Archive for the ‘Policy & Advocacy’ Category

Pharmacist petition on provider status

Monday, January 23rd, 2012

As many of you are aware, El Rio pharmacist Sandra Leal, an APhA member and newly recognized APhA Fellow, is circulating a petition through the Change.org website advocating for recognition of pharmacists as health care providers.

To date, Leal has gathered more than 15,000 signatures from physicians, patients, pharmacists, and a senator from Kentucky. Her grassroots effort was profiled on January 15 in the Arizona Daily Star newspaper.

Leal works in a community health center that is a recognized medical home and has been having challenges integrating into the medical home model because the lack of provider status causes payment challenges in her work setting.

APhA has been in frequent contact with Leal to get updates from her, and we facilitated a conference call she had with a CMS representative. We have been supportive of her efforts to raise awareness about pharmacists and lack of provider status by promoting them in our electronic communication vehicles.

We’ll continue to update you as this initiative progresses.

Surgeon General supports USPHS report on pharmacists as providers

Saturday, January 21st, 2012

The U.S. Public Health Service (USPHS) recently released a landmark report identifying a “rationale and compelling discussion to support health reform through pharmacists delivering expanded patient care services.”

In an exciting development for the pharmacy profession, U.S. Surgeon General Regina Benjamin, MD, MBA, released a letter publicly supporting the report. It is notable that a high-ranking government official would get behind a report that advocates pharmacists as health care providers.

The USPHS report is already generating a buzz within the profession, and APhA will be using the report in our advocacy and practice development work. The report and the letter from the Surgeon General are available on pharmacist.com.

The report, “Improving Patient and Health System Outcomes through Advanced Pharmacy Practice: A Report to the Surgeon General 2011,” was coauthored by several USPHS pharmacists and led by U.S. Assistant Surgeon General Scott Giberson.

APhA Board of Trustees member and student pharmacist Sara McElroy is currently on rotation with RADM Giberson and was instrumental in developing communication strategies for the report and interfacing with APhA so that we were ready with a public statement and news article as soon as the report was made public.

2012: A time to unite and prove our mettle

Saturday, December 31st, 2011

The following thoughts will be published as my January 2012 editorial in Pharmacy Today.

We all know about the fight-or-flight response from pharmacology class. When threatened, though, the turtle exhibits a third response—retreating into its shell and waiting for the world to get better on its own. The ostrich, head in sand, provides another passive option for dealing with problems.

As pharmacists move into the pivotal election year of 2012, we have much to feel threatened by. Whether health care reform survives the Supreme Court and the presidential election, the inexorable wheels of change will continue turning in our professional world. As they do, we have a number of responses we can take, some more effective than others.

We can disengage from the conversation surrounding changes in health care, retreat to our caves, and hope the storms will pass, or just go through our daily motions as if nothing is happening. But what will those options achieve? As one of the mice in Who Moved My Cheese said, “I guess we resist changing because we’re afraid of change.” That’s true, but do we want to be sitting around in a few years talking about Old Cheese, or feasting on the New Cheese we’ve found?

APhA members are laser focused on finding and, when needed, fighting for the New Cheese. We see opportunity in change. We work together well, and we are capable of leading from where we stand. I’m proud of members like Sandra Leal, a Tuscon, AZ, pharmacist we featured in last month’s mini-profile in Today’s Pharmacists in Action section. She singlehandedly launched a change.org petition asking for the federal government to recognize the knowledge and capabilities of the nation’s third-largest profession by making pharmacists eligible to bill for clinical services provided to Medicare patients. Just 5 weeks later, she had nearly 13,000 signatories to her petition, including pharmacists, physicians, other health professionals, and patients. That’s the kind of response to change that characterizes APhA members. That’s leading from where you stand.

Leal’s zeal for change won’t take root without strong advocacy from organized pharmacy. We need your strength and your numbers to succeed as your advocates! The largest association of pharmacists in the world, APhA has grown well above 60,000 and our average member’s age is younger. We need your support now—that of people who care about pharmacy and want to make a difference in years to come. When we talk to Congress about provider status, we need stories and we need numbers. It will be a fight, but it’s a fight we can win if pharmacists across America are willing to support the effort. Whatever other New Year’s resolutions you’re working on this year, please add this one to your list: I will support my profession by joining and getting involved in APhA, my state association, and another pharmacy group that supports my practice setting.

