Provider Status and the Future of Pharmacy: An Update on Current - - PowerPoint PPT Presentation

Provider Status and the Future of Pharmacy:

An Update on Current Events

Andrea Winterswyk June 2014

Provider Status

¤ Pharmacists and pharmacists’ care services are not included in key sections of the Social Security Act

¤ SSA determines eligibility for health care programs (Medicare Part B, etc.) ¤ Other health care providers listed in this section are: ¤ Physicians, physician assistants, certified nurse practitioners, qualified psychologists, clinical social workers, certified nurse midwives, and certified registered nurse anesthetists

¤ State and private health plans cite this omission as a reason for:

¤ Lack of coverage for beneficiaries ¤ Lack of compensation of pharmacists for providing comprehensive, patient-centered care

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. Accessibility verified June 12, 2014.

Provider Status

¤ Attaining provider status is essential

¤ Coverage for pharmacists’ patient care services ¤ Recognition for pharmacists for their critical role in providing patient care in collaboration with a health care team

¤ Without provider status

¤ Pharmacists are at risk of their services being excluded in future Affordable Care Act (ACA) promoted integrated care delivery models (i.e. medical home and accountable care organizations) ¤ Lack of provider status limits Medicare beficiaries’ access to pharmacists’ services to the outpatient setting only

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. Accessibility verified June 12, 2014.

Implementing the Change

¤ National/Federal Pathway

¤ Amending the SSA related to Medicare programs (e.g. Part B, Part D, ACOs) ¤ Working with CMS to amend regulations to include specific language referencing pharmacists and pharmacist inclusion in integrated team- based models

¤ State Pathway

¤ Seek changes in Medicaid programs and opportunities with the Health Insurance Exchanges formed by the ACA

¤ Private Pathway

¤ Opportunities with ACOs, medical homes, commercial health plans and private or self-insured employers

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. Accessibility verified June 12, 2014.

Focus of Initiatives

¤ Ensure… payers and policy makers recognize pharmacists as health care providers who improve access, quality and value

• f health care

¤ Ensure… access and coverage for pharmacists’ patient care services are facilitated through Medicare/Medicaid, other federal and state health benefit programs, integrated care models, and private payers ¤ Ensure… pharmacists are included as members of health care teams

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. Accessibility verified June 12, 2014.

Pharmacy Collaboration: JCPP

¤ The Joint Commission of Pharmacy Practitioners (JCPP)

¤ Formed in December 2012 ¤ Collaborating on a set of priciples to guide the provider status campaign at the federal level ¤ Coalition of 14 organizations ¤ “Principles for Improving Patient Health: The Pharmacist’s Role”

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. Accessibility verified June 12, 2014.

AACP ACCP AMCP APhA ASCP ASHP CPNP FMI IACP NACDS NASPA NCPA Rite Aid Corporation Walgreens

Pharmacy Collaboration: PAPCC

¤ Patient Access to Pharmacists’ Care Coalition (PAPCC)

¤ Formed in March 2014, many JCPP members ¤ PAPCC now to lead the campaign for provider status ¤ Pharmacists, patients, pharmacies and other interested stakeholders

¤ Coalition drafted legislation for current bill in Congress: H.R. 4190

¤ More than 20 members

American Society of Health-System Pharmacists. H.R. 4190 FAQs. Available at: http://www.ashp.org/menu/Advocacy/FederalIssues/ProviderStatus. Accessibility verified June 12, 2014.

Albertson’s AACP APhA ASCP ASHP AmerisourceBergin Bi-Lo Pharmacy Cardinal Health CVS Caremark FMI Fred’s Pharmacy Fruth Pharmacy IACP NACDS NASPA NCPA Rite Aid Safeway Inc. SuperValu Pharmacies Thrifty White Pharmacy Walgreens Winn-Dixie

H.R. 4190

¤ Bipartisan legislation that will amend the Social Security Act to recognize pharmacists as providers under Medicare Part B ¤ Bill was introduced by

¤ Reps. Brett Guthrie (KY), G.K. Butterfield (NC), and Todd Young (IN)

¤ Legislation:

¤ Recognize licensed pharmacists to deliver care for patients in federally defined medically underserved communities ¤ Establishes a mechanisms to pay for pharmacist provider services as a percentage of the current physician fee schedule ¤ Or pursuant to pharmacist-specific codes as part of schedule ¤ Formula is consistent with Medicare reimbursement for other non- physician practitioners ¤ Bill does NOT expand pharmacists’ scope of practice

American Society of Health-System Pharmacists. H.R. 4190 FAQs. Available at: http://www.ashp.org/menu/Advocacy/FederalIssues/ProviderStatus. Accessibility verified June 12, 2014.

