While the current congressional debate largely focuses on healthcare insurance coverage, the availability of primary care services 1 is another important issue that we face in Pulaski County. The Association of American Medical Colleges projects that by 2020, there will be up to 94,000 fewer physicians than needed to meet the demand for care in the United States. The impact on the physician shortage is particularly felt in rural areas, such as Pulaski County, where many primary care providers are nearing retirement. As a hospital pharmacist, I’ve seen the difficulty in recruiting new physicians of all types (hospitalists, general surgeons, orthopedic surgeons, emergency department physicians). For instance, a local medical practice with 5 physicians as recently as 5 years ago is now down to only 2 physicians.
As a result, the hospital emergency room frequently serves as a proxy primary care provider, particularly for uninsured patients. Another contributor is the lack of urgent care centers 2 in the county, a contrast to both Montgomery County and Radford City, who have 3 and 1 urgent care centers respectively. A likely deterrent for companies to open an urgent care center in Pulaski County is an unfavorable payer mix due to county demographics of both elderly and the uninsured. Elderly patients, who are primarily ensured through Medicare, equate to a lower reimbursement than many private insurance companies. For uninsured patients, no payment may ever be received and emergency medical services charges are written off by facilities. As a result, healthcare offices often refuse to accept new Medicare or Medicaid patients in fear of losing money providing care. This can easily seem inhumane, but hospitals and healthcare office face the real threat of closure; a 2014 estimate predicted that up to 1 in 5 hospitals in America would close by 2020.
A potential bipartisan solution is the Pharmacy and Medically Underserved Areas Enhancement Act (HR592/S109). The bill would amend section 1861(s)(2) of the Social Security Act, enabling Medicare beneficiaries access to pharmacist-provided services under Medicare Part B. Services would be reimbursable under Medicare Part B if they are provided in medically unserved areas. Much of Virginia, including Pulaski County, is considered a medically underserved area/population. Consistent with other non-physician providers, reimbursement would be 85% of the physician rate.
Pharmacists are both readily accessible and qualified to assist with medication-related issues. Pharmacists are often ranked among the top trusted health professions and are integrated in the communities that we serve. Pharmacists now receive doctoral training and many complete residencies and board certifications modeled after medical school education, which can exceed that required to become a nurse practitioner or physician’s assistant. My personal resume includes a bachelor’s degree in chemistry, a doctorate of pharmacy, a master’s degree in institutional pharmacy leadership, a year of residency training at a large hospital in Washington, DC and a board certification in pharmacotherapy.
Services could include health and wellness testing, administering immunizations, and titrating medications for blood pressure, cholesterol or blood thinners such as Warfarin (Coumadin®). Pharmacists have provided these services for many years in settings such as hospitals and within the Veterans’ Affairs system, including outpatient clinics. One landmark change in the bill is that it would be the first time that pharmacists would be officially recognized as providers at the Federal level.
While a potential opposition to the bill is the debate over the cost (more care provided even with the lower reimbursement rate), the considerable cost avoidance through expanding preventive care services must be considered. Healthier patients would need fewer medications long-term and require fewer hospital readmissions. Perhaps most importantly, ethically Southwest Virginians (and all rural Americans) don’t deserve 2nd rate care or lack of any healthcare services at all. Currently, there is much bipartisan support, equally distributed by party, made up of 146 cosponsors in the House (including Morgan Griffith) and 33 cosponsors in the senate (none from Virginia).
After the no vote on the “Repeal and Replace” Act or ACHA, a shift in focus on areas of agreement would be a welcome change.
Disclaimer – any opinions expressed here are my own and do not represent the views of my employer or any healthcare organization.
- Primary care includes health promotion, disease prevention, health maintenance, counseling, patient education, diagnosis and treatment of acute and chronic illnesses.
- Urgent care centers provide care for less severe ailments than emergency rooms and often have expanded hours when compared to physician offices.