Excitement in the air

November 12th, 2009

Bill Ellis just pointed out, and I agree with him, that there’s a real feeling of excitement in the air here at APhA headquarters.

Tomorrow, we’re hosting our building dedication ceremony. Folks here are sprucing up, and the caterers are loading in. Tropical Storm Ida can’t hold us down. Soon, we’ll have more than 400 remarkable supporters who helped us build the vision that John Gans and dozens of board members and leaders have had for almost 20 years. I’ll write more about the event after tomorrow, but right after the Dedication we move into a board meeting, so it may be a few days before I get to it. I’m sure there will be photos on pharmacist.com.

Thanks to Dr. Gans, all the staff, and our volunteer leaders for their hard work and dedication, and for putting up with all the detail-oriented people who had to make hard decisons about sometimes seemingly trivial things. When you stand back, and look at the entire picture, it is clear to me that sweating all the details was worth it. It’s time to stop for a day and celebrate!

Celebrating America’s veterans

November 11th, 2009

We marked Veterans Day with a ceremony at APhA headquarters, one made all the more meaningful by the events of last week at Fort Hood.

Reflecting on those who are serving or have served our country, I recalled an October visit I made with APhA staffer and former Navy pharmacist Duane Tackitt to the National Naval Medical Center in Bethesda, MD. For the American Pharmacists Month celebration, we were hosted by NNMC Pharmacy Chief, Commander Tingh (Tin) Ha, MSC, USN.

After a tour of the pharmacy facility and a visit with some troops in the BTC (Brain Trauma Center), I met with the NNMC Commander, Rear Adm. Matthew Nathan, Medical Corps, USN. Nathan is in charge of NNMC and also the merger of the Walter Reed Army Medical Center and NNMC. The logistics, personnel, and systems issues are daunting, but I was impressed with Nathan’s clear understanding and direction.

Back at NNMC, we had lunch and a follow-up meeting with the pharmacy leadership, including Cmdr. Ha; Lt. Ben Schwartz, Assistant Chief, HMC (Chief Petty Officer); and Robert Wagenman, Pharmacy Technician Advisor to the Pharmacy Specialty Leader. Together with a number of volunteers from all walks of life — including pharmacists and technicians — these sailors provide excellent pharmacy services to active duty and retired Navy personnel and families in the area. To a person, they exuded pride in their work and a determination to serve their patients and our country.

Many of the professionals I met have been or will be in harm’s way to support our troops, who are themselves in danger wherever they are serving. Our colleagues in uniform deserve our continued support. It was a privilege to meet them last month and to honor America’s veterans today.

HR 3962: Affordable Health Care for America Act vote is imminent

November 7th, 2009

By the time you read this, the House may have voted on the AHCAA. Debate on amendments is under way as I type this.

We’ll follow up with analysis as we learn more. Check it out at www.pharmacist.com.

This proposal has many pharmacy-friendly provisions that we support. I also understand an importation amendment that we would oppose was not allowed during votes in the House Committee on Rules on Friday.

What a month!

November 6th, 2009

I talk with other executives around town, and they all agree that this time of year is more intense than any other. I thought it would be fun to just share a glimpse at my last 30 days working on your behalf.

During this time, I’ve visited four school of pharmacy campuses, one state association meeting, two federal facilities, five senators’ offices, Institute of Medicine, the annual meeting of the Pharmacy Compounding Centers of America, 8 pharmacies, CMS to meet with the number 2 person there, the Joint Forces Pharmacy Seminar, several APhA client meetings, the NCPA meeting, the new Trustee orientation for those joining the board in March, and a West Virginia University football game against the University of Connecticut (well, maybe that one wasn’t on your behalf, but it was remarkable for the sportsmanship since it occurred just after UCONN lost one of its players to unnecessary violence).

I also participated in the Pharmacy Compounding Accrediation Board meeting, the Joint Council of Pharmacy Practitioners meeting, and an APhA Foundation board meeting. This weekend, I’ll finish it off with a Midyear Regional Meeting in New Brunswick, NJ.