Barriers to Achieving Provider Status

¤ Congress is focused decreasing health care costs

¤ Members of congress often equate provider status with “fee-for- service” payment model ¤ Legislators may be reluctant to engage in “old” payment reform as new delivery and payment models develop ¤ There must be sufficient evidence that pharmacists and pharmacist- provided services are valuable to the system financially

¤ Other health care providers with provider status have strength politically, financially and in numbers

¤ Already billing Medicare on a fee-for-service basis ¤ May strongly oppose the pharmacist provider status initiative

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. Accessibility verified June 12, 2014.

Progressive States

¤ Examples of states that have passed legislation for expanded pharmacy services:

¤ Montana ¤ North Carolina ¤ New Mexico ¤ Wisconsin ¤ Hawaii ¤ Iowa

American Society of Health-System Pharmacists. Daigle, L. ASHP Policy Analysis: Pharmacist Provider Status in 11 State Health Programs. September 2008. Available at: http://www.ashp.org/menu/Advocacy/StateAdvocacy/Provider-Status. Accessibility verified June 12, 2014.

The Argument for Idaho

¤ Idaho ranks LAST in the nation for primary care providers per capita

¤ There is a great need for increased access to quality health care, which pharmacists can provide

¤ Achieving provider status is the last step to initiate models for payment in Idaho

¤ Payment for service models are not supported unless classified as provider

¤ Our laws are already in place to support an expanded role for pharmacists

¤ Pharmacists are recognized and able to provide services ¤ Collaborative practice agreement authority is fully maximized ¤ Pharmacists have prescriptive authority for immunizations

Working Towards the Goal: Student Advocacy Accomplishments

¤ Meetings in Washington D.C. with Senator Crapo and Representative Simpson ¤ Coffee Sleeve Advocacy Project and Postcard Initiative ¤ Meeting with Governor Butch Otter ¤ Pharmacy Day @ the Capitol ¤ Presentation to the House Health & Welfare Committee

¤ Meetings were set up by students

¤ APhA-ASP Summer Leadership Institute- July 2013 ¤ Students: Shelby Lancaster (‘16), Ben Morris (‘16), Lindsey Hunt (’15) ¤ Crapo Staff ¤ Simpson Staff

¤ APhA lobbyists prepared students to speak with legislators ¤ Focus:

¤ Pharmacists increase access to health care ¤ Pharmacists decrease costs to the health care system ¤ Pharmacists improve outcomes for patients

Washington D.C.

Postcard Initiative

Support: ISPA provides postage Target: Legislators (Idaho/Washington D.C.)

Coffee Sleeve Advocacy Project

¤ Support: ISU-COP Dean’s Excellence Fund, ISPA, ISHP ¤ Target: General public & health care providers ¤ 10,000 coffee sleeves were distributed to coffee shops throughout the state ¤ October 20th-26th, 2014

¤ American Pharmacists Month & National Hospital and Health System Pharmacy Week

Meeting with Governor Butch Otter and Staff

¤ Presented on:

¤ Student Pharmacists Community Outreach ¤ Pharmacist Training ¤ The Role of the Pharmacist in providing quality care to Idahoans

¤ Governor/Staffer Recommendations:

¤ Get pharmacists involved in the Idaho Medical Home Collaborative ¤ Work with the Idaho Medical Association

¤ Attended:

¤ Lindsey Hunt (’15) ¤ Ben Morris (’16) ¤ James Upson (’16) ¤ Meagan Rupert (’17) ¤ Lauren Whiteford (’14) ¤ Glenda Carr, PharmD

¤ Date: January 20, 2014 (MLK Jr. Day) 10:00-2:00 ¤ Support: ISPA, Ladd’s Family Pharmacy, Rite Aid ¤ Students collaborated with various pharmacists:

¤ Kevin Cleveland PharmD, Rex Lott PharmD ¤ Pharmacy residents from Boise VA, St. Luke’s, St. Alphonsus, & Mountain States Tumor Institute

¤ Student Organizers:

¤ Lindsey Hunt (‘15), Policy Vice President ¤ Andrea Winterswyk (‘15), ISPA Student Representative ¤ James Upson (’16)

Poster Presentations

Posters about different areas

• f pharmacy:

¤ Ambulatory Care ¤ Compounding ¤ Health-System Pharmacists ¤ Medication Therapy Management ¤ Oncology Pharmacists ¤ Psychiatric Pharmacists

10 20 30 40 50 60 70 80 P1 P2 P3 P4 Pharmacists

INVOLVEMENT

Hours

Idaho Health and Welfare Committee

¤ Support: ISPA arranged a presentation with both House & Senate Health and Welfare Committees ¤ Presenters:

¤ Cory Nelson (’14) ¤ Andrea Winterswyk (’15) ¤ Lindsey Hunt (’15)

