Provider Status

[RomanPax]

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https://petitions.whitehouse.gov/petition/recognize-pharmacists-health-care-providers/3lkFWfvw

Dear Mr. Blum,
A four year doctorate degree. One year of physical assessment. Two years of pathophysiology and pharmacology. One year of clinical rotations and patient care. An additional year of residency. The same ability to bill Medicare as a medical assistant without a college degree. This is the position pharmacists are in. The nation faces a primary care shortage and pharmacists stand ready to serve as mid-level practitioners and fill the need. You don't have to pay us physician level wages to do the work. Many would gladly do it for less. The VA and Indian Health services already use pharmacists to fill the need, why don't you?

If you have not already written a response to the governments response, please do. This is what I wrote.

http://www.whitehouse.gov/webform/t...tion-response-pharmacists-and-social-security
https://petitions.whitehouse.gov/petition/recognize-pharmacists-health-care-providers/3lkFWfvw

 

[7884CK]

That's awesome you wrote a response. I read the gov't response and was pretty disappointed. I was also trying not to be insulted by them listing allll the other professions that DO have provider status, but that's" ok, since you can still bill through medicare for dispensing prescriptions, services etc ". Right, since the current billable services are adequately capturing all of pharmacists' activities.

Can we get some other people to respond as well? Facebook movement? Come on Pharm forum- let's do this. The response was inadequate!

=============
Thank you for your petition on recognizing pharmacists as health care providers under the Social Security Act.

As you noted, pharmacists are not recognized in the Social Security Act as health care providers who are authorized to bill and receive payment for their services from Medicare. To do so would require a change to the statute by Congress.

But we recognize and value the trusted role that pharmacists play in the community, and their importance to patient care -- in particular to Medicare beneficiaries who need prescription medications.

The term "provider" is defined in Medicare regulations at 42 C.F.R, §400.202 and includes hospitals, skilled nursing facilities, and home health agencies. That term does not include pharmacists. Moreover, the Medicare law specifically authorizes the health care providers who can bill and receive payment from Medicare. For instance, section 1861(r) of the Social Security Act defines "physicians" under the Medicare program. This definition includes, with various restrictions and exceptions, doctors of medicine and osteopathy, doctors of dental surgery and dental medicine, doctors of podiatric medicine, doctors of optometry, and chiropractors. The statute also authorizes several specific non-physician practitioners including nurse practitioners, clinical nurse specialists, physician assistants, nurse midwives, clinical psychologists, and physical therapists to bill and receive payment from Medicare for their professional services that fall within their State scope of practice.

So while pharmacists are not recognized as "providers" who are authorized to bill and receive payment for their services from Medicare, they can receive payment for their services when furnished to Medicare beneficiaries in certain circumstances. For example, pharmacists can receive payment for furnishing services "incident to" the services of a physician or non-physician practitioner. The requirements under the "incident to" provision must be met, including the supervision requirements. The physician or non-physician practitioner who bills for the "incident to" services that the pharmacist furnished would receive payment from Medicare, and the pharmacist would receive payment from the physician or non-physician practitioner based on the agreement established by the parties involved.

Pharmacists can also be paid under Part D by Medicare prescription drug plans to dispense prescription drugs as well as to provide medication therapy management services to patients to identify problems and perform medication reconciliation.

Please visit CMS.gov for additional information.

Jonathan Blum is the Principal Deputy Administrator at the Centers for Medicare & Medicaid Services.

Tell us what you think about this response and We the People.

 

[7884CK]

Did you just squish your comments in to the survey provided in the linkor use some other method? I suspect that the survey focuses primarily on using the "We the People" website, it really wouldn't send our responses to the appropriate people, maybe some back IT department.

 

[7884CK]

You could just email the white house directly haha. http://www.whitehouse.gov/contact/submit-questions-and-comments
I don't know what character limit they have on it though

 

[Jibby321]

This is interesting. What can one do at a state level? To get things rolling?

 

[BeLikeBueller]

This is interesting. What can one do at a state level? To get things rolling?

Pay the nursing associations to lobby for us. They get stuff done.

 

[radio frequency]

This is interesting. What can one do at a state level? To get things rolling?

Work to change the practice act in your own state? That's a least a start...

 

[Jibby321]

Work to change the practice act in your own state? That's a least a start...

That's what I mean. But how? Contact senators?

 

[RomanPax]

Work to change the practice act in your own state? That's a least a start...

In my state and in many others the scope of practice laws are not what's holding pharmacists back, it's insurance reimbursement. We can already team up with independent prescribers through the collaborative practice model in many states. But medicare doesn't pay for our service and what medicare does every other insurance follows. The key to our future as a clinical profession is the recognition that we can provide clinical services by the largest insurance carrier in the healthcare system. It's important to advocate for increased scope of practice at the state level, but the biggest change will happen when we get medicare recognition. Provider status can only happen with an amendment to the Social Security Act. I know ASHP and other pharmacy groups are working at the congressional level. Last time they got a bill drafted it never made it out of committee. This time it's critical. What can we do? Writing/calling your senator is a start. Apart from that I don't know. Perhaps somebody on this forum has other ideas?

 

[deleted437652]

That's what I mean. But how? Contact senators?

Contact your state organization and see what they are doing. You can also call or contact your state representatives, but it might be good to first have a good idea about what your state org is doing and working on.

 

[Silent Cool]

Pay the nursing associations to lobby for us. They get stuff done.

Yeah seriously. They know how to work it.