Archive for the ‘Policy & Advocacy’ Category

Talking MTM and the clinical role of pharmacists at CMS

Tuesday, 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.

Are you ready for community pharmacy practice standards?

Friday, 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.

HCR update: APhA’s current objectives

Tuesday, 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.

Your direct link to the White House

Thursday, October 8th, 2009

Pharmacists, please join me in making our collective voice heard at the White House! If you have an account on LinkedIn, log in and then click on the below link. Review APhA’s core messages on health care reform, and pick one or two points through which you can blend the big health care problems in your state with your professional experiences. Go back to LinkedIn and type a short passage that shows how important your patient care services are. Office of Health Reform Director Nancy-Ann DeParle is waiting to hear from practicing pharmacists about the key role we are playing as primary caregivers. Don’t let this opportunity pass us by!

Dear Tom,

LinkedIn is working with The White House to provide you with a unique opportunity to have your voice heard as a medical professional. The White House is interested in the most important perspective on health care: yours.

Office of Health Reform Director and Counselor to the President Nancy-Ann DeParle asks: “What is the biggest health care problem in your state?”

The President is asking for your feedback! Provide Ms. DeParle with your questions and concerns, and some of them will be addressed in an upcoming webcast.

Sincerely,
The LinkedIn team

Yesterday’s surgical strike

Wednesday, September 16th, 2009
APhA Takes to the Hill for Health Care Reform
Nancy Alvarez (APhA Board of Trustees) and Patricia Epple (Executive Director, Pennsylvania Pharmacists Association) with Rep. Tim Holden (D-PA).
APhA Takes to the Hill for Health Care Reform
Florida Pharmacy Association Executive Director and CEO Michael Jackson and APhA President Ed Hamilton in front of the U.S. Capitol

On Tuesday, a group of 18 APhA Trustees, representatives, and state pharmacy association executives spent the day on Capitol Hill conducting what one executive director described as a “surgical strike.” The group was selected based on their Senators’ and Representatives’ membership on key committees. We spent the day working with members of the Senate and House to assure that the key MTM provisions are secure as currently present in the Senate HELP proposal and the House Energy and Commerce proposal. We also worked on an AMP fix, DMEPOS Surety Bond relief, workforce support, and other key pharmacy issues.

This group of motivated folks volunteered their time to be here on behalf of all American pharmacists. For that I am grateful, as all readers of this blog should be. Also, I would like for you to commit to making contact with your own representatives STAT should we get word that any of our provisions are in trouble in the coming debate. We’ve made this plea in the past, and we may make it again in the future. Nothing is assured until legislation is passed. Of course, we will then gear up our work with CMS to assure that regulation is workable and in the best interests of our patients as the statute is operationalized through regulations.

International Pharmacy Federation: The world stage

Thursday, September 10th, 2009

Yesterday, I returned from the International Pharmacy Federation meeting in Istanbul, Turkey. The FIP meeting was attended by nearly 2,000 pharmacists and scientists from literally all around the world. As I spoke with pharmacists from Turkey, Australia, Japan, the Netherlands, Portugal, China, Canada, the UK, Sweden, India, and many other countries, I noted the influence American pharmacy has had on the world stage. In many countries, pharmacists are far more politically effective than we are, and there are certainly innovative practice leaders who shine and lead their country’s practitioners to higher ground. American pharmacy too can be proud of our innovations and the interest others have in what we’re going to do next. 

Despite our current apoplexia over health care reform, or health insurance reform as it is now being called by the White House, we are blessed in the US with resources well beyond those enjoyed in most countries. Together with other developed countries, we need to continue to lead and listen, as others show us new and better ways to help our patients get the most from their pharmacist experience.

Obama speech heads up

Wednesday, September 9th, 2009

Check your local listings. According to Politico, President Obama is “set to strongly endorse a public insurance option before Congress tonight but stop short of an ultimatum, leaving room for negotiation. Reaching out to the GOP, he plans to acknowledge a problem with malpractice litigation.” For APhA’s coverage of the speech, watch your Twitter feed and Facebook page, or check pharmacist.com about an hour after the President completes his address from the chamber of the House of Representatives.

Next Monday and Tuesday (September 14 and 15), APhA will host a Hill “fly in” with a group of nine state pharmacy association executives and a number of our elected leaders. We will carry the message again to our own Congressmen and Senators that pharmacists’ services must be a part of any health reform package.

Town hall meeting in Ohio – Guest blogger Ernie Boyd

Wednesday, September 9th, 2009

On Tuesday, August 25, Ernie Boyd was one of four panelists at a local health care reform town hall meeting sponsored by AARP in Wintersville, OH. Below is an excerpt of the report from Ernie, who is executive director of the Ohio Pharmacists Association. I thought it captured the spirit of the debate that this past month has witnessed.

