Compensation Hinges on Congressional Action
The need for congressional action, says Government Affairs Division (GAD) Director Brian M. Meyer, M.B.A., derives from the way legislators designed Medicare in 1965. At that time, Congress recognized that hospitals and physicians provided beneficial health care; thus the Social Security Act created a system that pays hospitals and physicians.
The original plan did not include medications used outside of hospitals and did not recognize outpatient health care providers other than physicians.
Without a change in the Social Security Act, all that the Health Care Financing Administration (HCFA), which runs the Medicare program, can do to compensate a pharmacist for providing patient care services is to consider those services "incident to the physician's," says Meyer. "HCFA's hands are tied," he says, because of the wording in the act.
Meyer and Gary C. Stein, Ph.D., director of federal regulatory affairs, met in late May with officials in HCFA's Division of Practitioner and Ambulatory Care to discuss an array of issues related to pharmacist compensation.
For a pharmacist to bill "incident to," says Stein, the ambulatory care clinic must be financially independent of a hospital and the pharmacist must be an employee, not necessarily full-time, of a physician or group medical practice. (See Stein's July issue of ASHP Government Affairs Regulatory Summary.
"This points out the need, ultimately, to obtain provider status in the Social Security Act so pharmacists aren't constrained by these arcane rules," says Meyer.
Since fall 1999, Meyer has been leading ASHP's efforts to expand the opportunities for pharmacists to obtain compensation for their ambulatory patient care services. These efforts include increasing payers' and health policy-makers' awareness of the vital role that pharmacists have in patient care, a mission the Board of Directors designated in June as a top priority. A staff working group has developed three action planscovering advocacy, public relations, and educational programmingto address the complex issue of compensation.
"We've made numerous contacts both on the House and the Senate side, and those contacts need to be supplemented by ASHP members," says Kathleen M. Cantwell, Esq., ASHP's lobbyist on Capitol Hill. Legislators need to see for themselves that pharmacists can do more for patients than provide the basic counseling information mandated by the Omnibus Budget Reconciliation Act of 1990.
Says Ambulatory Care Associate Mae M. Kwong, Pharm.D.: "Many pharmacists in the ambulatory setting are providing more patient care, such as limited physical assessments with monitoring and assessment of overall drug therapy....Invite your legislators to your ambulatory care site where you're providing care and show them what it is that you're doing."
Then contact GAD so that a staff member can follow up when those legislators return to Washington, D.C.
Kwong says she also wants to hear from pharmacists who have been paid by any insurer to provide nondispensing services.
GAD staff is also working with the ASHP Section of Clinical Specialists to promote pharmacist compensation and is seeking to ally with other organizations on this issue.