Archive for the ‘Health Care Reform’ Category

How to care for 30 million more patients

Friday, July 23rd, 2010

That was the title of an opinion piece published on July 19 in the Wall Street Journal (subscription required). We all have Dean Pete Vanderveen of the University of Southern California School of Pharmacy to thank for this very succinct, articulate viewpoint.

Dean Vanderveen describes to the world what many of us in pharmacy have been saying—that pharmacists can play a major role in the provision of primary care, especially for the millions of new folks who will be enrolled in health plans as the Affordable Care Act is implemented. You may recall that we met last summer with the White House to pitch pharmacists’ role in primary care, and we’ve continued to work with medicine to ensure there’s no worry regarding “scope creep.” We are emphasizing that our goal is to improve patient care, not usurp physician authority.

To quote Dean Vanderveen, “Pharmacists are not spoiling for a turf war with physicians. The two professions already team up under ‘collaborative practice’ agreements as in Asheville and Los Angeles that clearly define what the pharmacist can and cannot do.”

For our part, we’ve got a lot of work to do if this vision is to become a reality, but we’re working on it. I believe we are doing that as collaboratively as possible.

I would love to have more examples like the ones cited in the opinion piece that describe the safety-net clinics in major metropolitan areas where physicians, pharmacists, and nurses are teaming up to improve care and lower costs in a world where the medically underserved address chronic homelessness, low literacy, and unemployment. Please let us know if you are aware of practice models that are working.

Let’s continue to spread the word about how pharmacists can help fill the gap in the number of primary care providers for our nation’s population!

HCR: There is one more thing

Thursday, June 10th, 2010

As a follow-up to my last post, I thought I’d share one more piece of information. During the Health Affairs health reform briefing, the CEO of the American Hospital Association discussed that group’s “Hospitals in Pursuit of Excellence” initiative, which we applaud. AHA’s nicely designed HPOE website has a great description of a pharmacy-based anticoagulation service. While you’re on the site, also check out a case study that explains how computerized provider order entry systems can be used to address the 1 million serious adverse drug reactions that occur annually in U.S. hospitals.

Challenges and opportunities with HCR implementation (and a musing)

Wednesday, June 9th, 2010

Earlier this week, a group of APhA management team members sat in on a Health Affairs briefing on “Moving Forward on Health Reform.”

The first thing that struck me about this briefing if the continued variation in terminology with regard to the Affordable Care Act. We continue to hear about “health care reform,”  “health insurance reform,” and “health reform” as people discuss the new law.

Of course, it’s not just one law. ACA refers to two laws. The HCR bill signed by President Obama on March 23 was the Patient Protection and Affordable Care Act (Pub. L. 111-148). It was then amended by section 1101 of the Health Care and Education Reconciliation Act of 2010 (Pub. L. 111-152), signed a week later. Since neither bill title alone is accurate, the Obama administration is using “Affordable Care Act,” or ACA, to refer to these bills collectively, and APhA is using that acronym to describe the new law.

In any case, it was clear from the Health Affairs panelists that we’re going to get significant insurance reform, and almost certainly reforms in health information technology (HIT) and integrated care delivery systems. Even though there are hundreds of deadlines in the ACA, some at the conference suggested the government should not be too harsh on enforcing them. I might suggest that it’s easy to predict the future, but it’s hard to predict “when.”

Despite terminology ambivalence, it is clear that the world of health insurance will be very different (and larger) as companies grapple with loss ratio and exclusion policy changes, individual mandates and coverage policies, and a host of other insurance reforms required to implement ACA.  If you’re interested, this issue of Health Affairs will be great reading.

Meanwhile, pharmacy continues to focus on the reforms that we can influence and that will improve the lives of our patients. For example, APhA recently pulled together a 22-page list of the panels, committees, and commissions formed by ACA. We are sorting out which ones are most critical in our quest to promote patient access to pharmacists’ services. We’re working with other associations and groups to “divide and conquer” by supporting their nominees and asking them to support ours as we figure out our priorities.

We’re also working outside the Beltway to integrate care, as promoted by ACA, with our colleagues in medicine, nursing, and other health care disciplines. My attitude is that health care is a team sport, so we’ve got to reach out to our teammates if we want to optimize our respective contributions to care. On June 23, APhA will lead a contingent of pharmacy representatives in a meeting at AMA where we will discuss collaborative drug therapy management and MTM, adherence and immunizations, medical homes, HIT, FDA’s Risk Evaluation and Mitigation Strategies, and educational challenges with physicians and pharmacists. This will primarily be a door opener but promises to set the stage for significant collaboration between organized medicine and pharmacy. I’ll report more on the meeting and follow up later.

Closer to home, I’m happy to report that Bonnie and I watched our nephson’s (it’s a made-up word, but you get it) 8th grade graduation last night. It’s an important event for us, as it was just 2 years ago when he suffered a major health setback, which he weathered like a hero.