Idaho Health and Welfare Committee

¤ Prezi Presentation included: ¤ ISU-COP Student Pharmacist Outreach efforts

¤ Operations (Immunization, Heart, Diabetes, GenRx) ¤ Fundraising efforts (Make-A-Wish/Camp HODIA) ¤ Awards (National/Regional)

¤ Pharmacist Training

¤ Doctor of Pharmacy ¤ Postgraduate Opportunities ¤ Credentialing Opportunities

¤ The Future of Pharmacy in Health Care

¤ Used local and national examples to highlight the ways pharmacists: ¤ Increase Access (Idaho 50th in nation for Primary Care Physicians) ¤ Decrease Costs (St. Luke’s Antimicrobial Stewardship Program) ¤ Improve Outcomes (St. Alphonsus implementation of ED pharmacist/ MSTI Medication Safety Finalist)

How Can You Get Involved?

¤ Be proactive! ¤ Participate in ISHP/ISPA activities ¤ Write a letter/send an email to your legislator ¤ Join Idaho Pharmacists on Martin Luther King Jr. Day 2015 for Pharmacy Day @ the Capitol

¤ Talk with your legislator in person

Education: The Legislator’s Role

¤ Implement pharmacist-provided MTM in state Medicaid and state employee benefit programs ¤ Expand pharmacist-integrated collaborative practice agreements and coordination of care with other health care providers ¤ Include pharmacists in statewide or regional health information technology initiatives ¤ Utilize pharmacists’ role as public health extenders

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

Legislators: Idaho Talking Points

¤ Pharmacists are the 2nd most highly trained health care professional, behind only physicians (based on years of formal education)

¤ Pharmacy education consists of a post graduate doctoral program ¤ Extensively covers direct patient care, disease prevention and management ¤ Requires clinical rotations in a variety of healthcare settings

California Pharmacists Association. Get Involved: Pharmacist Provider Status. Available at: http:// www.cpha.com/Advocacy/Pharmacist-Provider-Status. Accessibility verified June 12, 2014.

Legislators: Idaho Talking Points

¤ Pharmacists are highly trained and qualified to provide expanded services

¤ Over 76% of physician office visits are chronic care ¤ Conditions such as diabetes and hypertension require

• ngoing maintenance to ensure maximum efficacy

¤ Idaho ranks 50th in the nation for Primary Care Providers per Capita

¤ IDAHO PHARMACISTS as PROVIDERS are a viable solution to our

• verwhelmed health care system

California Pharmacists Association. Get Involved: Pharmacist Provider Status. Available at: http:// www.cpha.com/Advocacy/Pharmacist-Provider-Status. Accessibility verified June 12, 2014.

Legislators: Idaho Talking Points

¤ Pharmacists are the foremost experts in medications

¤ More than 80% of health conditions are treated with prescription medications ¤ Nearly $290 BILLION spent annually on mostly avoidable costs to treat adverse events from inappropriate medication use

¤ Remember… Pharmacists provide safe care that:

¤ Increases access to quality care ¤ Decreases cost for our health care system ¤ Improves patient outcomes

California Pharmacists Association. Get Involved: Pharmacist Provider Status. Available at: http:// www.cpha.com/Advocacy/Pharmacist-Provider-Status. Accessibility verified June 12, 2014.

References

¤ California Pharmacists Association. Get Involved: Pharmacist Provider Status. Available at: http://www.cpha.com/Advocacy/Pharmacist-Provider-Status. Accessibility verified June 12, 2014. ¤ 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. Accessibility verified June 12, 2014. ¤ Pharmacy Times. Weiss, D. The Push for Pharmacist Provider Status. 2013. Available at: http://www.pharmacytimes.com/news/The-Push-for-Provider-Status. Accessibility verified June 12, 2014. ¤ American Society of Health-System Pharmacists. Legislative Review: H.R. 4190. Available at: http://www.ashp.org/menu/Advocacy/FederalIssues/ProviderStatus. Accessibility verified June 12, 2014. ¤ American Society of Health-System Pharmacists. H.R. 4190 FAQs. Available at: http://www.ashp.org/menu/Advocacy/FederalIssues/ProviderStatus. Accessibility verified June 12, 2014. ¤ 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. Accessibility

verified June 12, 2014. ¤ American Society of Health-System Pharmacists. Daigle, L. Pharmacist Provider Status in 11 State Health

• Programs. 2008. Available at: http://www.ashp.org/menu/Advocacy/StateAdvocacy/Provider-Status.

Accessibility verified June 12, 2014.

Questions?

Andrea Winterswyk wintandr@pharmacy.isu.edu

Thank you to Lindsey Hunt for the creation of the Student Advocacy Slides