"Education matters much more than convenience," remarked Timothy M. Smith, a contributing news writer for the American Medical Association (AMA), in a February 2024 publication.
His article discusses the concept of "scope creep," a term the AMA uses to refer to expansions in the scope of practice by non-physician health care providers that could potentially compromise patient safety. The AMA insists that allowing non-physicians—such as pharmacists, nurse practitioners, and physician assistants—to diagnose and treat patients without physician supervision could be detrimental, emphasizing the need for physicians to remain the leaders of health care teams.
The publication stirred reactions, particularly from the American Society of Health-System Pharmacists (ASHP), the American Pharmacists Association (APhA), and the American Association of Colleges of Pharmacy (AACP). Both APhA and AACP criticized the AMA's stance as "arrogant, self-centered, and out of touch." ASHP stated that the AMA does not represent the views of all physicians. They highlighted that pharmacists, like physicians, are licensed health care professionals with responsibilities to ensure optimal, safe, and effective medication therapy, in collaboration with multidisciplinary teams.
The issue of pharmacists’ provider status, also recognized as scope creep, has been debated for years. The AMA's Scope of Practice Partnership, initiated in 2006, aims to counter the scope expansions for non-physicians. The primary concern in the debate involves the reimbursement of services provided by pharmacists and the recognition of their roles within the health care system.
Dr. Troy Trygstad, PharmD, PhD, MBA, described the opportunity for pharmacists to practice and bill for patient encounters as transformative for the profession, leading to its inevitable growth, particularly expedited by the COVID-19 pandemic. However, the landscape remains unclear. While pharmacists provide essential services, such as vaccinations and point-of-care testing, federal law currently restricts reimbursement for these cognitive services.
The concept of provider status is multifaceted. Federally recognized health care providers are eligible for Medicare Part B reimbursements, which currently exclude pharmacists. On a state level, variations exist, with some allowing pharmacists to provide reimbursable clinical care under certain conditions.
Historically, practice agreements and legislative changes have gradually expanded pharmacists' roles, enabling them to perform tasks previously outside their scope. For instance, collaborative practice agreements (CPAs) allow pharmacists to engage in patient care responsibilities in partnership with physicians, although state laws regarding these agreements vary.
Pharmacists have played crucial roles in public health initiatives, especially evident during the COVID-19 pandemic. They administered numerous tests and vaccines, showcasing their capabilities. Efforts like the Equitable Community Access to Pharmacist Services Act aim to further integrate pharmacists into health care delivery, seeking Medicare Part B reimbursement for specific services. Despite opposition from the AMA concerning patient safety and the potential exacerbation of pharmacist workload, there's support to enhance pharmacists' roles given their extensive training.
Dr. Zahra Mahmoudjafari emphasized the significant roles pharmacists play in integrated health settings, stating the necessity of a billing mechanism for their services. Collaboration and shared responsibilities among various health care professionals form the cornerstone for optimized patient outcomes. The AMA's concerns about scope creep are acknowledged, yet effective teamwork remains the solution to provide comprehensive care. Thus, while the debate over pharmacists' provider status persists, the focus remains on collaboration and expanding health care access to ensure the best possible patient outcomes.
