

"These services would be reimbursable under Medicare Part B if provided to patients in medically underserved communities and if the services are consistent with state scope of practice laws."

I live in Texas and I'm not aware of any state scope of practice laws that allow me to do any more than I do right now. Certainly none that I could bill Medicate for.

This sounds like another one of those pie in the sky pet projects of our worthless professional organizations that in the end if passed really means nothing.

 

[gwarm01]

That's really what it sounds like to me. Vague and flowery language that amounts to nothing in the real world.

 

[confettiflyer]

That's really what it sounds like to me. Vague and flowery language that amounts to nothing in the real world.

You're confusing statute for regulation.

 

[halipharmd]

In the real world it amounts to being paid for services (being able to bill) that we currently provide for free. An LCSW (licensed clinical social worker) can diagnose but cannot prescribe, why can't we have our own corner of the market (medication therapy mangement? compliance? etc...) and be able to bill and therefore give VALUE to what we do.

 

[halipharmd]

http://www.pharmacytimes.com/contri...us-will-change-health-system-pharmacist-roles

 

[PharmdA07]

Not to bash anything or anyone but I agree with @ gwarm01; even if this bill is to be passed, it will take forever for "something" to actually happen let alone for us to be able to bill for what we've been doing everyday already. Like someone on this forum already said before: when I was in undergrad, it was "pharmaceutical care model"; then when I was in pharmacy school, it was MTM and now I'm practicing, it's the "provider status". Yes, I am glad that our roles are being advocated for vigorously; however, I'd be happier for actual materialized results rather than a paper trophy displayed in the museum of pharmacy. For anyone dealing with Medicare/Medicaid system, we know how much a pain it is with medicare Part B just for the DME: simple glucometers, strips and lancets require frequent audits of BS logs or neb'ed meds require even more audits of paperwork! Imagine the amount of hoops you have to jump through for this "provider status" thing to bill medicare.

 

[Mad Jack]

This looks dangerous, particularly from a liability standpoint. I can see this going very poorly.

You should also consider that being a health care provider puts you up to an entirely different standard than pharmacists currently hold. There'll be tons of charting, record keeping, audits, and the like, all so you can bill for services that primary care physicians already generally lose money on providing. You can't have the responsibility without the accountability, and the accountability part of things makes it a real time sink (the average PCP spends more time on paperwork than patient treatment on a given visit) so be careful what you wish for. Making 20 bucks on a blood glucose test that it takes you 8 minutes to chart and 8 minutes to deliver consultation and counseling on may seem like a great deal, but when you factor in the fact that you can't fill any scripts while you're doing all of that and that you have to pay for supplies and other expenses, in addition to paying for a provider EMR system, it really doesn't end up making you much. Hell, it might cost you a lot. And that's before we even get into the liability side of things...

 

[gwarm01]

Although I am pessimistic, I would love to see this pass and turn into something worthwhile for the profession. I was inspired a bit by a post on these forums that explained the "clinical practitioner pharmacist" role as defined by the state of North Carolina. In particular, this post which contained a link to the first published data on the outcomes when using a CPP: http://forums.studentdoctor.net/threads/clinical-pharmacist-practitioner.824780/#post-16165626

I wouldn't consider provider status to be something that elevates us to the level of a primary care physician. You won't suddenly have clinics that are owned and operated by pharmacists. I wouldn't imagine anyway. The real value for me is in the hospital setting. The ability to generate revenue for the hospital would hopefully elevate our status, transform us from an expensive necessity into revenue generators.

My hospital is fairly progressive with regard to pharmacy practice. We order our own labs for TPN, drug levels, etc. We have full autonomy over following and dosing vancomycin and aminoglycosides. Freedom to change doses for renal function. We are often consulted to follow kinetics for caffeine, phenobarbital, and a slew of other drugs. Some of my more trusted physicians (and a frightening number of PAs) will tell me to just "fix it, whatever you think" when they admit a new patient and re-order every screwed up thing on some med rec done by a nurse five years ago. We do document our consults, although I'm sure it's not to the level that would be required.

I do all of this as bonus, a sort of "value-add" to my staffing duties. Our clinical guys do this all day, and the only justification for it (aside from high praise and demand for more pharmacists from our nursing staff and physicians) is the I-vent system that shows some theoretical amount of money saved. When times get tough, people who only save money are shown the door. People who generate money are valued.

Wow, that turned into a long and rambling post.