Without provider status, pharmacists can’t justify role in primary care

Dole sees patients at University of New Mexico Pain Clinic

In a typical visit with a patient, Ernest Dole, PharmD, FASHP, usually asks, “Are you taking your medication?”

“This is a seemingly obvious question that we forget to ask patients when nothing’s changing,” said Dole, who sees patients at University of New Mexico Pain Clinic and is a Clinical Associate Professor at the university’s College of Pharmacy. His patients often answer, “No, because it wasn’t doing anything.” During 30-minute medication therapy management sessions, Dole takes the time to educate patients on how their medication works and how long it should take patients to feel its effects.

$290 billion: Cost of nonadherence

“Adherence rates tend to go up when you spend more time talking about those medicines. The patient’s questions are answered. They’re more likely to believe the medications are going to work, and they’re more comfortable with them,” Dole said.

Medication nonadherence costs the health care system as much as $290 billion a year, according to a report by the National Community Pharmacists Association. Chronic disease, which is treated with chronic medication, is the leading cause of death and disability and responsible for 75% of health care spending, says CDC.

Pain clinic uses cost offset strategy

Yet pharmacists like Dole—arguably the health care providers best positioned to educate patients about medication and thereby improve adherence rates—typically cannot bill insurance for their services because CMS does not recognize them as health care providers.

“Not being able to bill for that visit puts pharmacists at a tremendous handicap to justify why they should be there,” Dole said. The UNM Pain Clinic can justify Dole’s presence in part using a cost offset strategy. For each 30-minute pharmacist visit, an interventional physician can administer two epidural steroid injections—a major source of revenue for the clinic. But without provider status, Dole worries that pharmacists might never justify their presence where they’re needed most: in primary care.

Pharmacists part of primary care

Primary care physicians don’t perform many revenue-generating procedures that would offset the cost of an in-house pharmacist. Yet a large part of the primary care patient panel is people living with chronic diseases that are managed by chronic medications. Physicians barely have time to see the patients they have, much less provide extensive medication counseling. This time crunch is compounded by the growing primary care physician shortage.

“Ideally pharmacists could step into this setting where there are not enough health care providers and where most chronic conditions are managed by medications,” Dole said. “It’s been shown that pharmacists do a great job of managing chronic conditions. And it would increase access and allow the physician to see new patients or more acute patients.”

Physicians are trained to diagnose, Dole says, so diagnosis is the focus of the visit, which culminates with a prescription before the patient walks out the door. But patients’ main concern, Dole says, is not what they have, but rather what they can do about it, and that’s where medication comes in. “Medication is one of the most powerful tools we have to treat chronic diseases, yet there is very little discussion of what it does,” Dole said. “If we spent more time discussing medication, we’d get better buy-in, stronger adherence, and better outcomes.”