In turn, and along with the incredible APhA staff team, we promise that we will make the most of APhA members’ time, money, and energy as we fight for a better world for pharmacists.

Pharmacy is at the table

Friday, December 16th, 2011

Today I participated in an invitational roundtable discussion on clinical leadership in health care reform at the Brookings Institution, a leading think tank in Washington, DC. The other invitees were primarily physicians from 12 leading physician organizations, as well as nurse practitioners and nurses.

I shared with the group that, while the number of pharmacists in the US is only about one-quarter that of physicians and about one-tenth that of nurses, most Americans are in a pharmacy several times a month and have ready access to us. While we are in an uncomfortable place between building service offerings (medication therapy management) and finding payment for those services, we have a medication use crisis and there are very few incentives to fix that crisis, despite pharmacists being readily accessible and well trained. Also, we typically make a significant number of referrals to our medical colleagues in the course of our practice.

I further shared that I’ve been encouraging pharmacists to “walk across the street” and talk with physician colleagues about their approach to accountable care organizations and medical homes or medical neighborhoods. We should consider organizing joint listening sessions to learn more, and then to discuss in an interdisciplinary way the best approaches to integrated care delivery. It will only change if it changes at the practice level. I also shared that we have a growing workforce, well trained to integrate with physicians in medication management, but that we need help and cooperation among our physician colleagues to build the business models.

We MUST agree on principles for collaborative practice if we are going to avoid the typical turf wars that occur in state houses around the country when one discipline or another wants to change a practice act. And we must create incentives for all. I shared that incentives are not just about driving selfish action, but are primarily about a system describing through incentives the behaviors and outcomes desired.

I shared, too, how the lack of provider status was not only hurting our profession, but also the medical profession and health care in general. If we pursue it, we will face a major war absent up-front agreement in principle, but all have much to gain, as many of the services we provide will likely be done through physician practices and will lead to gains in improved patient care.

We had a chance to discuss each of these points, and I felt there was agreement that all of these topics were worth continued dialogue. I did not hear any disagreement. While there’s no cause for celebration just yet, I think it’s fair to say that pharmacy is at the table.

Thought you’d like to know.

Petition seeks recognition of pharmacists as providers under Medicare

Tuesday, December 13th, 2011

APhA member Sandra Leal—a true patient care rock star—has organized a petition on Change.org to raise awareness that pharmacists need to be recognized as health care providers under the Social Security Act to be paid by Medicare for their services.

According to our pharmacist.com news article, Leal believes people should sign the petition because now—while health care reform is being implemented—is a “critical time to assert ourselves as pharmacists.” So far, the impact of the petition has been to educate people that pharmacists do not actually have provider status. She hopes to reach 10,000 signatures, a realistic goal considering that more than 7,000 pharmacists, physicians, patients, and legislators have signed the petition since it started on November 15.

Leal told pharmacist.com that she will keep the petition open until she receives enough signatures to make a difference. Sign on in support!

 

At Thanksgiving, rough seas and a nearing shore

Wednesday, November 23rd, 2011

There were several emotive responses to one of my recent blog posts. I read each comment several times to not only get the words, but to put myself in the place of the writers. The general point made was that front line pharmacists face difficult challenges in their long shifts. They have to balance the demands of management, the requests of patients and caregivers, the endless stream of phone calls, and the constant denials and information requests of third-party payers, all while supervising the work of pharmacy technicians and student pharmacists. When I suggested that a large pharmacist employer was pursuing new initiatives, several folks took issue.

At this time of thanksgiving, I’m grateful for these comments and have great respect for the perspectives of my colleagues. It wasn’t that long ago that I was there. At different times in my career, I have been an employee, a manager, and an owner. As an employee, I too sometimes felt I didn’t have the help and support I needed. Even in management and ownership, life as a pharmacist can be challenging, and at times overwhelming.

Despite our challenges, I hope we can all see that we have the talent, insight, and innovative spirit to create a better world. My sole purpose in sharing my observations was to stimulate others to think about their own opportunities. Change is never easy, and we all know how hard it is, for example, to add immunization services on top of everything else we do as pharmacists during our 12-hour shifts. MTM programs take time to develop and even more time once implemented. But we know—somewhere deep inside—that while we continue to dispense safely and accurately, our pharmacy services must grow. “Buy low, sell high” is broken. Margins will never get better on either brands or generics. Chains, independents, and specialty pharmacy owners need to find other ways to pay for the services we know patients need. While we fervently pursue recognition and value (read “compensation”) for our services, we must embrace technology and certified paraprofessionals to give pharmacists the time needed to develop new services and new skills for the pharmacy workplace of the future, if we are to have a relevant role there.

