In a recent conversation with a patient’s wife, Justin Ruffridge, PharmD, learned a lot more about the patient’s condition than he expected.
“Any time that you can take the time to talk to your patients, in what can otherwise seem like an almost factory-like atmosphere, you’ll be shocked at the level of care that you can provide,” said Ruffridge, a staff pharmacist at Soldotna Professional Pharmacy, a large independent pharmacy in Soldotna, AK.
Ruffridge had asked his patient’s wife, who is also the patient’s caregiver, about her husband’s blood sugar. His blood sugar was fine, she said, but he was having a hard time getting out of bed every morning. He’d wake, get out of bed, feel too lightheaded to stand, and lie back down until he was able to stand, which was sometimes 10:30 or 11 am.
The conversation triggered a call to the patient’s physician, which led to a reduction in the dosage of his ACE inhibitor and his beta-blocker, plus a new prescription for midodrine that he could take as needed if he continued to feel dizzy in the mornings, which he did not.
“This interaction got him a higher quality of life, lowered his risk of falling and breaking a bone, and kept him mobile,” Ruffridge said.
At the end of the encounter, Ruffridge billed the patient’s insurance for a diabetes disease state management visit.
Many state pharmacy associations have fought for years to earn pharmacists the legal right to provide and bill for this level of care. According to Alaska law, pharmacists have always been health care providers who can bill for their services. But, in part because state and commercial provider enrollment and claims processing systems are not set up to enroll pharmacists and accept claims from them, very few pharmacists in the private sector currently provide and bill for patient care services. Many Alaska pharmacists may not even know that they can.
A small team of pharmacists, led by Tom Wadsworth, PharmD, is working to change that.
“Health care will look so different when we get more pharmacists in the game practicing at a higher level,” said Wadsworth, assistant dean for Alaska programs at the University of Alaska Anchorage/Idaho State University Doctor of Pharmacy Program. “It’s up to my generation to get clinical pharmacy out to patients. The only way to do that is to get pharmacists paid for those services.”
Wadsworth teamed up with Oregon-based pharmacists Zachary Rosko, PharmD, and Andrew Hibbard, PharmD, to launch the Sustainable Education & Training Model under Pharmacist Provider Reimbursement (SETMuPP) practice transformation demonstration project. With funding from CDC and the Alaska Pharmacists Association, the program partners with pharmacists to “set ‘em up” to practice and bill as providers.
SETMuPP ensures that PharmD students learn how to bill for clinical services while they are in pharmacy school. It also educates current pharmacists on how to provide and bill for clinical care. SETMuPP helps the pharmacy gain access to their patients’ electronic medical record as well. Finally, it advocates for policy changes to further facilitate pharmacists’ provider practices. For example, its program leaders are lobbying for a bill that will include pharmacists in laws that prohibit payers from discriminating against providers. Recently, SETMuPP fought for and achieved having “pharmacist” added to the state’s Medicaid provider enrollment portal.
“Alaska’s a rural, frontier state,” Wadsworth said. “We don’t need rigid rules. We need the ability to answer the patient’s needs in front of us, the ability to make a professional judgement.”
In the last 3 years, SETMuPP has helped embed 4 pharmacists in family practices and launched the clinical services that Ruffridge offers at Soldotna Professional Pharmacy. Three more community pharmacy practices are in the set-up process in Sitka, Ketchikan, and Juneau, AK.
Sonya Collins, contributing writer
For the full article, please visit www.pharmacytoday.org for the September 2021 issue of Pharmacy Today.