And right outside my window, it’s a glorious weather day. I never get used to the feeling of good fortune that we have in occupying this space on the National Mall. I am grateful for the opportunity to serve our members as we all strive to improve medication use and advance patient care—together!

HCR Implementation Team formed

Tuesday, May 25th, 2010

Just as we did in the advocacy phase of health care reform, APhA has established an internal HCR Implementation Team for the coming onslaught of regulations. The Affordable Care Act is now in the hands of several federal agencies, and APhA will need to track a multitude of tasks and details in the coming months and years.

The HCR Implementation Team cuts across divisions and is action oriented. The group coordinates our efforts from legal and political analysis through advocacy with regulators, pursuit of funding and legislative fixes, publications, and communications.

Those of you who followed and participated in the Congressional process through our HCR Hub will find similar timely, useful information posted in the coming months. But tasks and topics will be more focused on the shaping and implementation of new regulations as well as the communication of opportunities in which you can participate.

Stay tuned—and thanks for your ongoing support. The level of participation these past months has been nothing short of amazing!

HCR: Key contacts, grassroots supporters come through

Wednesday, March 31st, 2010

In a recent blog, I thanked our Government Affairs staff and those of other pharmacy organizations for sticking together to achieve success in the health care reform process. In addition, lots of others deserve thanks and recognition for their efforts during this important time in pharmacy history.

Heroes this past year include our members who served as volunteers and advocates on our Government Affairs Committee and Key Contact Network, or those who were active in our grassroots-lobbying initiatives. Every pharmacist in America owes a debt of gratitude to their colleagues who cared enough to contact their Members of Congress.

Let’s keep up the momentum and the unity! We still have a long way to go, but we’re off to a great start on redefining pharmacy’s future.

The Dems did it! Now it’s our turn

Tuesday, March 23rd, 2010

The health care reform (HCR) bill signed this morning by President Obama includes provisions to ensure patient access to pharmacists’ medication therapy management (MTM) services, medications, and a viable pharmacy infrastructure. These critical services reduce the toll of inappropriate medication use, including nonadherence, and improve the quality of our nation’s health care system.

APhA strongly supported the bill’s inclusion of provisions to address our nation’s medication-use crisis. This is an opportunity for us to deliver as the medication experts on the health care team. We opened the door for the recognition of pharmacists’ services. Now we need to continue that work with regulators and our colleague organizations to ensure that patients have the tools that they need to use their medications safely and effectively.

The opportunity is there—grasp it!

HCR passage imminent

Sunday, March 21st, 2010

At this writing, the passage of health care reform legislation appears imminent. This morning, the Democrats announced they now have the necessary 216 votes.

Like many comprehensive proposals, this bill may need to be “tweaked” in years to come as we see the benefits roll out (which in some cases will happen several years from now). While your politics may differ from the current path on the broader aspects of the legislation, this effort was, at least by my account, unprecedented. It includes some major advances for pharmacy.

Intact in the final bill are pharmacy’s provisions. We helped to shape those elements, and all of pharmacy advocated their passage. Perhaps the MTM grant programs could have been larger, but what we have is a good move in the right direction.

We will have years of work ahead of us in the regulatory process to assure that our patients get the full benefit of our services. And pharmacists will have to step up and deliver. But the profession’s years of work to promote patient care services together with safe and accurate dispensing production may be paying off.

Congrats to our APhA Government Affairs team and our HCR Task Force, not only for their incredible hard work, but for their productivity, effectiveness, and excellent communications with our membership. Congrats too to all of the other pharmacy association government affairs teams. It has been and will continue to be a pleasure working with all of you.

House Democratic leaders expect the vote on HCR to occur between 6 p.m. and midnight this evening. Watch pharmacist.com for news and updates as the vote occurs.

A note to Allison: Great work on health care reform!

Friday, February 12th, 2010

(The below e-mail message was sent to Allison Wiley, one of our dedicated Government Affairs staffers, by Julie Stading of Creighton University. Following that is a message I sent to Dr. Stading after Kristina Lunner, our VP of Government Affairs, told me about this great feedback.)

Allison,

I wanted to send a personal e-mail to encourage you to continue with your efforts. It was not until this current situation with health care reform that I realized that APhA is really the main pharmacy organization that is taking consistent action to push for pharmacy as a part of the health care reform. The other organizations that I belong to talk about it, but APhA is taking action… regularly. Again, thank you for all your efforts… it is noticed!

Julie

My response:

Hi Julie,

Thanks for your kind note to Allison Wiley regarding APhA’s advocacy. If you’ll indulge me, I’d like to share a story.

I first became involved with APhA as a student, although in those early, formative days of Student APhA, I really didn’t make the connection between our school’s chapter and anything “big picture.” After I graduated, like many of my peers I got immersed in life, building a family, and launching a practice. I wasn’t really involved in any organizations, until Frank McClendon invited me to a local association meeting and Harvey Barton, another Huntington, WV, pharmacist, started talking with us about our myriad opportunities. The three of us are still friends and business partners in a home infusion and specialty practice we own in Huntington. From the local association, I got involved in the state association, and in 1984, my first interface with APhA “national,” I was invited to make presentations on home infusion practice. In 1986, I was offered a job at APhA, which I accepted. Joe McGlothlin joined me as a partner in my Medicine Shoppe, and I moved my family to Washington for my first first day on the job with APhA 23 years ago on February 2, 1987.

