The Pharmacy Physician Assistant

The disruption of large sectors of the healthcare industry that has occurred since the ACA became law has produced the opportunity and necessity for systemic change. This crisis must not be wasted. Primary care physicians led by family practice doctors must take control of the healthcare system.

A key element of such a change involves pharmacists. The market is ready for the Pharmacy Physician Assistant (PPA).

Pharmacists have long been recognized as the most underused element of the primary care team. Their role has expanded already in some underserved portions of the healthcare market. A New York Times editorial, titled “When the doctor is not needed,” published December 15, 2012, commented:

A report by the chief pharmacist of the United States Public Health Service a year ago argued persuasively that pharmacists are “remarkably underutilized” given their education, training and closeness to the community. The chief exceptions are pharmacists who work in federal agencies like the Dept. of Veterans Affairs, the Dept. of Defense and the Indian Health Service, where they deliver a lot of health care with minimal supervision. After an initial diagnosis is made by a doctor, federal pharmacists manage the care of patients when medications are the primary treatment, as is very often the case.

With creation of PPAs, the role of the pharmacist can quickly expand to include additional services. Many pharmacists have trained in a variety of specialty areas, including immunization, basic lab testing, and collection of clinical data. Using theses skills, they can serve as an extension of the patient’s primary care doctor.  

Already in place

The mechanism is already in place. MD anesthesiologists supervise numerous certified registered nurse anesthetists (CRNAs), who perform much of the anesthesia for surgery in this country. Physician assistants (PAs) and nurse clinicians have expanded patient care for their supervising physicians.

In the case of pharmacists, it would be a simple matter for them to electronically communicate with primary physicians, who can supervise and review their services and coordinate with third-party payers for these services. Most pharmacists have a NPI number and can be added quickly to various plans for reimbursement for these services.

With PPAs added to the care team, the patient will receive more efficient and more cost-effective care at multiple points of service, while physicians maintain control as they monitor patient care.

This will increase physician income, improve patient care, and return to pharmacists the responsibility for coordination of pharmaceutical therapeutics for patient care.

The primary role of pharmacists is patient care, not simply drug sales. Pharmacists are weary of market-driven medicine, where they are regarded as shilling for the drug companies or for their large corporate employers.  

Super-systems take all

If the ACA collapses, as many think it will, millions of patients will lose their coverage, and when they seek routine care they will be shocked at the way cash prices have quietly escalated, nearly unnoticed, because of the reimbursement from third-party payers.

In addition, many patients will discover an acute shortage of primary care providers. And with the expansion of Medicaid, demand for primary care will increase, effectively increasing demand for these already scarce resources.

In many markets, most, if not all, of the physicians specializing in family practice, pediatrics, obstetrics, and internal medicine are now hospital-based or hospital-owned. These vertically integrated, super-sized hospitals need to maintain tight control of primary care, in order to feed referrals within “the system.”

To finance their nearly exponential growth in overhead, these super-sized hospitals have sought to increase their “income net” by hiring more primary care givers, including nurse practitioners and PAs.

Paradigm shift

The time to expand the pharmacist’s role as part of the primary care team has arrived.

The PPA, by contract or regulation, will have authority to provide additional basic services for patients. Pharmacists, using their NPI, will facilitate billing for services and not merely for product. This is critical because not filling, or not refilling, a prescription for a particular patient is often a crucial element of patient care.

Most important, pharmacists will be available to help reduce or eliminate gaps in patient care quickly, efficiently, and at reasonable prices. Through contracts and regulation, the services of PPAs can be made quickly available in many jurisdictions. In other states, new statutory provisions may be necessary. For many patients, PPA services will provide access to essential care at a reduced price.

This new paradigm will place family practice doctors at the center of healthcare reform. This is the position for which they have been trained. They can provide the bulk of the care patients need and perform the triage function needed to get patients referred when specialized care is necessary.

It is essential that these family practice doctors have expanded resources to serve this expanded pool of patients. Their compensation will increase because they will be serving a much larger group of patients, but they will need additional assistance to fully meet the needs of these patients. PPAs, quickly providing much of this assistance, will be a key part of the long-term solution.

Transformed institutions

Under this scenario, primary care physicians, led by family practice doctors, will replace overpriced hospital executives as the “comptrollers” of healthcare spending.

The super-sized hospitals have outlived their usefulness. Facilities don’t provide healthcare. The providers are the people who provide the care, led by family practice doctors.

In an era defined by nanotechnology, super-sized hospitals with unnecessary overhead are no longer an efficient means by which to deliver care to the majority of patients. PPAs will play an essential role in expanding healthcare quickly and efficiently, by expanding the services provided by primary care physicians.

Robert L. Mabee is a pharmacist and attorney practicing in Sioux Falls, S.D. He also holds an MBA. Contact him at rlmabee@midconetwork.com.