Over the last several weeks, if you’re like me, you been reading and listening to the Health Care Reform debate in the House and Senate while President Obama pushes both to stay focused on the completion of legislation for his signature. As detail gets added to proposals, more opportunities for discord develop. Americans generally agree that our system could be better, but doubts about the cost and the specter of rising taxes are being voiced.
I have heard similar concerns from our members, some of them expressing vehement opposition to the cost of HCR. Yet, this opposition has not risen to a level that suggests to me that APhA should oppose reform. Rather, I have kept us focused on the offensive — pushing for inclusion of pharmacists’ SERVICES in any reform model. Thus far, we’ve been successful in getting pharmacist-provided MTM plugged in.
I’ve talked with many pharmacists at meetings the last few months. The sense I get from them is that we are on the right course. This blog is yet another channel for you to express your thinking. I hope you’ll take advantage of the opportunity and share your views.
On the contrary, I have also spoken to and work with many Pharmacists and health professionals over the past several months and the prevaling question is “What are we really getting in HCR?” The answer is nothing of value. MTM while laudible is being funded through grants, not direct payments for service to Pharmacists. In fact, medicaid reimbursement in the current bill in senate Finance will cut payments to Physicans, while forcing individuals to use a single-payer plan. As many of us who read the newspaper and listen to media reports understand, there is no consensus on HCR, only a rush to pass a bill that has not been fully vetted or understood. The presidents poll numbers continue to drop and the American public along with health professionals are increasingly skeptical. That includes pharmacists. “Plugging in” MTM means nothing if you are not being reminbursed for this service. Especially for something that most Pharmacists know works well to controll cost and provide a continuity of care that improves patient health. Many Pharmacists remember being left out of Medicare Part D. It’s important to remember that grants are not direct payments. Many states have recently passed, had signed in to law services that Pharmacists will now be reimbursed for. http://www.azcentral.com/news/election/azelections/articles/2009/07/19/20090719politics-vaccines0719.html States understand the demand and the need on the ground better then the beltway. That’s real progress you can believe in.
Mark’s observations and concerns are valid. Poll numbers do suggest that broad HCR is not a “slam dunk” and I too am concerned about financing. It is also true that some states are being successful in attaining specific reimbursement for services provided by pharmacists and I applaud those successes. APhA and the coalition of national pharmacy groups, including the NASPA, NACDS and NCPA, worked hard to get specific payment language in committee proposals in the House and Senate. We agree that direct payment is the best approach.
However, it wasn’t going to happen and we had to make a strategic choice to either oppose reform altogether and risk getting shut out as the “opposition” or focus on getting what we could for pharmacists to continue the quest for services recognition. We chose the latter. The medical home concept was the consensus approach to primary care. We needed to get recognized as a service provider within that home. Yes, there will be negotiations among physicians, pharmacists, and other providers for payments to medical homes. I recognize not everyone agrees. That’s what makes our country great. Thanks to Mark for his dissenting view.
BTW, pharmacists have opportunities in Part D and those opportunities will improve in the coming year as plans are mandated to upgrade pharmacists services.