What struck me about APhA back then was that they (now “we”) were for things, rather than against things. I first saw the organization through the eyes of Steve Crawford, a West Virginian, former APhA President, and practice innovator, and Tim Covington, a West Virginia University faculty member at the time and an innovator in community pharmacy residencies. From my vantage point, they and APhA in general always seemed to be looking forward, reaching for something better, working hard to learn from their leaders, and sharing those learnings with their members. As a young staffer back then, my initial impressions were validated, first by Jack Schlegel, the APhA CEO who hired me, and then during the ensuing 20 Gans years. I’ve been privileged to learn from these two, as well as from hundreds of others whom I’ve met over the years who share our passion for innovation and lifelong learning.

My tenure as exec is dedicated to making a difference and providing opportunities for pharmacists to contribute to excellent patient care by practicing as they’ve been trained. We do that, because that’s what we hear from our members that they want. We continue to be for things, whether in our work on Capitol Hill to advance our agenda, or with CMS or managed care, where we’re trying to maintain the MTM momentum.

In just 4 weeks, when 7,000 folks convene in Washington for our Annual Meeting, I’ll spend 18 hours each day talking with really energized and positive practitioners and students who are excited about our profession. That exercise should be exhausting, yet I’m always pumped and filled with new ideas at meetings’ end. I just wish more pharmacists took advantage of the opportunity.

I doubt you realize how important your encouragement is to staffers who work on pharmacy’s behalf. Thanks again for taking the time to do so.

Best regards,

Tom

DC’s imperfect storm!

Tuesday, February 9th, 2010

We’re in the midst of an imperfect storm!

Over the past few days, Washington has been hammered with 28+ inches of snow. And we’re expecting another 10-22 inches tonight. That will make the winter of 2010 the snowiest on record for the nation’s capital. The snow coming tonight is the product of two low fronts–one from the southwest and one from the northeast. The Metro has been shut down at times, the federal government is closed, and just about everything else has stopped as well.

The same descriptor–Imperfect Storm–could be applied to the Cornhusker Kickback, the Louisiana Purchase, and the election in Massachusetts, events that produced the current paralysis over health care reform. Today’s headlines suggest that President Obama’s interest in convening a health care summit later this month may go nowhere as Republicans jockey for compromise and Democrats hold their ground.

In terms of educating Members of Congress, we’ve made a lot of headway despite the storms over health care reform of the past year. As we go forward, we’ll do our best to maintain this momentum, despite this Imperfect Storm!

“Don’t walk away from reform!”

Thursday, January 28th, 2010

Those words, spoken by President Barack Obama during his State of the Union address on January 27, were intended to spur Congress to continue its deliberations until health care reform is achieved. How Congress will respond will be the topic of speculation, conjecture, and debate for weeks. I have concerns about how we’ll pay for reform, but even more serious concerns about what will happen if we don’t.

My personal views on the “whether or not” are unimportant. What is important to you as a pharmacist in America is that we are working for you to ensure you have the opportunity to practice what you’ve been trained to do and to provide the services you’ve asked us to promote for you.

APhA will continue to pursue with Congress, CMS, AHRQ, FDA, and managed care organizations the principles we’ve so often articulated: consumer access to quality pharmacist-provided medication therapy management (MTM) services. We will continue that fight because it is the mission we set about achieving 20 years ago and the mission that the Joint Commission of Pharmacy Practitioners (made up of all pharmacist-member national associations) articulated for 2015.

I’m willing to accept criticism that APhA is too focused on this mission! And believe me we do receive criticism. We get it from folks who feel stuck in jobs that don’t allow them lunch breaks, let alone the time to conduct MTM. And we get it from pharmacists who don’t think immunization is the purview of pharmacists. We sometimes hear that our pursuits aren’t realistic to young practitioners who enter a practice that isn’t yet progressive enough to allow them to practice as they were trained. The criticism is healthy. If someone is feeling beaten up by the “system,” no one can say they are wrong.

Yet, what really energizes me are the conversations I have with practicing pharmacists who have incorporated MTM in their daily practice through use of technology that allows their review and entries into electronic medical record systems. I get energized when I talk with large pharmacist employers who have awakened to the power of their pharmacist workforce. These leaders are conducting training, providing additional certifications or education, and promoting services to employers and others.

If you are a pharmacist who hasn’t yet talked with someone in an empowered practice, there’s an opportunity to do so just around the corner. Please join us in Washington, DC, March 12–15 for APhA2010, the must-attend pharmacy conference of the year. If you are open to new ideas and want to get turned on by the possible, I promise you won’t be disappointed.

You have a choice: Grumble about how bad things are, or join us in creating a brighter future.  We need your support. Don’t walk away from reform!