BETHESDA, MD 19 Sep 2014—Fifteen pharmacy students answered ASHP's call to spend September 17 on Capitol Hill as part of a group advocating to grant pharmacists status as healthcare providers in the Medicare program.
In all, 108 ASHP members visited 146 congressional offices during ASHP's annual Legislative Day. This year's event focused on securing the passage of H.R. 4190, a bill that was introduced in the House on March 11 by Representative Brett Guthrie from Kentucky.
In its current form, H.R. 4190 would amend the Social Security Act to allow pharmacists to bill Medicare for services permissible under state law provided to patients in medically underserved areas.
Sylvia Okrzesik, a fourth-year pharmacy student at Notre Dame of Maryland University School of Pharmacy in Baltimore, is familiar with H.R. 4190's moniker among pharmacists as the "provider status" bill.
"But for me, it's about being able to take the knowledge that I learned in school and really be able to utilize it . . . to help those that need us the most," Okrzesik said. She said the national shortage of primary care physicians presents an opportunity for pharmacists to be at the forefront of patient care, and provider status recognition can help make that happen.
Legislative Day participants were coached to emphasize to their legislators that today's pharmacists provide direct patient care in a variety of settings. These services include coordinating transitional care; screening patients for hypertension, diabetes, and hyperlipidemia; modifying drug regimens; administering vaccines; and helping patients improve their adherence to medication regimens. All of these interventions have the potential to improve public health, especially for patients with chronic conditions.
Participants also emphasized the role of pharmacists on interprofessional healthcare teams that provide patient-centered care with the goal of improving health outcomes and reducing overall healthcare costs.
Okrzesik's group met with staff from New Jersey's congressional delegation. She said her House representative has not signed on as a cosponsor of H.R. 4190, and it was difficult to gauge the staff member's reaction to the bill. But she said the representative from Senator Corey Booker's office "seemed very interested" in what the pharmacists had to say.
Gaining Senate support for provider status is important for moving the legislation forward. According to ASHP's Legislative Day briefing information, a bipartisan Senate working group is drafting language for a companion bill to H.R. 4190.
Okrzesik said her team provided information about the Senate's interest in the issue to alleviate concerns among House staffers about the upper chamber's support for the bill.
On the day of the pharmacists' Capitol Hill visit, H.R. 4190 had attracted 113 cosponsors in the House, including two Democrats and a Republican who signed on that day. Three more representatives became cosponsors yesterday.
Okrzesik participated in Legislative Day last year, and she has also discussed with members of her state legislature the role of pharmacy in healthcare.
She said those endeavors have taught her "how important it is to advocate for what we believe in."
"I think if we keep on being persistent and making our voice heard, we'll get the support that we want . . . and create the change that we want," she said.
Elizabeth Tien, fourth-year student at the University of Maryland School of Pharmacy in Baltimore, said a staffer for Representative Elijah Cummings of Maryland specifically asked her for her perspective, as a soon-to-be pharmacist, on the profession's role in healthcare.
Tien responded with an anecdote about how pharmacists communicate with patients about their medications.
"I was on rotation in a critical care unit at the beginning of this summer and was following the care of a patient admitted to our unit for bleeding due to blood thinner use," Tien recalled. "While looking at his home medications, I realized that the patient was also taking an herbal tea that was known to thin blood."
Tien said the patient had heard of the herbal tea's properties but did not believe that taking it with his anticoagulant medication would increase his risk for bleeding.
"This experience was a prime example of the importance of proper patient education to prevent hospitalization," Tien said.
Second-year pharmacy student Brittany Powers traveled to Washington, D.C., from Union University School of Pharmacy in Jackson, Tennessee, to participate in Legislative Day—a first for her. She her interests in public health and policy led her to make the trip.
"I also believe, as a pharmacy student, it is important to take hold of our career structure, our path, because the field of pharmacy is ever-changing, and I would rather make decisions for our profession than [have them made by] someone who is not a pharmacist," Powers said.
Powers said meeting with congressional staff was somewhat intimidating at first. But she was able to observe and learn from the experienced pharmacists in her group. She gained confidence with each visit and was able to participate in discussions with the legislative staff.
Powers' representative is not a cosponsor of H.R. 4190. But she said his staff is familiar with some of the work that pharmacists do because of a previous meeting with Legislative Day participants to discuss pharmacy compounding.
She said the staff was mostly interested in the costs and benefits associated with H.R. 4190, and the pharmacists were able to provide some information on those issues.
Powers said H.R. 4190 is about more than just Medicare reimbursement for pharmacists' care and a seat for the profession on the patient care team.
"It means that the underserved areas and my future patients will be able to receive the care that they need," she said. "And that will lead to better care for them and better health outcomes, and it will also reduce costs."
H.R. 4190 has an effective date of January 1, 2015, but Congress is not expected to act on the bill during the current session. Thus, Legislative Day participants are laying important groundwork for the quick reintroduction of the bill next year.
Medicare recognizes nurse practitioners, psychologists, clinical social workers, dietitians, physical therapists, and other professions as healthcare providers eligible to independently bill Medicare Part B for patient care. According to ASHP, failing to extend this recognition to pharmacists "unnecessarily limits patients' access to healthcare services and the valuable contributions" that pharmacists can make in a variety of patient care settings.
ASHP is working with other members of the Patient Access to Pharmacists' Care Coalition to engage legislators and promote the bill's passage.