Along the way, I figured out how to use Windows Live and webcams so I can help with my 14-year-old nephew’s homework face to face while I’m on the road.

Despite the hectic pace, I am more thankful than ever for the opportunity to serve this organization and its members. Thanks to all of you who shared your thoughts with me this month. I took a lot of notes.

American Pharmacists Month: Visiting Ukrop’s Pharmacies

November 5th, 2009
Tom Menighan Receives His Seasonal Flu Vaccination From Pharmacist Jessie Evans

Getting my seasonal flu immunization from Ukrops pharmacist Jessie Evans

APhA Trustee Kelly Goode and I last month had the opportunity to visit Ukrop’s Pharmacies in the greater Richmond, VA, area. John Beckner, Pharmacist and Director of Pharmacy and Wellness, hosted us for the three-store visit on October 16.

While each location had a generally similar feel, the pharmacists and technicians were proud of their unique services, their teamwork, and perhaps most importantly, their connection with their patients. One store offered an extensive travel immunization service that was being tested for ways to extend it to other stores via a “hub and spoke” process. Other stores conducted extensive MTM. All were heavily involved in influenza vaccinations.

I received my seasonal flu shot from pharmacist Jessie Evans and gladly paid my fee!

At APhA, we get questions about the scalability of MTM all the time. We also get questions about whether most pharmacists even know what the services include. Ukrops is just one example of many—as evidenced on the pharmacist.com MTM map —where MTM is a major part of practice.

To everyone who is doing the work—keep it up. You are making a difference!

Talking MTM and the clinical role of pharmacists at CMS

October 27th, 2009

On Friday, I went to the Centers for Medicare & Medicaid Services (CMS) to meet with CMS top leadership ─ Acting Administrator Charlene Frizzera and several of her key Medicare staff. I had the opportunity to introduce her to APhA, our top priorities related to Medicare, and the clinical role of pharmacists. We highlighted APhA’s MTM resources, our support for the expanded MTM provisions in the 2010 Medicare Part D plan year and the CMS proposed rule (released the day before), and our interest in working together with CMS to address MTM implementation challenges, both in the current Medicare program and in new provisions that may be a part of health care reform.

I’ve heard from many MTM practitioners that inconsistencies among various billing systems are one of the biggest challenges we face in broad deployment. Thus, I was pleased that the CMS staff was interested in better understanding MTM billing and documentation challenges and in helping to address these issues. CMS seemed interested in working with us to improve the situation with the plans.

We also highlighted the success of pharmacists providing immunizations and using this model to expand beneficiary access to preventive services, such as diabetes screening. I appreciated that CMS recognized that the clinical role pharmacists could play is limited by the lack of Medicare Part B status. CMS also acknowledged “provider status” as being a big lift.

CMS appreciated that APhA expressed our support for e-prescribing while continuing to point out the challenges with the quality of e-prescription and the time that pharmacists spend fixing or clarifying e-prescriptions. We will continue to explore ways to work with CMS and other stakeholders on e-prescribing quality improvement.

We also used the opportunity to express to CMS our support for efforts to reduce medication waste through utilization management (first-fill) techniques. I also noted the need to work together to ensure that such initiatives in any practice setting work for patients, pharmacists/pharmacies, and CMS.

We’re staying close to CMS and working hard to be there when regulators begin to focus on whatever bill the White House ultimately signs regarding health care reform.

REMS for opioids put on hold

October 19th, 2009

In today’s Federal Register, FDA reopened the comment period for its Risk Evaluation and Mitigation Strategies, or REMS, for certain opioid drug products. The new deadline for comments–a year from today, 10/19/2010–indicates that no action will be taken for a long while.

The move shows that the agency recognizes the problems identified in the comments filed about the development of an opioid REMS, which has important implications for the daily practice of pharmacists, is rethinking its approach, and reflects the impact of the nearly 2000 comments that FDA received on this topic. APhA was a key voice in calling for modifications to the REMS plan.

In the notice, FDA wrote that it recognizes the challenges and need for an opioid REMS to be “carefully designed” (due to the number of prescribers, pharmacists, and patients involved with these medications) and the need to ensure a REMS does not unduly burden the health care system or limit patient access.

