All of my pharmacy friends should be familiar with the term “provider status.” It’s a phrase that gets tossed around in all areas of pharmacy practice – but what does it really mean?
If you’re not a pharmacist or student pharmacist, I have a question for you. Would you consider your pharmacist a healthcare provider?
Believe it or not, according to the Social Security Act, pharmacists are not considered healthcare providers under Medicare. What does that mean? That means that pharmacists who provide the same services as other healthcare providers are ineligible for payment for these services. This also means Medicare doesn’t cover certain services when they’re provided by a pharmacist. This could mean that beneficiaries may have to travel hours or perhaps even across state lines to see a practitioner that can provide the services they need.
What provider status is:
- Provider status has been introduced in both the House of Representatives (H.R. 592) and the Senate (S. 314) as the Pharmacy and Medically Underserved Areas Enhancement Act.
- It is a bipartisan bill to increase patient access to pharmacists’ care, especially in medically underserved communities (Do you live or work in a medically underserved community or healthcare provider shortage area? Click here to find out.)
- The fact that both of these bills have been introduced in both chambers of Congress is a great testament to the growing momentum behind the provider status movement. Last year, a bill was introduced in only the House of Representatives (H.R. 4190). After much work by pharmacists and student pharmacists across the country, there were 123 bipartisan cosponsors of the bill as of the end of 2014.
- Provider status will help fix the problem of medication non-adherence — in total healthcare costs, that’s a $290 billion (with a B) problem — by increasing access to pharmacists, who are the medication experts.
- With more and more Americans gaining healthcare coverage under the Patient Protection and Affordable Care Act (“Obamacare”), there is an increased need for accessibility to care. The Association of American Medical Colleges projects that, by 2020, there will be more than 91,000 fewer doctors than needed to meet demand, and the impact will be most severe on underserved populations. Nearly 90% of Americans live within five miles of a community retail pharmacy, making pharmacists one of the most accessible healthcare team members.
- The goal of provider status is to increase access to care by utilizing pharmacists as an integral part of the healthcare team to optimize medication regimens and improve patient health outcomes.
What provider status is NOT:
- Pharmacists do not seek to expand their scope of practice. Pharmacists will not be able to prescribe, they will not be able to diagnose, and they do not wish to “intrude” on physicians’ (or other providers’) respective scopes of practice. Pharmacists’ scope of practice will still be dictated by state law, not federal law.
- Provider status will not mean that pharmacists get paid more than other providers for providing the same services.
- You will not have to pay your pharmacist to get the same personalized care you’ve come to expect.
If you’re a pharmacist or student pharmacist, I urge you to become involved and advocate for the future of our profession. Talk to your family, your friends, your colleagues, and your congressmen. Not sure what to say? Here are the basics:
- Pharmacists have more medication education and training than any other health care professional.
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When pharmacists are included on patients’ health care teams, the quality of care increases and outcomes improve.
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Physicians, nurses, dieticians, chiropractors, and midwives are all recognized as health care providers.
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PHARMACISTS ARE NOT CURRENTLY RECOGNIZED AS HEALTH CARE PROVIDERS! YOU can change that!
If you’re not a pharmacist or student pharmacist, and have read this far: THANK YOU! The word is getting out. If you want to help, call your representatives in Washington and urge them to support S. 314 or H.R. 592. Tell them a story of how a pharmacist helped you. Explain to them what provider status really means. I’m always available to talk if you’d like more information, or if you have any questions.
We were able to convince 123 Republicans AND Democrats in Washington last year that provider status was worth it. Let’s make this continue to grow this year! Our advocacy efforts paid off, but the job isn’t done yet. Pharmacy has come a long way thanks to the men and women who came before us. We would be doing them an enormous disservice if we didn’t continue to advance our profession.
Thank you for reading.
H/T to the American Pharmacists Association, the Patient Access to Pharmacists’ Care Coalition, and the National Association of Chain Drug Stores for some of the statistics presented in this post.
Eric Barbye 