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GOAL ASHP Initiatives Charting the Course for Provider Status with State Affiliate Champions Seena L. Haines, PharmD, BCACP, FASHP, FAPhA Nicholas J. Gentile,

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Presentation on theme: "GOAL ASHP Initiatives Charting the Course for Provider Status with State Affiliate Champions Seena L. Haines, PharmD, BCACP, FASHP, FAPhA Nicholas J. Gentile,"— Presentation transcript:

1 GOAL ASHP Initiatives Charting the Course for Provider Status with State Affiliate Champions Seena L. Haines, PharmD, BCACP, FASHP, FAPhA Nicholas J. Gentile, ASHP Director of State Grassroots Advocacy and Political Action Tools to Advance Federal & State Advocacy Efforts History of Provider Status

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3 Seven Rights of Medications www.googleimages.com Significant costs to healthcare system for chronic conditions and complications Prevent Med Errors

4 Public Health Need: Access to Primary Health Care # Medicare beneficiaries # patients w/ 1+ chronic conditions Newly covered patients via ACA Projected physician shortage www.googleimages.com

5 Opportunities and Impact Patients and Providers Trusted Health Professional

6 Payment Climate Changes www.googleimages.comFee for Service  Pay for Performance

7 Provider Status Is: Giving access to care that improves: www.googleimages.com

8 Provider Status HistoryGOAL 1965 1977-1997 2003 2010 * Pharmacists not recognized as non-physician practitioners  Medicare enacted  No Rx drug benefit  Part A: Hospital  Part B: Physician Outpatient services*  Medicare enacted  No Rx drug benefit  Part A: Hospital  Part B: Physician Outpatient services* Nurse Practitioner and physician assistants gain provider status  Medicare Modernization Act  Part D Rx drug coverage and MTM services  Medicare Modernization Act  Part D Rx drug coverage and MTM services  Affordable Care Act  Expands coverage  Establishes:  ACOs  PCMH  Pay for performance w/ quality & outcomes for hospitals  Affordable Care Act  Expands coverage  Establishes:  ACOs  PCMH  Pay for performance w/ quality & outcomes for hospitals

9 Public Policy Solution: Provider Status Health and Wellness Testing Manage Chronic Diseases Perform MTM Administer Immunizations Transitions of Care Access within state scope of practice

10 ASHP Ambulatory Care Summit www.ajhp.org/content/current Visioning the future of ambulatory care practice 1.Defining and Advancing Ambulatory Pharmacy Practice 2.Patient Care Delivery and Integration 3.Sustainable Business Models 4.Outcomes and Evaluation 1.Defining and Advancing Ambulatory Pharmacy Practice 2.Patient Care Delivery and Integration 3.Sustainable Business Models 4.Outcomes and Evaluation

11 Current Provider Status Physicians Nurse practitioners Physician assistants Certified nurse midwives Psychologists Clinical social workers  Certified nurse anesthetists  Speech-language pathologists  Audiologists  Registered dietitians  Physical therapists

12 Defining Provider Status Listed in section 1842 or 1861 of SSA as supplier of medical and other health services Pharmacists can participate in Part B of Medicare program and bill Medicare for services within their STATE SCOPE OF PRACTICE SSA determines eligibility for new payment systems, which emphasize quality and outcomes (ACOs, PCMH) Pharmacists are not recognized under SSA as health care providers

13 House Provider Status Bill Bipartisan bill to amend SSA to recognize pharmacists as Medicare Part B providers in medically underserved communities – Introduced by Representatives Guthrie (R-KY), Butterfield (D-NC) and Young (R-IN) in the House of Representatives on March 11, 2014 – Garnered 123 bipartisan cosponsors include two physicians: Reps. Roe (R-TN) and Bera (D-CA) – Applies to licensed pharmacists working within their state’s scope of practice laws – Establishes a mechanism of pay for pharmacist provider services under Medicare

