IHS NATIONAL CLINICAL PHARMACY SPECIALIST (NCPS)

NCPS PowerPoint Presentation

Issue

For decades, Indian Health Service (IHS) pharmacists have practiced in a variety of expanded clinical roles to provide primary care. IHS pharmacy is widely known (in the federal sector, private sector and academia) for its innovative pharmacy practice, which includes privileges in disease management. In many IHS facilities, it is common for patients to have pharmacists providing focused medical care through clinic visits very similar to that of any other primary care providers. With this advanced level of clinical care provided by pharmacists (through expanded scopes of practice agreements approved by local facilities), it is important to establish best practices, promote uniformity among credentials and competencies, and explore appropriate reimbursement for services. As of Dec. 2008, this uniformity will now extend beyond the IHS into the Bureau of Prisons (BOP) as a Memorandum of Understanding was signed between IHS and BOP to expand the NCPS Program into BOP.

Purpose

The Indian Health Service (IHS) established a national credentialing system for IHS, Tribal, and Urban (I/T/U) pharmacists in an effort to promote enhanced patient outcomes and address the following:

• Promote uniform clinical competency among I/T/U pharmacists;
• Define and recognize advanced scopes of practice for I/T/U pharmacists;
• Establish critical elements for developing collaborative practice agreements (CPA)
• Develop a review process to approve CPAs and clinical pharmacy specialists by a national group of subject matter experts to help ensure uniformity of scope and competence;
• Review credentials, protocols, training, education and experience of I/T/U and BOP pharmacists and grant NCPS certification to recognize a pharmacist's local privileges that meet the specified national standards for credentialing;
• Establish the above elements to help promote universal recognition of NCPS pharmacists as billable providers.

Background

The October 18, 1996 memorandum from the Indian Health Service Director established IHS pharmacists as primary care providers (PCPs) and allows for privileges to include prescriptive authority. In response to a growing interest in clinical practice nationwide and meetings with key stakeholders such as the Health Care Financing Administration (HCFA), the NCPS Program and NCPS Committee (NCPSC) were established by the Chief Pharmacy Officer in 1997 and 1998 to provide a mechanism to assure that all Clinical Pharmacy Specialists in the IHS display a uniform level of competency. The provision of advanced pharmacy care follows the IHS Pharmacy Standards of Practice as outlined in Chapter 7 of the Indian Health Manual. With this official charge and history of advanced clinical care spanning over 30 years, the scope of NCPS care includes all criteria and responsibilities covered in the IHS Standards of Practice, as well as focused management of disease states for selected patients in whom medications are the principle method of treatment. Patient care may include a patient interview, chart review, ordering and interpretation of laboratory tests, limited physical assessment, prescribing medications, providing patient education, and patient follow-up. Treatment and management are performed through the approved CPA by the local medical staff. If the pharmacist is a credentialed NCPS, the CPA has also been approved by the NCPSC. NCPS certification is intended to uniformly recognize an advanced scope of practice locally aimed at managing one or more disease states and/or optimizing specific pharmacologic therapy. Pharmacists may practice disease state management at a facility after completing local requirements, however NCPS certification will only be granted after submission of an appropriate application and fulfillment of all national requirements. In order to promote uniform competency and consistency in the credentialing process, it is now also strongly recommended that all facilities adopt, at a minimum, the NCPS standards for local credentialing of pharmacists in advanced scopes of practice.

Activity

An IHS/ Tribal/Urban (I/T/U) or Bureau of Prison pharmacist may apply for certification as a National Clinical Pharmacy Specialist (NCPS) if he/she meets the national qualifications. After 11 years, the program has credentialed well over 200 I/T/U pharmacists - representing more than 20% of IHS pharmacists from 10 different states. The areas of disease management include eight distinct clinical services.

Additional Information

For additional information, please contact LCDR Mike Lee at 918-342-6298, RADM Scott Giberson at 301-443-2449, or visit the IHS intranet site at http://home.pharmacy.ihs.gov/index.cfm?module=gen_one&id=10