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

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

Washington D.C. ¤ 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

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 20 th -26 th , 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