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 www.googleimages.com

Significant costs to healthcare system for chronic conditions and complications

Public Health Need: Access to Primary Health Care

# Medicare beneficiaries # patients w/ 1+ chronic conditions Newly covered patients via ACA www.googleimages.com

Projected physician shortage

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 access to care that improves: www.googleimages.com

1965

Provider Status History

Nurse Practitioner and physician assistants gain provider status 2003    Affordable Care Act Expands coverage Establishes:  ACOs  PCMH  Pay for performance w/ quality & outcomes for hospitals

GOAL

    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 Perform MTM Administer Immunizations Transitions of Care Access within state scope of practice

ASHP Ambulatory Care Summit

Visioning the future of ambulatory care practice 1. Defining and Advancing Ambulatory Pharmacy Practice 2. Patient Care Delivery and Integration 3. Sustainable Business Models 4. Outcomes and Evaluation

www.ajhp.org/content/current

Current Provider Status

• • • • • • Physicians Nurse practitioners Physician assistants Certified nurse midwives  Psychologists  Clinical social workers    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

Patient Access to Pharmacists’ Care Coalition (PAPCC)

• More than

20

organizations • Representing patients, pharmacists, pharmacies, other stakeholders • To expand

medically underserved patients’

access to pharmacist services • Consistent w/

state scope of practice

PAPCC Members

ASHP APhA AACP ASCP NCPA NASPA Walgreens IACP Albertson’s Amerisource Bergen Bi-Lo Pharmacy Cardinal Health CVS Caremark Food Marketing Institute Fred’s Pharmacy Fruth Pharmacy Rite Aid Safeway Inc.

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 (CA Advanced 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

Ask legislators to cosponsor the bill www.googleimages.com

YOU can support Federal Legislation

Petitions

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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