Transcript Document

Charting the Course for Provider Status with State Affiliate Champions
Seena L. Haines, PharmD, BCACP, FASHP, FAPhA
Nicholas J. Gentile, ASHP Director of State Grassroots Advocacy and
Political Action
ASHP Initiatives
History of Provider Status
Tools to Advance Federal & State
Advocacy Efforts
GOAL
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Seven Rights of Medications
Prevent Med Errors
Significant costs to healthcare system
for chronic conditions and complications
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Public Health Need: Access to Primary Health Care
# Medicare
beneficiaries
# patients w/ 1+
chronic conditions
Projected
physician shortage
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Newly covered
patients via ACA
Opportunities and Impact
Patients and Providers
Trusted Health Professional
Payment Climate Changes
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Fee for Service  Pay for Performance
Provider Status Is:
Giving
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access to care that improves:
Provider Status History
Nurse Practitioner and
physician assistants
gain provider status
1965
2003
 Affordable Care Act
 Expands coverage
 Establishes:
 ACOs
 PCMH
 Pay for
performance
w/ quality &
outcomes for
hospitals
GOAL
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
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
Medicare enacted
No Rx drug benefit
Part A: Hospital
Part B: Physician
Outpatient services*
1977-1997
 Medicare
Modernization Act
 Part D Rx drug
coverage and MTM
services
2010
* Pharmacists not recognized as non-physician practitioners
Public Policy Solution: Provider Status
Health and
Wellness
Testing
Manage
Chronic
Diseases
Administer
Immunizations
Access within state scope of practice
Perform MTM
Transitions of
Care
ASHP Ambulatory Care Summit
Visioning the future of ambulatory care practice
1.
2.
3.
4.
Defining and Advancing Ambulatory Pharmacy Practice
Patient Care Delivery and Integration
Sustainable Business Models
Outcomes and Evaluation
www.ajhp.org/content/current
Current Provider Status
•
•
•
•
Physicians
Nurse practitioners
Physician assistants

Certified nurse
midwives

• Psychologists
• Clinical social workers
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Certified nurse
anesthetists
Speech-language
pathologists
Audiologists
Registered dietitians
Physical therapists
Defining Provider Status
Listed in section 1842 or 1861 of SSA as supplier
of medical and other health services
• Pharmacists can participate in Part B of
Medicare program and bill Medicare for
services within their STATE SCOPE OF
PRACTICE
• SSA determines eligibility for new payment
systems, which emphasize quality and
outcomes (ACOs, PCMH)
Pharmacists are not recognized under SSA as health care providers
House Provider Status Bill
Bipartisan bill to amend SSA to recognize pharmacists as
Medicare Part B providers in medically underserved
communities
– Introduced by Representatives Guthrie (R-KY), Butterfield (D-NC)
and Young (R-IN) in the House of Representatives on March 11,
2014
– Garnered 123 bipartisan cosponsors include two physicians: Reps.
Roe (R-TN) and Bera (D-CA)
– Applies to licensed pharmacists working within their state’s scope
of practice laws
– Establishes a mechanism of pay for pharmacist provider services
under Medicare
House Provider Status Bill
• Amends section 1861(s)(2) of SSA to include:
– Pharmacists services licensed by state law and is legally
authorized to perform in the state
• In settings located in/for and defined in federal law:
– Medically underserved area
– Medically underserved population
– Health professional shortage areas
Increase Access, Improve Quality, Decrease Costs
Similar path taken by other HCP to gain provider status
HCP= Health care professional SSA= Social Security Act
Senate Companion Bill
• Bipartisan Senate Working Group
– Grassley (R-IA), Kirk (R-IL), and Wicker (R-MS)
– Brown (D-OH), Cardin (D-MD) and Casey (D-PA)
• Originally far apart from House Provider
Status Bill.
– Senate wanted a Demo Program
• Companion Bill expected from the Senate in
the coming weeks.
Why Medically Underserved
Fulfills Unmet Need
Gives Pharmacists A
Nurse Practitioners
Physician Assistants
Limits Opposition and Cost of Legislation
Medically Underserved Communities

Medically
Underserved Areas

Medically
Underserved
Populations

Health Professional
Shortage Areas
18
• To expand
medicallyunderserved
patients’
access to
pharmacist
services
Access to Pharmacists
• More than 20
organizations
• Representing
patients,
pharmacists,
pharmacies,
other
stakeholders
Drafted H.R. 4190
Formed January 2014
Patient Access to Pharmacists’ Care Coalition (PAPCC)
• Consistent
w/ state
scope of
practice
PAPCC Members
ASHP
APhA
AACP
ASCP
NCPA
NASPA
Fred’s Pharmacy
Walgreens
IACP
Albertson’s
Amerisource Bergen
Bi-Lo Pharmacy
Fruth Pharmacy
Cardinal Health
Rite Aid
CVS Caremark
Safeway Inc.
Food Marketing
Institute
SuperValu Pharmacies
Thrifty White Pharmacy
Winn-Dixie
Fee For Service Ending
• Will be phased out  new payment systems
• Emphasis on quality, outcomes, team-based care
• We view ourselves as members of interprofessional
teams throughout the continuum of care
• SSA remains the reference point for which practitioners
are eligible to participate in current and NEW emerging
delivery systems and payment models (ACO)
Credentialing Requirements
Provider Status bill requires pharmacists to be
licensed by state, and the state legislature and
board of pharmacy, health care organizations,
and private health plans determine the
credentials required to perform services (CAAdvanced Practice Pharmacist)
Health systems and hospitals have a process to
credential and privilege pharmacists based on
level of patient care services provided.
ASHP Credentialing Perspective
• ASHP supports board certification and
residency training
• Does not belong in federal law
• For states and organizations to decide through
state pharmacy practice acts, private health
plans requirements, and health
system/hospital credentialing and privileging
Pharmacist Provider Designation
No need to create a new category of pharmacist in
federal law.
A suggested new pharmacist category—”Qualified
Clinical Pharmacist”—be codified in federal law and
therefore distinguished from all other pharmacists.
(example in California)
States and health care organizations may do such
things, but it is inadvisable to do so at the federal level.
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Professional Citizenship:
Reengineer Practice to Achieve Change
Create a
Coalition
Lobbying
Campaign
Rally
Support
Advocacy effort levels: patient, practice, profession and extraprofessional
Patients  Legislators  Payors  Society
State Affiliate and Individual Advocacy Action
House Bill
Seek Co-sponsorship
Seek senate
companion bill to
House Bill
Support and supplement
ASHP Grassroots Calls to Action
Profile member advocacy in newsletters
Attend campaign fundraiser and events
GOAL
In state/ in-district
elected officials and
staff meetings, health
fair demonstrations
Coordinate health
system/ hospital facility
tours
Focus on your state’s members who sit on Energy and Commerce
Committee and Ways and Means Committee in U.S. House of Representatives
State Scope of Practice
• At federal level, allows pharmacist to
participate in Medicare program and bill for
services within state scope of practice
• Provision of service determined at State level
• As provider status at federal level is achieved
 efforts needed to ensure a robust scope of
practice
Passionate Activism
Join
Talk
Write
YOU can support Federal
Legislation
Ask legislators to cosponsor
the bill
Petitions
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http://www.ashp.org/menu/Advocacy
“Never doubt that a small group
of thoughtful, committed citizens
can change the world. Indeed it
is the only thing that ever has.”
-Margaret Mead
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