With baseball season back in full swing, and fans across the nation focused on their favorite teams and players, a compelling question to consider might be: What if your team took the field, but decided to leave its first baseman, or shortstop on the bench? Chaotic, reckless and ridiculous are outcomes that likely come to mind.
Now let’s use that comparison with regard to patient health care teams. What happens if a key member of the team gets left on the bench?
Well in the current landscape, that is precisely what is happening in communities across the United States. This is because pharmacists are not included among Medicare Part B providers, and as a result, are ineligible for reimbursement for many services routinely provided.
As a result, pharmacists are denied compensation for critical services provided to patients – services that would be reimbursed if performed by a nurse practitioner, or other “approved” provider. This is an outdated, glaring omission that does a disservice to pharmacists, and to the patients they serve.
Under Medicare Part B, coverage is provided for patients who receive preventive and screening services including flu shots, tobacco cessation counseling, obesity counseling and general “wellness” counseling. However, if these services are provided by a pharmacist, they are not eligible for reimbursement. This seems to ignore both the high regard most patients have for their local pharmacist and the reality of what is taking place in today’s pharmacies.
Achieving their rightful spot on the health provider team has been a top priority for pharmacist-based organizations for several years. The American Pharmacists Association (APhA), National Community Pharmacists Association (NCPA), and the American College of Clinical Pharmacists (ACCP) are among the leaders in advocating for a solution to this inconsistency.
So far though, these efforts have been unsuccessful. Legislation was introduced in the U.S. Congress in 2017 by Representative Brett Guthrie (R-KY) and Senator Chuck Grassley (R-IA) that would have amended Title XVIII (Medicare) of the Social Security Act “to provide Medicare coverage and payment with respect to certain pharmacist services that: (1) are furnished by a pharmacist in a health professional shortage area, and (2) would otherwise be covered under Medicare if furnished by a physician.” To date, comparable legislation has yet to be introduced in the 116th Congress, which convened in January 2019.
Meanwhile, efforts are also underway at the regulatory level, to change the language in existing Medicare guidelines to include pharmacists as authorized providers. In a September 2018 letter to Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma, APhA head Thomas Menigham wrote:
“There are over 300,000 pharmacists in the U.S., many of whom are underutilized in their capacity to contribute to addressing unmet health care needs. Pharmacists receive doctoral-level education and training, with some pharmacists furthering their training to become specialists with board certification… As vital members of patient care teams, APhA strongly believes better integration of pharmacists into Medicare is necessary as CMS continues to transition toward value-based payments.”
While that attempt to force a regulatory change was also unsuccessful, many are encouraged that the discussion has been elevated, and is receiving a fair amount of attention.
“Look for accelerated activity on these fronts in 2019 and beyond as the cultural and economic necessity of payment transformation for pharmacists begins to come to a head,” Troy Trygstad, PharmD, Ph.D., MBA and editor-in-chief of Pharmacy Times recently editorialized.
Until then, U.S. patient care teams seem destined to continue taking the field without a key player. And let’s hope, that hole on the team won’t have any detrimental effects.