Provider status not the only path to payment for clinical services

May 15, 2012

As pharmacists and others wait to learn ACA's fate in the U.S. Supreme Court, the issue of provider status under the Social Security Act continues to worry those seeking to expand into MTM and other clinical services.

A heavy lift

The profession can't advance without a sustainable payment methodology that includes payment for pharmacists' services. Pharmacy strongly supports provider status, but it will literally take an act of Congress to get us there. That's a very heavy lift, politically speaking, and we must pursue other solutions in parallel.

That said, under current rules there are situations for which provider status would add much to pharmacists' economic toolbox. Pharmacists working in physician offices would have new billing options, and our members who work in those situations tell us that would help greatly in expanding MTM services.

Pharmacists such as Dan Buffington of Tampa, who has an independent pharmacology practice to which physicians refer patients, would be able to provide care for more patients and add additional services, benefitting patients at high risk of medication-related problems. Terry Forshee of Cleveland, Tenn., could expand his weight-counseling program, which supports Medicare patients in losing weight and reducing their risk of developing diabetes and other chronic diseases.

Given the creativity of our pharmacists in helping to solve America's growing drug problem, I have no doubt that provider status would be an incredibly important advance in patient care.

Important developments

The recent endorsement by the U.S. Surgeon General (http://www.usphs.gov/corpslinks/pharmacy/comms/sgreport2011.asp) of the important role of pharmacists and the need for provider status is a highly important development. Another highly visible effort has been Sandra Leal's http://change.org/ petition (http://www.change.org/petitions/the-president-of-the-united-states-recognize-pharmacists-as-health-care-providers/). Last time I checked on the petition of this Tucson, Ariz., innovator, the number of supporters approached 20,000. It's especially pleasing to read the comments of physicians and patients, who know firsthand the difference pharmacists can make.