Pharmacist Providers Can Save System $4 for Every $1 Spent

An Expert Interview With Scott F. Giberson, RPh, PhC, MPH

Troy Brown

March 23, 2012

March 23, 2012 (New Orleans, Louisiana) — Editors note: Pharmacists could play a much greater role in reducing the burden of healthcare if they are fairly compensated for the level of services they're already providing, according to a new report — Improving Patient and Health System Outcomes Through Advanced Pharmacy Practice. A Report to the US Surgeon General, 2011 — which was discussed here at APhA 2012: American Pharmacists Association Annual Meeting and Exposition.

Rear Admiral Scott F. Giberson, RPh, PhC, MPH, US Assistant Surgeon General and chief professional officer of pharmacy at the US Public Health Service in Rockville, Maryland, discussed the report, which he coauthored, at the meeting. He spoke with Medscape Medical News about how legislating provider status for pharmacists would improve patient care and save money.

Medscape: How would granting provider status change the practice of pharmacists?

Dr. Giberson: First, it would recognize in legislation what already exists in practice — that pharmacists provide healthcare and patient care. Healthcare providers are essential members of the health team who can help improve clinical outcomes, increase access to quality care, and contain costs.

Recognition as healthcare providers helps affirm that this model of healthcare delivery has been tested and is successful. It also reduces legislative barriers as we explore additional compensation mechanisms, which we realize should only compensate for the level of service provided.

Medscape: How would this model change the way pharmacists are compensated for their services? How cost effective is it?

Dr. Giberson: This model would compensate pharmacists (as healthcare providers) based on the level of service they provide. Much like other health professionals, as the complexity of care increases, so too would the compensation. It may include both Medicaid Part D and Medicare Part B.

Currently, pharmacists receive compensation within Medicare Part D for services provided through Medication Therapy Management (MTM). However, this is limited by a number of restrictions, including the number of medications the patient takes and the number of chronic conditions.

In nearly 75% of the MTM programs, pharmacists are not allowed to provide these services until a patient is already on at least 7 medications and has at least 2 or 3 chronic conditions. Entering the healthcare equation at this point limits our capacity and is not preventive in nature.

Currently, MTM Part D does not cover the expanded level of clinical patient care delivered by pharmacists that is similar to the level of compensation of other healthcare providers that deliver similar care.

Our patient care is also not recognized under Medicare Part B. Not all pharmacists will be in the same practice environment, so levels of compensation should match levels of care provided. However, at this time, our options are extremely limited, which in the long run certainly can negatively affect patient care and access to care.

There is a wealth of data showing that this model of care is successful clinically, and it is cost effective. Across decades of collected data (inclusive of meta-analysis and systematic reviews), cost savings and return on investment averages roughly 1:4, meaning that for every dollar spent, a return on investment (healthcare savings) of $4 is realized. In many cases, it exceeds this ratio.

Medscape: What has the response of the medical community at large been to this paradigm?

Dr. Giberson: I'm unable to generalize the opinion of the medical community. However, physicians and other primary care providers who work within this paradigm have been supportive for decades. That said, there are practice settings where the expanded paradigms — and thus exposure to them — are more challenging to implement.

There will always be some dissent and disagreement, but that is okay. It helps all of us think of the best ways to collaborate and logically overcome barriers for the benefit of our patients. Some key stakeholders and physicians in the medical community have been supportive of the concepts and models of care discussed in the Surgeon General's report, and have written support letters to the US Surgeon General. These letters have come from physician-based clinics, academicians, family practice groups, and physician leaders from large federal health systems.

Medscape: What role does the federal infrastructure play in this issue?

Dr. Giberson: The ability to practice to the fullest extent of our scope, education, and licensure has been the federal infrastructure's main contribution to the advancement of federal pharmacy practice. Pharmacy programs in the federal sector have benefited from various structural and policy supports that have encouraged innovative practice. Access to patients' real-time clinical information (laboratory data, clinical visits, and care plans) improves the pharmacist's ability to adequately coordinate and assist in care. Interprofessional collaboration is also necessary to alleviate the burdens of healthcare. Working together in the midst of these challenges has been essential to provide the best care possible.

With our recent Public Health Service (PHS) call to action (A Call to Action: Lead the Profession) and ongoing collaborations with the Veterans' Administration and the Department of Defense, we hope to continue to help advance the profession. It's about identifying the best models for the patients, for the health system, and for health; it's not really about pharmacy, but pharmacy is a logical and evidence-based tool for our health system to utilize.

Medscape: Will this model change the physician–pharmacist relationship?

Dr. Giberson: First and foremost, it will expose the great relationship that already exists in many practice settings. In these cases — and the data attest to it — physicians find the expanded role of the pharmacist to be very collaborative and to improve overall outcomes. In other practice settings that have not been exposed to this type of collaboration, moving toward this model will not only benefit the patient, it will also benefit the health system.

Effective collaboration among healthcare providers is necessary to improve patient care. As healthcare providers recognize each other's capabilities and refine the paradigms of healthcare provision, communication and relationships can advance. By maximizing the expertise of each health professional, we will be able to better care for our patients.

Medscape: How would this paradigm affect the quality of patient care?

Dr. Giberson: Given the level of training and the years of education of the pharmacist, coupled with the accessibility to the patient, maximizing the use of this profession is logical. The data collected over the years have demonstrated that the practice is evidence-based and the results improve overall outcomes (i.e. the quality of patient care). This report includes hundreds of references to research studies (including meta-analyses) that have documented improved patient and clinical outcomes using this paradigm. As this model of care is expanded, the quality of — and access to — patient care can and should improve.

Medscape: Will this practice model affect job satisfaction for pharmacists?

Dr. Giberson: Based on all that I know — from nearly 20 years of practice and historical interest by students and academia in pharmacy practice in the PHS, the Veterans' Administration, the Department of Defense, and other innovative nonfederal programs — I would have to assume the answer is a resounding "yes, it would positively affect job satisfaction." Pharmacists train for many years to become healthcare professionals, and valuing them for their expertise and maximizing their scope should only enhance job satisfaction.

Medscape: Have you or your colleagues done anything to move this issue forward at the APhA meeting?

Dr. Giberson: Absolutely. The PHS was given the opportunity to do an hour lecture at the second general session with a large audience. Our Deputy Surgeon General, Rear Admiral Boris Lushniak, MD, MPH, shared the stage with me to discuss the pharmacy report and other important health and prevention topics. As well, we had multiple meetings with other pharmacy organizations, such as the National Alliance of State Pharmacy Associations, who partner with us to disseminate facts contained in the 2012 pharmacy report to the Surgeon General. Also, we had multiple PHS pharmacist colleagues presenting on various clinical and administrative topics throughout the annual meeting that helped demonstrate the success of this paradigm of care through evidence-based outcomes.

Medscape: What else would you like pharmacists to know about this issue?

Dr. Giberson: I believe the most encompassing thing I can say is to understand that we need to keep all the doors open for pharmacy practice so we can help reduce the burden of healthcare.

We can transform the profession, since much of the healthcare burden matches directly with our capabilities and expertise. We should transform the profession for the patients, the health system, and the nation's health.

Dr. Giberson has disclosed no relevant financial relationships.


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