Pharmacist Medical Providers PostSB 5557 Update Don Downing

Pharmacist Medical Providers: Post-SB 5557 Update Don Downing Clinical Professor, UW School of Pharmacy dondown@uw. edu

Pre-SB 5557 • Pharmacists could only bill for medications ▫ Pharmacists could not bill for clinical services ▫ Pharmacists were, however, providing clinical services �Prescribing prescription drugs �Managing: Anticoagulation services, diabetes, hypertension, lipid, pain, contraception, etc. �All without compensation ▫ PBM-based billing: Not appropriate for clinical care ▫ A strong disincentive to coordinate or reduce medication complexity even for those on 20 Rxs

Post-SB 5557 • Pharmacists are being hired to fill in gaps where primary care physicians are unavailable • Pharmacists are initiating services that health departments can no longer provide: ▫ Chlamydia, gonorrhea, TB, HIV/AIDS, Hepatitis C, etc. screenings ▫ Immunizations, STI treatment, incl. expedited partner therapy ▫ Teen pregnancy prevention services • Pharmacists now have financial incentives that are aligned with best medication practices

Washington State Pharmacy Association workgroups: • On February 19, 2016, the Billings Workgroup met to continue its work on creating a Billing Guide and Documentation Guide to help pharmacists implement ESSB 5557. . • Earlier this year, the WSPA established workgroups to develop educational and training tools to help prepare pharmacists to take advantages of new opportunities as medical providers. • The Billing Workgroup is developing two draft documents: ▫ (1) a Billing Guide which includes billing codes and diagnosis codes that pharmacists may use when billing for medical services provided to patients; and ▫ (2) a Documentation Guide to help pharmacists understand how to appropriately document outpatient and office visits services using complexity-based billing rather than time-based billing. • In the next few months, the WSPA will be rolling out new training and education programs. For more information about the Billing Workgroup, please contact Vergil Cabasco at vergil@wsparx. org.

Consequences… • Almost 2000 pharmacists, physicians and others signed up, nation-wide, for Feb 2016 “Pharmacists as Medical Providers” webinar • Some hospitals in WA have added pharmacists to their medical boards • Tribes have hired pharmacists to fill their longvacant medical provider positions • Are pharmacists specialists or primary care?

Questions & Consequences… • • • Medical referral vs patient self-referral Coordination of care / Non-duplication of care Conflict of Interest policy development Pharmacy School curricular changes Network adequacy Board specialty certification decisions ▫ Access to Care ▫ Quality of Care • More to come… Thanks