Wintersville is a small town on the eastern border of Ohio, a beautiful area of hills and lakes. A herd of deer crossed the road at 5 am as I made my way to the meeting. I had spoken previously at a town hall meeting in the Congressman Charlie Wilson’s (D-OH) 6th District after he introduced legislation to correct the tamper-resistant prescription problem. That meeting was attended about 60 people, and there were some questions, with the Congressman handling a wide range of issues. He has recently moved to Congress from the state legislature, where we interacted rather often. 

I assumed that the meeting in Wintersville would be about the same size, although the topic was health care reform. I was wrong. AARP had arranged a luncheon, and they sold out the more than 360 seats. I arrived early, but people with signs on both sides of reform debate were already gathered in the parking lot. During the luncheon, cards were distributed for the people to submit questions. The moderator introduced us, and the fun began. The format consisted of an opening 15-minute presentation by Congressman Wilson, followed by 5-minute presentations by each panelist. Congressman Wilson, very well-liked by his constituents, is a conservative “Blue Dog” Democrat. His remarks covered the state of health care reform and the impact he felt change would have on the district. A national board member of AARP spoke, followed by the exec of the state medical association. Then the representative from the Service Employees International Union spoke, followed by me. I was given excellent background on pharmacy’s national position by APhA’s Kristina Lunner, and I covered MTM and our general views on reform. I also expressed Ohio’s concern with reimbursement issues, since the Governor just cut our reimbursement far below cost.  

The crowd politely listened to our presentations, but it was obvious that they were chomping at the bit to get to questions. The moderator began by posing one of the written questions, and the Congressman answered. However, an audience member stood up and emphatically asked his question. That was followed by a number of others. The questions ranged from the cost of the program —especially given all the other money Congress has spent this year. How will the funds be found? Some answers were followed by relatively loud sounds of disbelief. One person quizzed the Congressman on the concept of abortion being paid under the bill. Another brought up veteran benefits. It was a bit unnerving to be the focal point of 700 eyeballs, with the crowd pretty activated. It was extremely interesting to watch this microcosm of grassroots involvement. The crowd was polite, never interrupted, listened, but was very dedicated to getting answers.

I gained a lot of respect for Congressman Wilson for meeting with some relatively upset constituents face-to-face, and having strong answers for their questions. I’ve lobbied for a lot of years but had never seen a time when constituents were as informed, aware, and involved as they are in the health care reform debate. The information is shaky, but that’s understandable with the speed that Congress is trying to get this done. It was good to have a chance to provide pharmacy’s position, and I did have a few comments following the meeting. This meeting, however, was about what the participants wanted the Congressman to hear, rather than the other way around. Interesting politics.

After thinking more about this meeting, I also realized that our Ohio pharmacist membership is more activated than I’ve seen in my 21 years here. During August, we had at least six interactions of our members in small groups or in pharmacies with members of Congress. Over the past 6 months, I can think of dozens more, including a meeting of Congressman Zack Space with pharmacist John Coler and me in Zanesville, OH. John was incensed with the DMEPOS accreditation, and brought out the book of material needed, and discussed the hours of work his staff had to do. Being in the pharmacy, seeing what we are up against, and being face-to-face convinced the Congressman to introduce legislation on DME. It is gratifying to see our members understanding the issues, and conveying our messages effectively. That’s the value of APhA and OPA: bringing the facts to the pharmacist, and hopefully, shaping the debate on health care so we are not only included, but are a key player.

What do you do about it?

Friday, August 28th, 2009

As follow-up to our urging that you make your voice heard, the following are the links to share comments with legislators and President Obama:

For APhA members, share your comments with your Members of Congress using APhA’s Legislative Action Center.

For those who are not APhA members, share your comments with your Members of Congress through the U.S House of Representatives Web site and the U.S. Senate Web site.

Also, remember to send your comments to President Obama as well by visiting www.healthreform.gov.

A town hall experience in Ohio

Thursday, August 27th, 2009

So I get an email from Ernie Boyd, the longtime exec in Ohio.  He tells us he is attending a town hall meeting so I asked him for his story.  Here is what he said…

Tom, story to follow tomorrow. I just got back from 2 weeks vacation, and have been buried. I was a blip on this thing.  Abortion, high spending, and veterans benefits took the stage. The civilized instruction to  “put your questions on the AARP forms on the table” changed to “I’ll stand up and ask whatever the hell I choose.”  This was a small town in the middle of Ohio that filled 360 seats, turned people away, had dozens of demonstrators, and cops at the door.   Jeeeeeeepers. This was the most fun this Ohio pharmacy lobbyist had in years. Ernie

More to follow…Ernie is one of the good guys, doing his best to represent the interests of pharmacists in Ohio.  These town hall meetings have taken on a life of their own, and the sentiments expressed are transcending the current debate and allowing the public to express their concerns.