14 House Provider Status Bill Amends section 1861(s)(2) of SSA to include: – Pharmacists services licensed by state law and is legally authorized to perform in the state In settings located in/for and defined in federal law: – Medically underserved area – Medically underserved population – Health professional shortage areas Increase Access, Improve Quality, Decrease Costs Similar path taken by other HCP to gain provider status HCP= Health care professional SSA= Social Security Act

15 Bipartisan Senate Working Group – Grassley (R-IA), Kirk (R-IL), and Wicker (R-MS) – Brown (D-OH), Cardin (D-MD) and Casey (D-PA) Originally far apart from House Provider Status Bill. – Senate wanted a Demo Program Companion Bill expected from the Senate in the coming weeks. Senate Companion Bill

16 Why Medically Underserved Fulfills Unmet NeedGives Pharmacists A Nurse Practitioners Physician Assistants Limits Opposition and Cost of Legislation

17 Medically Underserved Communities Medically Underserved Areas Medically Underserved Populations Health Professional Shortage Areas

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19 Patient Access to Pharmacists’ Care Coalition (PAPCC) Formed January 2014 More than 20 organizations Representing patients, pharmacists, pharmacies, other stakeholders Drafted H.R. 4190 To expand medically- underserved patients’ access to pharmacist services Access to Pharmacists Consistent w/ state scope of practice

20 PAPCC Members ASHP APhA AACP ASCP NCPA NASPA Walgreens IACP Albertson’s Amerisource Bergen Bi-Lo Pharmacy Cardinal Health CVS Caremark Food Marketing Institute Fred’s Pharmacy Fruth Pharmacy Rite Aid Safeway Inc. SuperValu Pharmacies Thrifty White Pharmacy Winn-Dixie

21 Fee For Service Ending Will be phased out  new payment systems Emphasis on quality, outcomes, team-based care We view ourselves as members of interprofessional teams throughout the continuum of care SSA remains the reference point for which practitioners are eligible to participate in current and NEW emerging delivery systems and payment models (ACO)

22 Credentialing Requirements Provider Status bill requires pharmacists to be licensed by state, and the state legislature and board of pharmacy, health care organizations, and private health plans determine the credentials required to perform services (CA- Advanced Practice Pharmacist) Health systems and hospitals have a process to credential and privilege pharmacists based on level of patient care services provided.

23 ASHP Credentialing Perspective ASHP supports board certification and residency training Does not belong in federal law For states and organizations to decide through state pharmacy practice acts, private health plans requirements, and health system/hospital credentialing and privileging

24 Pharmacist Provider Designation No need to create a new category of pharmacist in federal law. A suggested new pharmacist category—”Qualified Clinical Pharmacist”—be codified in federal law and therefore distinguished from all other pharmacists. (example in California) States and health care organizations may do such things, but it is inadvisable to do so at the federal level.

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26 Professional Citizenship: Reengineer Practice to Achieve Change Create a Coalition Lobbying Campaign Rally Support Patients  Legislators  Payors  Society Advocacy effort levels: patient, practice, profession and extraprofessional

27 GOAL Seek Co-sponsorship In state/ in-district elected officials and staff meetings, health fair demonstrations Seek senate companion bill to House Bill Coordinate health system/ hospital facility tours State Affiliate and Individual Advocacy Action House Bill Support and supplement ASHP Grassroots Calls to Action Profile member advocacy in newsletters Attend campaign fundraiser and events Focus on your state’s members who sit on Energy and Commerce Committee and Ways and Means Committee in U.S. House of Representatives

28 State Scope of Practice At federal level, allows pharmacist to participate in Medicare program and bill for services within state scope of practice Provision of service determined at State level As provider status at federal level is achieved  efforts needed to ensure a robust scope of practice

29 Passionate Activism JoinTalkWrite Petitions www.googleimages.com YOU can support Federal Legislation Ask legislators to cosponsor the bill Ask legislators to cosponsor the bill http://www.ashp.org/menu/Advocacy

30 www.googleimages.com “Never doubt that a small group of thoughtful, committed citizens can change the world. Indeed it is the only thing that ever has.” -Margaret Mead

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