In times of crisis, every resource at a nation’s disposal can be called upon to serve. During the COVID-19 pandemic, we have seen Army and Navy hospital units mobilized, medical students granted degrees early, automotive manufacturers stepping up to make critical medical supplies, and public and private research labs across the nation working around the clock to create therapies to treat this virus as well as an immunization to prevent its spread.
Yet there are highly trained medical professionals in nearly every community in the nation who could be called upon to play a greater role in the pandemic: pharmacists. In fact, roughly 90 percent of Americans live within five miles of a community pharmacy. In this time of great national need, we ought to be able to call upon pharmacists to do more work away from the bench and provide crucial care to millions of Americans, thereby helping to alleviate the enormous strain on our health care system as it helps patients with COVID-19 to survive and recover.
Why aren’t we turning to pharmacists to help support and relieve frontline caregivers? Historically, a critical barrier has been that not every state recognizes pharmacists as members of a patient’s health care team. Some states, like my home state of Massachusetts, have waived such restrictions due to the pandemic. It should now be just a matter of mobilizing pharmacists, and giving them broader roles to perform, for example, administering COVID-19 tests, helping the medical team better triage patients, consulting on dosing and therapeutic options and providing direct care where needed.
For decades, the business of pharmacists has been primarily dispensing medication based on a physician’s prescription. But the rigorous coursework at colleges of pharmacy and the advanced training pharmacists receive — pharmacists earn a doctorate after six years of study — mean they can be supporting our caregivers on the frontline now, whenever and wherever they are needed. In New York, for instance, there has been a desperate shortage of caregivers in the years and months leading up to the COVID-19 pandemic. Pharmacists “called up” from community pharmacies could work in tandem with other clinicians to support patients.
All health care professionals, including pharmacists, have been heroes during this pandemic. Pharmacists are risking their own health to keep pharmacies open and serve their patients. They can and should be tapped to do even more.
Even beyond the pandemic, it is time for our health care system to better recognize and reward the many contributions of pharmacists. Those states that have not permanently recognized the role of the pharmacist on the care team should do so now.
Several years ago, a movement resulted in changing the way physicians are paid, from fee-for-service to pay-for-performance. Reimbursement methodologies from Medicare, Medicaid and commercial payors were changed to recognize a new factor: value. Payment rates were varied based on medical outcomes — how well the patients fared. This switch is seen as having ushered in higher-quality health care.
A similar paradigm shift must take place in pharmacy, too. As we explore ideas like shared savings or outcome-based health models, payors and regulators must commit to the change and recognize the benefits of a value-based model being used in pharmacies large and small.
Pharmacist reimbursement should shift from fee-for-product to a value- and quality-based system. The level of service a pharmacist delivers when filling a prescription is variable; reimbursement should be as well. Patient counseling should be reimbursed, as should consultations with medical staff about proper therapy, dose and strength. Fee-for-product defines pharmacy as a high throughput business and that is a mistake. The patient gets lost in a high throughput system.
Pharmacists have the potential to improve health care quality and access, especially in rural and underserved communities. Much like nurse practitioners, physician assistants and dental hygienists are filling access gaps, pharmacists can as well. As regulators expand the role of pharmacy technicians, pharmacists can dedicate more time to direct clinical care.
Pharmacy organizations have advocated for expanded pharmacist roles and some state legislatures have listened. But now is the time, during this generation-defining pandemic, to really put these changes into practice. Pharmacists, consistently among the most trusted professionals in our communities, should be “called up” to help make a difference in countless numbers of lives.
Over the course of months, years and even generations, we will look back upon this pandemic and ask ourselves, “what more could we have done?” It’s my hope that we don’t waste the talent, intellect and hardworking hands of pharmacists everywhere eager to do more to serve their communities.
Let’s use pharmacists in an expanded capacity and let that be the foundation for a broader discussion about the role of the pharmacist on the medical team.
Ernest P. Gates, Jr., R.Ph, is president and CEO of Gates Healthcare Associates, a national pharmaceutical and healthcare consulting firm based in Massachusetts.
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