I heard pharmacist may eventually gain a provider status which will give us the opportunity to bill for other services outside the filling fee and also give us the ability to write scripts. Anyone heard anything about this?
There seems to be a little bit of misinformation with regards to MTM and provider status. The two are not equivalent. "Provider status," in this context, is defined at a federal level by Medicare. MTM does not require you to have "provider status." MTM does require you to have certain provider numbers, but these are not related to Medicare defining pharmacists as healthcare
providers. Billing for MTM is very easy (speaking from experience) through either Mirixa or Outcomes, which handles MTM billing for Medicare patients (and possibly private-pay as well, I think?).
The reason that MTM is not catching on is twofold. One: it's being done predominantly in community pharmacies. A first-encounter for MTM can require up to thirty minutes. This means that if you were working a regular shift, you would be thirty minutes behind for each first-encounter visit. So in order to effectively do MTM, you have to do this on your off day, which is a bummer. Two: reimbursements can be good for MTM (upwards of $100/hour, but don't let that fool you...you still have overhead costs, etc.), but if you're working for a big-box store, you won't see a dime of that. Hence, some of the apathy towards implementing it.
MTM is, in my opinion, the springboard for pharmacists doing more than just traditional dispensing. However, it will have to be done outside of the big box pharmacies in order to help us gain professional autonomy and develop more patient-care centered roles. Think doing MTM in a physician's office that sees a lot of older, medicare patients (the population that is most likely to be eligible for/benefit from MTM services).
Provider status, on the other hand, would allow us to bill medicare directly for certain cognitive services (think chronic disease management, diabetic foot exams, anti-coagulation monitoring, etc.). Provider status does NOT necessarily equal the ability to write prescriptions though. In order to write prescriptions (
which would vary based on state laws), you would likely have to enter into a collaborative practice agreement with a physician (if you are interested in learning more, search for pharmacy collaborative practice agreement in North Carolina or New Mexico). Under this agreement, you would work within a limited scope of practice - only working with diabetes, HF, and HTN patients, for example.
Here's why you have to have physician oversight...pharmacists are not trained to diagnose. That's not a bad thing though. What we lack in diagnostic training, we more than make up in training on how to treat and manage disease. Pharmacists often get 16+ hours of pharmacotherapy training. Contrast that to the majority of MD programs which have only 4 hours. That's because the focus of an MD is diagnosing. Our focus is treating. So in that sense, there is great potential for a symbiotic relationship between doctors and pharmacists in managing patients who have chronic diseases that require a lot of intensive medication adjustments. Right now, under a collaborative practice agreement, the physician would bill for the service that you provide, and you would be paid out of the money that the physician/practice receives.
The reason that we want provider status is because it allows us to become a more autonomous profession. Right now, we are beholden either to dispensing or collaborative practice agreements that likely have a very limited scope of practice.
Be forewarned though, doing the types of things in collaborative practice will likely require additional residency training (although MTM does not require additional residency training).
Hope this helps!
