Provider Status: Moving Forward, Major Push by Practitioners Still Needed

By Paul Abramowitz posted 08-13-2015 12:02

  
As of today there are 185 co-sponsors in the House of Representatives and 28 in the Senate for the Pharmacy and Medically Underserved Areas Enhancement Act (H.R. 592 and S.314, respectively). As impressive as these accomplishments are, we are asking pharmacists working at the state and local levels to substantially increase their efforts in August to help increase the co-sponsors to at least 218 in the House and 50 in the Senate. The numbers 218 and 50 represent support by at least half of the House and Senate, respectively, and send a strong signal to congressional leadership that these are serious bills that demand action by committees and ultimately on the floors of both the House and Senate.  

ASHP and our partners in the Patient Access to Pharmacists’ Care Coalition (PAPCC) have been highly successful in educating members of Congress and gaining the support of various other non-pharmacy stakeholders at the national level. However, a national effort alone will not result in the passage of legislation. Now is the time for every pharmacist and ASHP state affiliate to lead the charge at the state and local levels, and to tell the story of how these bills will increase access to healthcare for medically underserved patients in their communities.

To support the efforts of practitioners at the local level, ASHP has created easy-to-use tools for members to find which elected officials have or have not sponsored the legislation, as well as a simple way to send a letter of support. ASHP also has many tools on our website to help members engage in and lead various grassroots efforts. And last, but certainly not least, ASHP has an exceptional team of government relations and public relations professionals available to members and state affiliates to contact for advice and guidance.

In the spring of this year, ASHP contributed $1 million to a multimillion-dollar media campaign launched by the PAPCC that is targeting federal lawmakers in the Washington, D.C., area. This campaign has been extremely successful in creating awareness and understanding about the important roles pharmacists play, and how these bills will help improve patient access to the care pharmacists provide. Also, through the PAPCC, ASHP has helped support the hiring of consultants in key states where leaders of key congressional committees reside, with the goal of helping them understand how important these bills are to their constituents, communities, and states.

In September, ASHP will be holding a legislative day on Capitol Hill with nearly 100 ASHP members from all around the country. Further, ASHP has invited residents to another series of legislative days on Capitol Hill in late October and another with students in February. Pharmacy residents whose programs are visiting ASHP headquarters will extend their stay in the Washington, D.C., area to meet with congressional staff and members of Congress. Their visit will coincide with the annual celebration of Pharmacy Week and a Pharmacy Health Fair on Capitol Hill. We will also repeat our popular Student Advocate Training and Legislative Day on February 1-2. The conference will give student pharmacists an in-depth and hands-on look at the policy process and prepare them for meetings with congressional offices. Registration for the conference opens on September 1.

As you can see, the push for provider status at the national level is moving full steam ahead, and ASHP is supporting our members in every possible way. Passing provider status legislation will help our patients receive the care they need and deserve, and will enhance the capabilities of pharmacists to provide that care to them. Please take some time out of your busy schedules during August to reach out to your elected officials in the House and Senate, asking them to support H.R. 592 and S.314. Given that they are all back home in August, also consider attending a town hall meeting or political fundraiser, writing an editorial in your local newspaper, or working with your hospital or health system leadership to invite them to see the patient care you are providing and how that could be enhanced through the passage of this legislation.

Lastly, thank you so much for being a member of ASHP. This is your organization, and we couldn’t do it without you! I hope you are enjoying your summer, and I look forward to seeing many of you at the 50th Annual ASHP Midyear Clinical Meeting in New Orleans in December.
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08-17-2015 12:47

The two critical negotiating points of these bills (fee for service payments and diagnostic ability) were acquiesced to during the California experience in determining provider status. In this national effort - "provider status" needs to maintain the diagnostic support piece of provider status designation under SSA - Medicare part B - statutes even if the FFS financing piece goes away. Pharmacists need not be primary diagnosticians, however their ability to reconfirm an HCC code during a F2F visit or modify an existing HCC code eligible for re-capture could be an eventual leverage point for eventual pay - since health plans and medical groups are paid according to risk adjustment of an eligible population. Currently, only Medicare Advantage and some ACO MSSP/Pioneer assigned beneficiaries are eligible for risk adjustments. It has been estimated that 50% of Medicare FFS beneficiaries may be enrolled in MA plans by 2020. Population health models of the future will be financed in part on risk adjustment models and pharmacists able to perform in this role (e.g., capture diabetes diagnosis HCC with renal manifestations based on their treatment plan and lab result interpretation) that is accepted by CMS in the Medicare Advantage population or eligible populations provides additional opportunity for pharmacists from a revenue perspective. Even if HRSA designation of an under represented area or population limits our involvement - at least it will be in areas with the most need and likely disease burden. Please ensure the team at ASHP is aware of this critical opportunity, especially if the FFS argument requires negotiation with opposing lobby's and competitive historical interests.