We will monitor this development and keep you posted as needed.

Are you ready for community pharmacy practice standards?

October 16th, 2009

You are invited to read my editorial in the October Pharmacy Today, due to arrive on your doorstep any day and available online. Since before I returned to APhA staff in February, I’ve been monitoring various groups’ interest in the creation of standards for community pharmacy practice. Some will call them best practices, while others will speak of accreditation of either pharmacies or pharmacists. I’ll share with you that at least three national organizations, none with a pharmacist membership, are interested in the creation of these standards.

The 2015 Vision for Pharmacy, put forth by the Joint Commission of Pharmacy Practitioners, “sees” pharmacists as autonomous and accountable for outcomes. To get there, I argue that we must take a leadership role as a profession and establish our own standards, rather than waiting for it to be done to us. In my editorial, I challenge you to think about that. Are you ready?   By writing this editorial, I intended to stimulate discussion, and I invite you to comment here. While I editorialize a bit — that’s my job — I am really very interested in what you think.

Traffic report: APhA numbers increasing

October 14th, 2009

We all hate to run into heavy traffic on the roads, but when looking at Web and readership of journals and magazines, increased “traffic” is a good thing. At APhA, we’ve been gratified at the rapid growth and visits to www.pharmacist.com, Facebook, Twitter, and this blog. Since July, our unique visits and time spent on our pharmacist.com “pages” has been increasing as well.

I get reports that readership and citations of our APhA periodicals are increasing. While not directly related, I think it’s relevant that our Political Action Committee contributions have doubled over last year as well. Attendance in our certificate programs like MTM and immunization are “through the roof” this fall.

All of these are positive signs, but we are just getting started. Your membership is incredibly valuable to our long-term ability to serve the profession. And our PAC is becoming increasingly important in our efforts to stay connected on the Hill. With pharmaceutical company sponsorship down, our ability to attract readers to our publications is more important than ever to sustain the provision of excellent content for pharmacists. Thanks for your continued support. We couldn’t be this successful without you.

HCR update: APhA’s current objectives

October 13th, 2009

Now that all five Senate and House committees have completed their work on health care reform (HCR) bills, we feel good that medication therapy management (MTM) provisions are included in some form in each version. They are not ideal, but the bills represent a good start at ensuring Americans’ access to pharmacists’ MTM services, in addition to our dispensing of medications.

The merging of House proposals and the merger of Senate proposals must occur before each body debates and votes on HCR bills. If each chamber approves HCR legislation, a conference committee will then take a shot at merging the two bills into one for final passage and consideration by President Obama.

APhA is now engaged in seeking improvements to language that clarifies what we believe to be the intent of legislators. We want “pharmacist-provided” or similar language added in several places where the term “MTM” appears. We also will present the data that pharmacists are effective in identifying medication problems.

In addition, we will seek to keep MTM in both the CMS Innovation Center and as a stand-alone grant program. As an alternative, we will ask that at least one of the MTM models tested in the CMS Innovation center be pharmacist-specific.

We want to ensure that the lack of Part B payment doesn’t preclude pharmacists from participating in programs. We don’t want a poor payment policy to limit patient access or hamper best practices.

We are encouraging prevention and wellness programs such as diabetes screenings, and we are seeking transition of care (hospital to home) programs that recognize pharmacists’ essential contributions. Currently, some believe that hospitals can’t bill for those services now if provided by pharmacists, so nurses are used instead.

We want any integrated care models that emerge from HCR to ensure that pharmacists are part of any team that involves medication management. As our VP of Government Affairs Kristina Lunner likes to say, “You like Asheville?  You like General Mills?  Well then, you need a pharmacist.”

We are supportive of NACDS and NCPA efforts to fix AMP and provide relief from accreditation to certain qualified pharmacies that want to provide DMEPOS.

Keep up with all this and more on our Health Care Reform Hub. Frequent updates on HCR keep you informed about the latest pharmacy-related action on Capitol Hill.