The COVID-19 pandemic has placed a spotlight on the vital role of pharmacists within healthcare teams and their ability to provide a wide range of patient care services. Recent developments are advancing provider status for pharmacists and show the potential for long-term changes within the profession.
“Momentum for provider status has been increasing for a while now. At this point, it’s really more a question of when the government is going to act to change sections of the Social Security Act to allow pharmacists to obtain provider status,” says Ken Maxik, MBA, MBB, FACHE, RPh, CompleteRx Vice President, Support Services. Maxik adds that a major hurdle for the profession is that pharmacists are unable to bill the Centers for Medicare and Medicaid Services (CMS) under Part B for services unless they’re under a recognized provider’s number.
Pharmacists have been steadily moving beyond simply counseling patients on medications. For a number of years now, pharmacists have administered immunizations and performed testing for streptococcal pharyngitis and influenza. And last April, the federal government authorized U.S. pharmacies to order and administer COVID-19 tests.
As the second wave of COVID-19 hits and a vaccine eventually becomes available, opportunities for pharmacists to contribute more directly to patient care will continue.
Barriers to Provider Status Remain
Before widespread COVID-19 testing by pharmacists becomes a reality, a number of operational issues need to be ironed out. One major challenge involves meeting state scope of practice and state laboratory requirements. The recently approved point-of-care COVID-19 tests require a Clinical Laboratory Improvement Amendments (CLIA) certificate of waiver. Once a certificate of waiver is obtained, pharmacists must figure out scope of practice regulations, which can be a complex undertaking.
Reimbursement also remains uncertain. While insurers are required to cover COVID-19 at no cost to patients, there are no requirements to reimburse those providing the tests. Commercial insurers cover medical costs, but not pharmacy costs.
With a vaccine expected to be available in early 2021, pharmacists will play a pivotal role in immunizing their communities. This is an ideal time for legislators to review and revise pharmacy practice statutes to remove barriers and create a smooth runway for the entrance of a COVID-19 vaccine.
Provider Status Considerations for Hospital Pharmacy
Although much of the buzz around provider status is occurring at the retail pharmacy level as community pharmacists work together to be reimbursed for patient care services, hospital pharmacists also play a valuable role in the profession’s move toward provider status. Across hospitals, pharmacists round with multidisciplinary teams and help optimize therapy by providing clinical services to patients. The work they do impacts hospital metrics and quality measures, such as reducing medication errors, preventing 30-day readmissions and reducing hospital length of stay.
As momentum for pharmacists to receive provider status gains steam, hospital administrators must consider a couple of key points:
Pharmacists can play a larger role on the patient care team, allowing physicians to focus on more complex cases. As medication therapy experts, pharmacists can manage drug therapy and direct refill review and approvals, freeing up valuable physician and nursing time. Allowing all healthcare providers to work at the top of their license optimizes and stretches valuable healthcare resources.
“A big component of pharmacist provider status is the ability of the pharmacist to act as a physician extender. They’re not replacing physicians, but filling a valuable role on care teams, particularly in rural areas where there may be limited access to physicians,” says Maxik.
Hospital Policies and Bylaws
Administrators must also examine how provider status affects overall hospital staffing and how these changes impact the organization’s bylaws, rules and regulations.
“While pharmacists may not necessarily become part of the medical staff, hospital bylaws, rules and regulations may need to be revised as far as pharmacists’ scope of practice within the facility,” says Maxik.
A Lasting Impact
The impact of COVID-19 on hospital pharmacy has been significant in the short-term and recent developments to expand the role of pharmacists will translate into long-term positive changes for the industry.
Join us for a webinar on Tuesday, July 21 that will cover advancements in pharmacy practice as a result of COVID-19. We’ll share guidance on proactive planning for a COVID-19 vaccine and other helpful information.