If nothing changes between now and 2018, we may see a 25% oversupply of pharmacists in the marketplace. Then again, we may not. What happens between now and then is, in large measure, up to us.
Ronald G. CameronThe profession of pharmacy faces a looming problem that cannot be avoided much longer. If nothing changes between now and 2018, we may see a 25% oversupply of pharmacists in the marketplace.
How can this problem be alleviated? The only solution would be to create more jobs for pharmacists, outside the normal dispensing that most pharmacists still engage in today.
Where would these jobs come from? The answer is known throughout the profession: Such jobs would come from medication adherence consultations, medication therapy management, pre- and post-hospitalization medication reviews, and any other direct contact that pharmacists can have with patients.
Pharmacists are, after all, the drug experts. They are Doctors of Pharmacy! Ask them first!
Pharmacists know more about medications than all the other medical professionals combined. When issues connected with medications arise, pharmacists are the ones whose expertise should be sought first. Yet all too often, things just don’t happen that way.
Pharmacists should be on every healthcare team. And they should be paid for the time spent working with or for patients. Time is money. Nobody works for free. All other healthcare providers are paid for the time they spend attending to patients. Pharmacists are the only exception. This has to change.
While the ACA has offered pharmacists some opportunities, it failed to designate them as “healthcare providers.” This failure has created a significant obstacle between pharmacists and the compensation they deserve.
The ACA went for value-based care and focused on accountable care organizations (ACOs), yet MTM, which should be a fundamental tool of ACOs, was hardly mentioned.
Medication errors are the biggest cause of hospital readmissions. Research has shown that when pharmacists do pre- and post-discharge medication reconciliation, readmissions go down.
Data have also shown that Transitional Care Management is reducing 30-day readmissions.
Wherever pharmacists are included in the care team, outcomes improve.
The above-mentioned programs are all great, but pharmacists need to be recognized under ACA as healthcare providers, so that they can do CMRs for the Medicare and Medicaid patients, and get paid for their time.
Here is a simple three-step solution to the problem of getting paid:
Next: The three-step solution
First, pharmacists must obtain healthcare provider status. The first step is to get H.R. 592 / S. 314, the Pharmacy and Medically Underserved Areas Enhancement Act, passed in Congress.
Second, CMS must make an adjustment under MTMP Requirements 423,153(d), which can be summarized simply as:
· Eliminate “Target Procedures.”
· Eliminate “Targeted Beneficiaries,” as described in Section30.2.
· Under Medicare and Medicaid, require “All Beneficiaries” to have an annual CMR, administered by a pharmacist or some other qualified healthcare professional.
The savings to CMS would be more than enough to pay the pharmacists for the time needed to administer the CMR’s to all the recipients.
Third is the matter of reimbursement.
The pharmacist, or the pharmacist’s employer, should be compensated for the time the pharmacist spends going through the CMR with the patient and submitting the proper documentation to CMS for payment.
That’s right - pay the employer.
The reimbursement to the employer should cover all the employer’s expenses, including the hourly wage rate, all mandatory taxes and insurance, the pharmacist’s fringe benefits package, and any and all other hidden payroll expenses items.
Why is this so important?
The U.S. Chamber of Commerce has estimated that these hidden payroll expense items account for between 53.6% and 56.8% of costs over and above the hourly wage rate.
For example, a pharmacist who earns $60 per hour actually costs the employer between $92.16 and $94.08 per hour.
The point is this. If employers are not being properly compensated, they will not participate. And that is exactly what they are doing - not participating!
If they don’t get paid, they’re looking at a losing proposition. Time is money, and employers are not getting paid for the pharmacist’s time. They are seeing no compensation whatsoever, for consultations, MTM, medication adherence, or any other tasks that consume the time of pharmacists. This is the problem!
Next: How pharmacists can get paid
Pay the employers, and they will get into compliance instantly - and they will start paying the pharmacists in their employ to perform patient consultations.
Some studies have estimated how much money CMS can save annually when pharmacists do CMRs for Medicare and Medicaid recipients. It amounts to approximately $13 billion dollars per year, every year.
This would be a win-win situation all the way around. CMS wins, the patients win, the employers win, pharmacists win, and the pharmacists oversupply would be at the very least partly alleviated.
Now is the time to act. Write, e-mail, and phone your lawmakers in Washington D.C. Support the professional groups that are fighting for these bills. Don’t wait until 2018!
Ronald G. Cameronis CEO of Cameron and Company, Inc.;The Pharmacists’ Registry, an authoritative source of temporary staffing solutions; AdherenceCameron, the medication adherence programs; and TeleCameron, the telepharmacy service. Contact him firstname.lastname@example.org.