12/19/2015 1 Provider Status…What’s in it for Me? Mohammed M. Abdulwahhab, Pharm.D. PGY-1 Pharmacy Resident Broward Health Medical Center Disclosure Mohammed Serves on the American Society of Health-System Pharmacists, Counsel on Pharmacy Management as a new practitioner Objectives Explain the concept of Provider Status and its impact on pharmacy practice in Florida Discuss why pharmacists should get involved in the legislative process Detail upcoming state and federal legislative efforts
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Provider Status…What’s in it for Me? - DCPA12/19/2015 1 Provider Status…What’s in it for Me? Mohammed M. Abdulwahhab, Pharm.D. PGY-1 Pharmacy Resident Broward Health Medical
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12/19/2015
1
Provider Status…What’s in it
for Me?
Mohammed M. Abdulwahhab, Pharm.D.
PGY-1 Pharmacy Resident
Broward Health Medical Center
Disclosure
Mohammed Serves on the American Society of Health-System Pharmacists, Counsel on Pharmacy Management as a new practitioner
Objectives
� Explain the concept of Provider Status and its impact on pharmacy practice in Florida
� Discuss why pharmacists should get involved in the legislative process
� Detail upcoming state and federal legislative efforts
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Provider Status Definition
� Adding pharmacists to section 1842 and 1861 of the Social Security Act (SSA)
� Allow pharmacists to participate in Medicare Part B program and bill Medicare for pharmacy services
Within the state scope of practice
Medicare
� Part A (Hospital)
� Hospital visits, skilled nursing facilities, home health, and hospice care
� Part B (Medical Insurance)
� Physicians visits, preventative care, durable medical equipment, hospital outpatient services, lab tests, some home health, and ambulance care
� No impact analysis form the Congressional Budget Office (CBO)
Health Care Providers
Under SSA, the following are considered Providers:
� Physicians
� Nurse practitioners
� Physician assistants
� Psychologists
� Social workers
� Speech language pathologists
� Audiologists
� Registered dietitians
Associations, A. P. (2013, Sep 13). Provider Status. Retrieved from APhA: https://www.pharmacist.com/sites/default/files/files/Provider%20Status%20FactSheet_Final.pdf
Possibilities
�California
� All Pharmacists
� Furnishing hormonal contraception, smoking cessation drug therapy, and medications that don’t require diagnosis for international travelers
� Order and interpret lab tests to manage efficacy and toxicity of drugs
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Possibilities
� Advance Practice Pharmacist
� Perform patient assessment
� Refer to other providers
� Engage in collaborative practices
� Credentialing (two of the following)
� Certification in the area of practice
� Completion of a residency program
� 1 year experience with Collaborative Practice Agreements
Possibilities
� North Carolina
� Must meet certain credentialing criteria
� Adjust pharmacotherapy
� Order lab tests
� The agreement must be specific to a patient and a diagnosis
� Washington State
� Insurance companies must include pharmacists for reimbursement
History
� Surgeon General Report in 2011
� For every dollar spent in Clinical Pharmacy Services (CPS) the average benefit was $10.7 with ROI averaging 1:5
Giberson S, Yoder S, Lee MP. Improving Patient and Health System Outcomes through Advanced
Pharmacy Practice. A Report to the U.S. Surgeon General. Office of the Chief Pharmacist. U.S. Public
Health Service. Dec 2011
ROI= Return on Investment
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History
� Dr. Regina Benjamin issued a signed letter of support for pharmacists to receive recognition and adequate compensation
History
� Jan 2013, APhA committed 1.5 million dollars to:
� Establish a coalition to draft legislative language
� Create a legislative advocacy plan
� Create communication and plan tools
� Initiate a non-bias report on pharmacists’ value in patient care
� Secure Score on Cost of this effort
APhA= American Pharmacists Association
History
� Numerous studies have shown the value of pharmacists in health care
� Limitation?
� Avalere Independent Contractor Report
� $350 savings per medication reconciliation conducted by a pharmacist
� Pharmacist medication management ROI 1.67
� Pharmacists on an anticoagulation team provide care based savings of $3,697 per patient Avelere. (2014). Exploring Pharmacists’ Role in a changing Healthcare Environment. 1-23.
