AMA Declares War On Pharmacists

The recent publishing by the PGA of “A Healthy Future”, a document expanding on the range of activities that can be performed in a pharmacy setting, and possibly written with 6CPA negotiations in mind, has provoked a blunt response from the AMA.
An AMA spokesperson issued a statement recently, slamming the initiatives highlighted in the document, saying the government would be “foolish” to consider giving health funding to an “untested and unnecessary primary care experiment”.

“It is time to end the Pharmacy Guild’s monopoly position in using the $15 billion five-year Community Pharmacy Agreement negotiations to secure funding for clinical services,” AMA president Associate Professor Brian Owler said.

“There needs to be analysis about whether such funding to the Guild would simply add costs to the system, as pharmacists would have to refer patients to doctors for management if a clinical condition was established from health checks.”

While the AMA response is typical, the time has come for pharmacists to be more than defensive, and to take the fight right back into AMA territory.

i2P has previously supported the type of PR campaign the PGA has committed to run and commends them for taking such an initiative, even though it is long overdue.
i2P has also highlighted the fact that pharmacy has long held a substantial segment of the primary health care market.
It has been the norm for a very long time that patients would see their pharmacist first, who would then refer the complex patient to their GP for further evaluation and possibly some management.
The more expensive GP channel is more efficiently enabled to gear up for complex patients, leaving the minor issues for clinical pharmacists.

It shows how much the AMA is out of touch when it describes potential funding for pharmacy clinical services as “an untested and unnecessary primary care experiment”.
I mean, what planet are these people from?

It’s also laughable when the AMA wants to enter into collaborative arrangements with pharmacists.
However, this is suspected to be operable only if you become “hand-maidens” and be prepared to be owned body and soul.
I will never sign up for that style of collaboration!

In the U.K there is a move to involve and pay pharmacists for emergency care, announced in Monitor, the publication of England’s NHS.
Clinical pharmacy is well established in the UK and valued (except for the occasional critic).
Monitor suggested that
community pharmacies could be paid for shouldering their share of the urgent and emergency care burden under proposals from England’s health regulator.

Monitor suggested community pharmacies could receive a fixed amount for being open to patients, with extra payments for volume and quality, in plans to overhaul urgent and emergency care reimbursement outlined on Tuesday (August 19).
This could enable pharmacists to help provide “better coordinated, better quality care closer to home.”

It would seem that UK pharmacists may have pharmacy-in-the-home projects reasonably developed, a concept that i2P has promoted for the past decade should occur in Australia.

The US is finding similar problems to Australia.

In the US they are asking “What’s the problem?”
They further argue that:
“All providers in the healthcare system should practice to the fullest extent allowed by their license.”

That principle, espoused by a national coalition of pharmacy interest groups working fervently to achieve provider status and recognition for pharmacists, seems straightforward enough. But gaining full provider status — and the fair reimbursement for pharmacy care services that would come if government and private health plan payers included pharmacists in the federal and state definition of a healthcare provider — continues to elude the profession.

The ongoing debate over pharmacists’ value and contribution to better health outcomes persists in the face of clear evidence that “community pharmacy can play an important role in helping to prevent and treat acute and chronic conditions,” said Kermit Crawford, Walgreens president of pharmacy, health and wellness.
“With new patients entering the system, a primary care physician shortage, an aging population and a growing prevalence of chronic diseases, there is a great need for convenient access to quality health care services,” Crawford said.

Pharmacy’s battle over recognition also lingers despite the fact that many health professionals other than physicians have provider status under Medicare Part B, the American Society of Health-System Pharmacists reported.

The list includes physician assistants, nurse practitioners, clinical nurse specialists, certified registered nurse anaesthetists, certified nurse-midwives, clinical social workers, clinical psychologists and registered dietitians or nutrition professionals, ASHP noted.

Nevertheless, “pharmacists are not currently recognized as healthcare providers under federal law, despite having more medication education and training than any other health care professional,” noted Tom Menighan, Executive Vice President and CEO of the American Pharmacists Association. “Beyond being unfair to our profession, this lack of federal recognition restricts the contributions pharmacists can make to improving patient care.”

Achieving recognition as designated health providers by Medicare, Medicaid and for-profit managed care plans would mean that “pharmacists are compensated directly by a third-party payer for providing medication therapy management” and other patient care services, noted ASHP. So the lack of provider status also hits community pharmacy hard in the pocketbook. Without that professional recognition, the industry is locked in a perpetual struggle with health plan payers to establish commonly accepted payment standards for medication therapy management (HMR type services), advanced counselling, and disease monitoring and management for patients with chronic conditions, among other services.

Australian pharmacists are not alone in the fight to achieve recognition and all pharmacists deserve to be able to become certified providers provided they satisfy reasonable regulatory constraints.
The U.K seems to value its pharmacists and is looking to expand their use in primary health care settings.

In Australia, it appears that even a hint of competition is enough to frighten the AMA and they seek regulatory protection rather than compete in the marketplace.
This is something often said of pharmacy owners, but over time the marketplace has whittled down any regulatory advantages pharmacies may have held.
The PBS as it currently exists is simply a form of “profitless prosperity” for community pharmacy and would be unattractive to most competitors except those that could graft pharmacy to other departments in their stores in an attempt to legitimise their sales of alcohol, tobacco, high-sugar content snack foods, and pesticide and preservative-laced general foods.
If that happened in Australia, supermarket patients (like their existing customers) would have the worst health care experiences (like their US counterparts), now proven to live in the worst and most expensive healthcare system in the world.

I think that a better arrangement for legislators to consider is that pharmacy should be the authorised retailer for all medicines, scheduled and unscheduled. Supermarkets ( and others) then become the authorised retailers for food and grocery items. That type of regulation would be more equitable and less problematic, allowing to get on with its real work, instead of being subjected to market strategies designed to destabilise the entire fabric of pharmacy.

It seems that 2014 is really “crunch time” for Australian pharmacists and their US global counterparts.
If we are not prepared to fight the AMA with a unified voice, then we can be picked off with impunity.
And the other internal war, clinical pharmacists wishing to have a level of autonomy with pharmacy owners and where clinical services income is concerned, needs to be addressed.
You can’t accuse the AMA of creating turf wars, disunity and conflict of interest positions when negotiating with government, and do the identical thing internally that you accuse others of doing, in another capacity.
There is a need to recognise and celebrate the “differences” and stop wasting energy, time and cost in unproductive political forays.
Not only are they exhausting, even patients eventually begin to recognise their futility and march with their feet to an alternative offering.
However patients do respond to professional collaboration in a positive way, they too, being tired of having to hide the fact that they may be taking vitamin supplements or undergoing other types of therapy that may be frowned upon by their G.P, pharmacist or other health professional.
They want a more permissive clinical space where they are in control, are able to give appropriate instructions to their health professionals, and be mentored during the process.

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