As I wrote in Chain Drug Review earlier this year, we in pharmacy are in an uncomfortable place. Times are challenging, and we’re not yet where we need to be. We have the opportunity to be the disruptive positive force in health care. We have the skills and ability to address the medication-use crisis in this country. I hope we can continue to talk about our profession’s internal challenges while simultaneously pursuing change in the system to allow us to practice the way we’ve been trained. We have a bright future as a profession. The question is not whether change is real or inevitable—it’s how are we going to manage that change.

I recognize these challenges and those faced by those who commented about my blog. I hope we can all focus our passions on positive change. We need all pharmacists as members of APhA, and I wish everyone could attend one of our meetings to see people being the change they want for our profession.

It’s not easy, and APhA will be there to help with this transition. The tide is rising and people are noticing. If we can keep our boats intact as we navigate these rough waters, we will all find ourselves in a much more comfortable place than many imagined.

Happy Thanksgiving, everyone!

President targets drug shortages

Thursday, November 3rd, 2011

On Monday, President Obama signed an executive order directing FDA to take steps to curtail prescription drug shortages. Highlighting the potential serious and growing threat to public health, the order focuses on getting manufacturers to provide FDA advance notice of shortages, accelerating FDA regulatory reviews for drugs that can help with existing or potential shortages, and requiring FDA to report drug stockpiling or price gouging related to shortages to the Department of Justice for possible prosecution.

APhA is very concerned about drug shortages and their effects on patients. APhA supports both FDA’s work on addressing drug shortages as well as the American Society of Health-System Pharmacists’ (ASHP) efforts in leading pharmacy on this issue. Additional information on drug shortages is available on FDA’s and ASHP‘s websites. For more information, read these articles on APhA’s pharmacist.com:

Obama executive order addresses shortages
Drug shortages bill considered by Congress

Trustee Dan Buffington of Tampa was interviewed on local television about the shortage issue as part of the ABC affiliate’s coverage of the presidential order. In the segment, Dan provided a broad overview of the shortage problem, and Brian Coleman, pharmacy buyer at Florida Hospital Tampa Bay Division, told viewers about the impact of the shortage on patients at his facility.

My thanks to APhA staff member Diana Yap for actively monitoring the release of this information and Tiffany Bridge for live-tweeting as HHS Secretary Sebelius, FDA Commissioner Hamburg, patient Jay Cuetara of San Francisco, and pharmacist Bonnie Frawley of Boston were speaking in advance of signing of the executive order.

Pharmacists are more than just medication dispensers

Tuesday, October 25th, 2011

Recently, some high-profile, controversial comments were made regarding automated dispensing technology and the role of community pharmacists.

On the surface, it may seem that comparing an automated machine with a real, live human is just about efficiency. But these comments are just one piece of a much larger conversation about how we can increase accuracy and reduce medication errors through the adoption of empowering technology and thus allow pharmacists to do all the great things we can do to improve patient care.

The reality is that, as all pharmacists know, machines are only as efficient and accurate as the humans who program and use them. As our colleagues at the National Community Pharmacists Association point out, there are many things pharmacists can do, and are doing, that a machine simply cannot. While nearly all pharmacies in America use Certified Pharmacy Technicians to hand prescription medications to patients, others use mail carriers. All pharmacies use pharmacists—and only pharmacists—to provide patient counseling, and often to each others’ patients.

Community pharmacy plays an important role in patient care. Pharmacists are more than just medication dispensers, or as aptly put by a major chain CEO in Monday’s Wall Street Journal, we’re about more than pills in a bottle—we’re about improved patient outcomes:

  • We counsel patients on drug interactions, side effects, safety, and efficacy of the medications they take.
  • We advise patients on how to use OTC medications and supplements safely and effectively, often in conjunction with prescriptions.
  • We hold conversations with patients on why they have to take a medication as directed and why the medication is important.
  • We evaluate medication histories and catch potentially serious dosing and interaction problems.
  • We counsel on managing chronic conditions.
  • We immunize.
  • We work with the patient’s physicians to clarify, adjust, and advise regarding therapy, and to help problem solve when patients can’t afford their medications.

