Is American healthcare facing an access crisis?
The Hill – Congress Blog
By Harry Leider
March 20, 2015

http://thehill.com/blogs/congress-blog/healthcare/236339-is-american-healthcare-facing-an-access-crisis

An understandable response would be, yes, we always seem to be facing a healthcare crisis.  But the access challenge confronting us today is different.  That’s because it’s being driven by a perfect storm of factors that together can impair the most fundamental aspect of healthcare: a patient’s ability to receive the care and treatment they need at an affordable cost and within a reasonable time frame.

America’s population is living longer than ever before; however, the number of people suffering from chronic disease is at an all-time high and growing.  Almost half of U.S. adults – approximately 117 million people – have at least one chronic disease, resulting in three-quarters of our nation’s annual healthcare expenditures going toward costs for treatment and management of these conditions.

We’re also challenged with a primary care physician shortage that’s only supposed to worsen, with the Association of American Medical Colleges predicting that in five years there will be nearly 100,000 fewer doctors than the number needed to meet a growing demand for healthcare services.  And, of course, there is the influx of newly insured individuals into the healthcare system as a result of the Patient Protection and Affordable Care Act (Obamacare) – this is predicted to add up to 37 million newly insured Americans.

Against this backdrop, it’s clear we need to make changes to our system to counter these trends that will only continue to hinder patient access. One viable solution is to promote the important role community pharmacists can play in providing patient care, in the same manner as other non-physician providers like nurse practitioners and physician assistants.  However, for this to happen, overdue policy changes need to take place in Washington.

A perfect example is the Pharmacy and Medically Underserved Areas Enhancement Act (H.R. 592 / S. 314) introduced by Reps. Brett Guthrie (R-Ky.), G.K. Butterfield (D-N.C.), Todd Young (R-Ind.) and Ron Kind (D-Wis.), along with Republican Sen. Charles Grassley (Iowa) with Sens. Mark Kirk (R-Ill.), Bob Casey (D-Pa.) and Sherrod Brown (D-Ohio). This legislation would clear the way for pharmacists to deliver, and be reimbursed for more of the valuable services they are clinically trained to provide – giving Medicare beneficiaries in medically underserved communities access to much-needed healthcare services.

The vast majority of pharmacists today are already doing much more than simply filling prescriptions.  They’re helping patients manage chronic disease, providing medication management services, conducting health tests to diagnose conditions like diabetes or high cholesterol, and administering a wide range of immunizations. They’re also partnering with healthcare providers working in nearby health systems and hospitals, serving as part of care teams to help improve patient health and outcomes.  For example, a recent study where employers contracted with community pharmacies to provide clinical support for their employees with diabetes resulted in significant improvements in control of: blood sugar, cholesterol and blood pressure, as well as increased rates of vaccinations, foot and eye exams.

The level of education and training pharmacists receive has increased significantly in recent years. Pharmacy students are now required to earn a doctor of pharmacy degree (PharmD), which typically takes seven to eight years to complete – including undergraduate and pharmacy school education. Many pharmacists go on to receive additional specialized training in areas of growing need like immunizations, diabetes or HIV/AIDs.

In terms of improving access to care, pharmacists provide a unique resource.  Patients with chronic conditions typically see their pharmacists more often than their primary care physician. Data from Walgreens shows that the average patient with diabetes comes to our pharmacy counter approximately 20 times per year.  Typically, they might see their physician three to four times per year.  This high frequency of interaction between community pharmacists and patients with chronic illness provides pharmacists with a tremendous opportunity to provide much-needed clinical services and support.

However, despite these and many other proof points, Medicare does not currently recognize pharmacists as full-fledged providers, and does not compensate them for many of the important services they provide.  This prevents pharmacists from practicing at the top of their license and supporting patients to the fullest extent possible. As pointed out in a January paper issued by the National Governor’s Association, lack of recognition blocks pharmacists from serving as providers within accountable care organizations (ACOs) and other emerging models of team-based, collaborative health care.

As a physician myself, I understand some individual doctors or physician groups may have concerns with other non-physician providers like pharmacists taking on greater responsibilities. But the reality is, healthcare is evolving and the access challenges are very real.  In order to meet the access pressures that these changes in the healthcare market are placing on our system, our attitudes as doctors and the policies in Washington need to evolve too. And ultimately, if we don’t support legislation like Bill 592, patients may be the ones who ultimately pay the price.

Leider is chief medical officer for Walgreens.