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History
� Patient Access to Pharmacists’ Care Coalition (PAPCC) was formed in Jan 2014
� A group of over 30 organizations representing patients and pharmacists
� ACCP advocates for special training and education to qualify as a provider
ACCP= American College of Clinical Pharmacy https://www.accp.com/images/logos/paclogo.jpg
History
� ACCP Position
� A Pharm.D. degree (or B.S. in Pharmacy with evidence of equivalent pharmacotherapeutic knowledge and clinical experience) from an ACPE-accredited degree program of a US college or school of pharmacy
� A valid CDTM agreement with a physician or a physician group, and/or clinical privileges formally granted to the clinical pharmacist
� Evidence of completion of an accredited post-graduate residency program or an equivalent level of experience in the provision of direct patient care
� Board certification or eligibility for certification
Pharmacy, A. C. (2012). ACCP Launches New Initiative to Seek Provider Status for Clinical Pharmacists Working in All Practice Settings. Retrieved from ACCP: http://www.accp.com/announcements/providerstatus.aspx
Doesn’t This Sound Reasonable?CDTM= Collaborative Drug Therapy Management
� Pharmacy and Medically Underserved Areas Enhancement Act
� Rep. Guthrie (R-KY), Rep. Butterfield (D-NC), Rep. Young (R-IN), and Rep. Kind (D-WI)
� Sen. Grassley (R-IA), Sen. Brown (D-OH), Sen. Casey (D-PA), and Sen. Kik (R-IL)
Current State
� Why only Medically Underserved?
� Most affected portion by the primary care provider shortage
� Lessons from other professions
� Limits opposition
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Medically Undeserved Areas in the United States
Current State
� Why only targeting Medicare?
� Private insurances usually follow Medicare
� There are no stipulations stating that private insurances can’t pay pharmacists for cognitive services
� Prove the value, and then expand
Current State
� As of 12/17/2015
� 259 Representatives co-sponsored the bill
� Florida has 16 co-sponsors out of a possible 27
� 39 senators have co-sponsored the bill
� Florida has 0 co-sponsors
� The American Medical Association (AMA) has not objected to the bill content
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Assessment Question
� True/False
Pharmacy Provider Status will impact pharmacy services in an inpatient, ambulatory, and community setting
Impact
� Decreases medication related problems
� Improves patient access
� Decreases healthcare costs
� Able to bill for services that are currently complimentary
� Allows for sustainable business model
� Allows pharmacists to practice at the top of their license
Assessment Question
� True/False:
If implemented all pharmacists will be allowed to bill Medicare Part B for services provided to all patients that can benefit from pharmacy services
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Legislative Efforts
Federal
� Provider Status
� USP 800
� Drug Supply Chain and Security Act
� Pain medication access and diversion
� 340B
State
� Last year
� Expansion of pharmacy immunizations
� Minimum Allowable Cost (MAC) pricing
Pharmacists added to laboratory bill !!!
Upcoming Legislative Efforts in Florida
� Not filed yet
� Increase maintenance refill medication authority to 30 day supply without prescriber authorization
� Senate bill 780 and House bill 583
� Does not allow patient’s health insurance policy to limit certain chronic medications to mail order only
Upcoming Legislative Efforts in Florida
� SB 692 and HB 547 Patient Access to Pharmacist Care
� Allow for consultant pharmacists (CPh) to perform
� Patient health and wellness assessments
� Patient counseling
� Referrals related to medication and health care services
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Upcoming Legislative Efforts in Florida
� SB 692/ HB 547
� Allow CPh to order diagnostic tests
� Extend lab orders to a Pharm.D. with training
� Initiate, modify, discontinue, and administer drugs within the framework of a drug management therapy order or protocol with one or more health care providers
Upcoming Legislative Efforts in Florida
�SB 692/ HB 547
� The bill provides that a health insurer or health benefit plan may pay or reimbursefor a pharmacist’s patient care services separate and apart from the payment for prescription medications, if the services provided are within the pharmacist’s lawful scope of practice
Assessment Question
� True/ False:
Federal Pharmacy Provider Status will allow for an expansion of pharmacy scope of practice
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Pharmacists Pay for Services
Information provided by National Alliance of State Pharmacy Associations
� Federal Provider Status is the framework for state efforts
� Opportunity for business expansion
� It’s a recognition that is long overdue
� Be involved in the political process
� Donate to your PAC
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Pharmacist Role on Health Care Team
References
� California Pharmacists Association. Get Involved: Pharmacist Provider Status. Available at: http://www.cpha.com/Advocacy/Pharmacist-Provider-Status.
� American Pharmacists Association. State Advocacy Fact Sheet. Available at: http://www.pharmacist.com/pharmacists-patient-care-services-state-advocacy-fact-sheets. Accessibility verified June 12, 2014
� American Pharmacists Association. Provider Status: What Pharmacists Need to Know. September 2013. Available at: http://www.pharmacist.com/provider-status-what-pharmacists-need-
know-now.
� American Society of Health-System Pharmacists. Issue Summaries: Recognition of Pharmacists as Non-Physician Providers. Available at: http://www.ashp.org/menu/Advocacy/StateAdvocacy/Provider-Status.
� Florida Pharmacy Association. Legislative Action Center. Available at http://www.capwiz.com/pharmview/issues/bills/?state=FL
Provider Status…What’s in it for Me?
Mohammed M. Abdulwahhab, Pharm.D.
PGY-1 Pharmacy Resident
Broward Health Medical Center
Questions? “It Is Safer to Search in the Maze Than Remain in The cheeseless Situation” Spencer Johnson