New England is being crippled by a shortage of primary care providers. More than one in ten Rhode Islanders do not have a doctor at all. In the nation’s smallest and second most densely populated state, there are twelve Medically Underserved Areas and four primary care Health Care Provider Shortage Areas. Even if they find a clinic that is accepting patients, people must wait 26 days on average to be seen. These delays cost over $32 billion annually in unnecessary emergency room visits. Many of these visits could be prevented by engaging with community pharmacies, which patients already visit 35 times per year compared to four trips per year to their primary care provider.
We are prepared to support and elevate our colleagues in primary care. In the U.S. Department of Veterans Affairs. pharmacists “offload 27% of primary care provider appointments, increase referrals through education, improve team satisfaction, and save primary care providers 20 minutes on average for new patients, which they were then able to reallocate time to necessary patient care needs.”
All pharmacists are trained in the nuances of medication management. Their expertise is largely underutilized in today’s health care system, creating an enormous opportunity to better serve the public. Pharmacy scope of practice overlaps with primary care practice in several ways, including the assessment and treatment of minor ailments, educating, and managing chronic diseases like diabetes, asthma and COPD.
In a recent article, treatment by a pharmacist cost a lot less and rarely required follow up:
- Washington state pharmacists treated minor health issues for an average $278 less than a doctor’s office or urgent care clinic, and much less than the $963 at an emergency room.
- Nearly every minor illness resolved after an initial pharmacist visit.
At the pharmacy counter, in clinics and hospitals, pharmacists regularly recommend, improve, and educate on medications in addition to dispensing. A core tenet of our training is to eliminate unnecessary or harmful medications while maximizing safer, more effective options. One in five Americans take at least five prescription medications. One study has suggested that nearly 60% of older adults may be taking a medication they do not need, while more than 40% are missing medications they do need. Both scenarios were linked to more emergency room and primary care visits. We have the expertise to review these treatment regimens, consolidate therapies and reduce troublesome side effects.
Community pharmacists excel in these patient-centered elements of practice, but are limited in the time they can allocate to them due to competing priorities and a lack of adequate reimbursement. Payment for dispensed medications used to cover these activities, but middlemen known as pharmacy benefit managers or PBM’s have made dispensing a net loss activity.
The ensuing financial instability has led to deprioritization of clinical services except in ambulatory care clinics, where pharmacists work in primary or specialty care offices to manage complex medication problems. Since pharmacists cannot bill insurance companies for these cost-effective services, they are paid out of the money they save when experts in medications manage drug therapy. People with medications directly managed by these pharmacists have fewer emergency room visits, drug interactions, and side effects. In addition, they have greater successes such as lower blood sugar, cholesterol, and blood pressure, ultimately lowering the risk of heart attacks and strokes. These outcomes save money for the health care system, save time for other health care providers, and save the lives of patients. We can bring these services to every community if insurers reimburse pharmacists directly.
Pharmacists are well-equipped to fill the primary care gap. Two bills introduced in Rhode Island, Senate Bill 2401 (DiPalma) and House Bill 7273 (Casimiro), would permit pharmacists to bill private insurers and Medicaid for clinical services rendered separately from the dispensing of medication. Payment incentivizes pharmacists to allocate more time to these patient care activities, without sacrificing precision and speed in medication dispensing. Bills such as S2401 and H7273 are important first steps in establishing Rhode Island as one more state with accessible, equitable, affordable options for the delivery of health care.
The primary care crisis is here, but so is the solution. We need pharmacists to bridge this gap.
