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Blood, Sweat, and Tears: Wasted by Medicare's Missed Opportunity

Medicare’s failure to include clinical pharmacists among its list of providers is costing the United States health care system several billion dollars annually and is contributing to several hundred thousand strokes, heart attacks, and deaths each year. The recent report by Drs. Bond and Raehl adds to the extensive data of more than 100 articles supporting this waste. Their report found that the absence of clinical pharmacy services for hospitalized Medicare patients requiring anticoagulation cost more than 60,000 units of blood, $3 billion (sweat) in additional hospital charges, and more than 25,000 avoidable deaths (tears) annually for Medicare patients alone. As sobering as these findings are, it should be recognized that even more patient harm and waste are occurring in non-Medicare patients, ambulatory patients, patients receiving other forms of medical therapy, and millions of patients who are not receiving recommended therapy. The failure of Medicare to recognize clinical pharmacists as providers is the primary reason that these benefits are not being realized by most patients in the United States and by the U.S. health care system. In some instances, other professionals (who are not as well trained to provide clinical pharmacy services) are being used, under clinical pharmacist supervision, because the provider status of these other professionals allows them to bill Medicare. Failure to recognize clinical pharmacists as providers under Medicare severely limits the provision of these services and, thereby, harms and even kills thousands of patients annually, increases health care costs, limits the return on the resources invested in clinical pharmacists’ education and training, and represents an unfair business practice within the health care arena. What possible justification can there be for not allowing clinical pharmacy professionals to provide the beneficial and cost-saving services for which they are trained and licensed? In view of the available data, one has to question how Congress, Medicare, the pharmacy profession, and any other group committed to improving health care can allow such extensive waste and patient harm to continue. Legislation to secure Medicare provider status for clinical pharmacists was introduced in 2001 in both houses of the U.S. Legislature (House bill HR2799 and Senate bill S974), but neither bill made it to the floor for a vote. In its June 2002 report to the Congress, the Medicare Payment Advisory Commission gave a favorable review to the issue of having Medicare pay for clinical pharmacy services; in June 2004 House bill HR4724 was introduced in a renewed effort to secure provider status for clinical pharmacists. At the time of this writing (October 2004), submission of a similar bill in the U.S. Senate is pending.