Community pharmacies are handling dramatically increased volumes by adopting enhanced technology, employing and training highly qualified technicians, and adopting systems to identify opportunities for assisting prescribers in recognizing opportunities to optimize therapy. In short, there’s more than one pharmacy in America that is focused on accurate dispensing and making difficult calls to prescribers.

At APhA, we are here to work for you by doing the following:

  • Developing business models for patient care that promote collaboration between payers who have an interest in improving care and lowering all costs, not just medication costs, and the pharmacists who can help achieve those goals
  • Supporting community pharmacy residency sites that often serve as incubators for innovative practices
  • Publishing the research and stories of innovative practitioners so others can learn and adopt new strategies for improved safety and outcomes
  • Promoting the essential role of the pharmacist to the public, so that the cognitive and special services you provide are fully known to the patients who walk into your pharmacy
  • Advocating for the pharmacist among regulatory and legislative bodies to make sure your work is recognized in health care bills and with regulatory bodies including CMS and FDA
  • Providing you with continuing education opportunities, so that you may continue to provide new and innovative services to your patients as our industry changes
  • Working with the Pharmacy Technician Certification Board to make sure that U.S. pharmacy technicians are highly trained and qualified

The conversation about how to decrease medication errors is an important one that must continue. Automation technology is an important tool that can increase accuracy and keep patients safer. However, it’s just an adjunct, not a substitute, for the judgment, training, and care of patients’ most accessible health care provider: their pharmacist.

Opportunity knocks: CMS Innovation Advisors Program

Tuesday, October 25th, 2011

Are you innovative? Do you influence the care patients receive in a health system through quality initiatives? You’re invited!

A new initiative announced by the CMS Center for Medicare and Medicaid Innovation is accepting applications for the Innovation Advisors Program from providers in health systems and any professional employed by a public health or health care facility, institution, or department.

The idea is to engage folks to refine, apply, and sustain the managerial and technical skills necessary to drive delivery system reform. Medicare, Medicaid, and Children’s Health Insurance Program beneficiaries want your help. The program will allow skilled individuals in the health care system to deepen key skill sets, including health care economics and finance, population health, systems analysis, and operations research.

The selection criteria for applicants include career achievements; their pre-existing skill set and its relevance to transforming the health care system for these beneficiaries; the quality of a proposed innovation project in their home organization; their organization’s explicit commitment to their work; and management experience.

As many as 200 Innovation Advisors around the country will be selected and developed in the program’s first year, and their home organization or group will be eligible to receive a stipend of up to $20,000 to support their activities, including travel.

The first group of Innovation Advisors will start a 6-month intensive orientation and applied research period in December 2011. During the initial 6-month period, advisors will commit up to 10 hours per week, with similar or less involvement thereafter. They’ll meet together at the regional level each quarter and at CMS in Baltimore once each year. Advisors will not be employees of CMS or the government.

The deadline to apply is November 15. Innovation Advisors will be notified of their selection by mid-December 2011.

It’s critically important that pharmacists from a variety of practice settings apply for this program. APhA encourages pharmacists to participate. Please let us know at iqi@aphanet.org if you intend to submit an application!

Thank you to students, residents

Wednesday, September 14th, 2011
CEO Tom Menighan with U.S. Surgeon General Regina Benjamin, head of CDC Dr. Tom Frieden, and students from DC-area pharmacy schools

Yesterday was a good day for raising America’s consciousness about the value of pharmacists with U.S. Department of Health and Human Services (HHS) Secretary Kathleen Sebelius and many others in the Obama administration. My blog post yesterday provided some background on the Million Hearts Initiative that HHS launched with our support. Today’s photo shows how well pharmacy was represented at the meeting. You’ll notice, in front of the group of students and residents, U.S. Surgeon General Regina Benjamin, MD, MBA, and Tom Frieden, MD, MPH, the head of CDC. Both were impressed that we got so many students to the event, and both had great things to say about the essential role that pharmacists play in the promotion of cardiovascular health in this country.

I’d like to thank each of the students and residents who participated. As is always the case in advocacy work, just showing up is huge! I listened to a number of conversations that were going on around me after the formal event, and I was highly impressed with how well our students can speak about patient services with Don Berwick, MD, MPP, from CMS and Janet Wright, MD, a cardiologist who has been tapped to lead this initiative. Here’s a tip of the hat to all those who have a role in teaching these wonderful representatives of our profession.