Policy journal cites barriers to pharmacists’ role on primary care teams


he federal government’s failure to classify pharmacists as direct providers of health services prevents the profession from fully participating in emerging models of patient care, according to two commentaries in a recent theme issue of the policy journal Health Affairs. “Policymakers need to consider establishing provider status for pharmacists in Medicare Part B, as well as in some Medicaid programs and commercial health plans,” stated University of Connecticut School of Pharmacy Assistant Dean Marie Smith, lead author of one of the commentaries, in an e-mail. The November 2013 Marie Smith theme issue of Health Affairs promotes team-based primary care for the expected surge in patients seeking medical services as a result of health care reform efforts. Team-based care is presented as a way to better use the expertise of nonphysician health care providers, allowing them to fill patient care gaps that may result from an inadequate supply of primary care physicians. Smith and her coauthors call for pharmacists to be routine providers of patient care in accountable care organizations and other integrated care settings. According to the commentar y, medication-related inadequacies in primary care are well documented and costly, and pharmacists are well positioned to address these problems as part of patient care teams. But the commentary notes that few mechanisms exist to reimburse pharmacists for their services on such teams, in part because pharmacists are not recognized as direct providers of patient care under Medicare. The second commentary, written by American Association of Colleges of Pharmacy Chief Executive Officer Lucinda Maine and others, promotes provider status for pharmacists and calls for the


alignment of federal and state policies defining the roles and responsibilities of pharmacists and pharmacy technicians. Impediments to optimal patient care that are described in the commentary include inconsistent scope-of-practice laws in the states, the lack of a mechanism to reimburse pharmacists for their clinical services, and the lack of national standards for pharmacy technician training. “Pharmacists’ scope of practice as defined by state boards of pharmacy may be limiting and outdated,” said Douglas Scheckelhoff, ASHP’s vice president for professional development and a coauthor of the commentary. Scheckelhoff also noted that traditional Douglas Scheckelhoff payment and reimbursement mechanisms are “heavily weighted towards dispensing of a drug product with limited payment for other pharmacist patient care services,” especially for ambulatory care. He said this creates barriers to pharmacists’ participation in high-quality care that is patient centered, improves population health, and reduces overall health care costs—the so-called triple aim of health care. Scheckelhoff said individual states have made progress toward modernizing policies related to collaborative drug therapy management, immunization, and provider status recognition. A state law that went into effect in California on January 1, 2014, declares pharmacists as health care providers and creates the designation “advanced practice pharmacist.” The law does not address payment for pharmacists’ services. Similar pharmacy practice laws are also in place in New Mexico, Montana, and North Carolina. Scheckelhoff said ASHP and many other stakeholder groups are advocating for provider status recognition at the

Am J Health-Syst Pharm—Vol 71 Jan 1, 2014

federal level and hope to achieve this “in the near future.” Smith noted that provider status is a requirement for reimbursement for health care providers’ services under some payment models, such as shared savings programs, that have arisen through health care reform initiatives. She encouraged individual pharmacists to participate in efforts to include the profession in team-based models of ambulatory care. Managers, she said, can promote this by developing business plans, clinicians can actively participate in initiatives related to medication safety and quality measures, and informaticists can help to document and report on the value of pharmacists’ services. Smith also said that pharmacy education can support team-based care by placing faculty, preceptors, and students in experiential sites in accountable care organizations, medical homes, and integrated community-based care teams. Both Smith and Scheckelhoff said discussions about how pharmacists improve patient care need to include people outside of the profession. “It’s really important to talk to nonpharmacists and inform them about our contribution and value in emerging health care models,” Smith said. She noted that Health Affairs reaches “a very broad audience that includes policymakers, payers, providers, other health care professionals, and the public.” The theme issue of Health Affairs was supported by the Robert Wood Johnson Foundation, Josiah Macy Jr. Foundation, Association of American Medical Colleges, American Association of Colleges of Nursing, American Association of Colleges of Osteopathic Medicine, American Association of Nurse Anesthetists, American Nurses Association, American Nurse Credentialing Center, American Organization of Nurse Executives, American Osteopathic Association, and American Association of Colleges of Pharmacy. —Kate Traynor DOI 10.2146/news140003

Policy journal cites barriers to pharmacists' role on primary care teams.

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