Pharmacists reflect on HCR as House takes up Senate bill
Politics aside, bill could open huge doors for MTM as
future of pharmacy practice
For more than a year now, the health care reform (HCR) debate has
been smoldering among the Obama administration, Congress, health care
providers, and the public alike. The politics of the issue have yet to
be reconciled. But many providers, pharmacists included, have reached
consensus that reform of some kind is needed to repair a broken
system.
Many who have been tuned into the debate think it shone new light
onto the medication therapy management (MTM) roles of the pharmacist in
the health care spectrum. In interviews with pharmacist.com as Congress
prepared for final votes on the bills, here’s what some
pharmacists had to say about HCR and MTM.
Rally and consensus
“I think the most profound thing that has affected us as a
whole is that organizations have rallied around a common theme, which
really hadn’t happened prior to this time,” said Gary
Matzke, PharmD., FCCP, FCP, professor and associate dean for clinical
research and public policy at Virginia Commonwealth University.
“This is one of the first times that pharmacy organizations have
united around this common theme.”
There may not be agreement on all issues, but the professor said he
gives APhA and the other representative organizations an “A”
grade overall. This is due to their diligence in reinforcing the three
principles put forth in the debate: the need for appropriate
infrastructure and access to health information technology; improvement
of drug quality and safety and appropriate reimbursements; and patient
choice of providers.
Creating these principles came from APhA and pharmacy coalition
partners getting together and taking an inventory of major issues, said
Kareem Karara, a third-professional-year student pharmacist at the
University of the Sciences in Philadelphia.
“One of the most fantastic things is that people are talking
about what the problems are and what are their solutions,” he
said. “We need action, but at this point, the most positive thing
is talk.”
This talk was effective because pharmacy was able to create a united
front, said Helene Levens Lipton, Ph.D., a professor of health policy in
the University of California San Francisco School of Pharmacy.
“In my long years of working with pharmacy policy I’ve
learned that policymakers don’t like to work with fractured
professionals at odds with each other,” she said. “Pharmacy
groups went to great pains to create consensus documents to move the
profession forward.”
Because of this, there was some agreement on issues such as MTM
grants and pharmacy’s involvement in medical homes.
“It was a stunning example of how the profession has moved
forward,” she said.
Along with reaching some compromise, the organizations have spent a
great deal of time educating members, said Karara, who spent the summer
working at the American Society of Consultant Pharmacists. He wrote a
newsletter on HCR and read numerous materials from other organizations
as well. He saw a jump in member participation, with pharmacists calling
and asking questions as well as visiting the organization’s
website for resources. Even at his school, students took part in
political policy education events.
Collaboration
Philip Hritcko, PharmD, CACP, said it is disappointing that pharmacy
has to constantly justify its role within the greater health care
system. The Assistant Department Head of Pharmacy Practice at the
University of Connecticut School of Pharmacy said the debate has helped
create a conversation and collaboration with other health care
professionals.
“We have been letting others know the value of our
services,” he said. “As long as we are on the forefront of
the reform movement and letting them know pharmacy is part of the total
health care team, that is a good thing.”
Levens Lipton agreed with the importance of pharmacy talking to other
caregivers to move forward their agenda of creating a team-based model
like a medical home setting.
“There is a system-wide primary care shortage,” she said.
“It can’t be dealt with in a vacuum, and this is where
pharmacists can work with physicians and nurse organizations to
transform the practice of primary care through increased use of other
health professionals.”
Voices heard
Matzke said he was pleased to see that in the end, both the House and
Senate listened to pharmacists and recognized them as one of the
professionals needed on an interdisciplinary health care team.
“There was language in both bills that address the expectations
of pharmacists,” he said. “It clearly creates expectations
that pharmacists should meet to implement MTM and provides funding for
these types of services.”
John Michael O'Brien, a pharmacist, professor, and health policy
consultant in Washington, DC, said the inclusion of the MTM grants in
the House and Senate bills were probably the biggest “home
run” for pharmacy.
Moving forward
If some sort of reform does pass, Levens Lipton said pharmacists
should be active when it comes to ensuring that the levels of
appropriation are appropriate for MTM grants and community health teams
in medical homes.
Another area to focus on is information technology initiatives. As
these efforts move forward, she said it will be important to keep
pharmacy active in the process in areas such as electronic
prescribing.
Congress has laid down a framework for what they support moving
forward for pharmacists. The impetus will now be placed on providers to
“incorporate this opportunity into their clinical practice,”
Matzke said.
He said it is imperative that pharmacists continue to remain informed
about the debate and legislation being undertaken.
Professional organizations may have stepped up to make their voices
heard during the past year, but O'Brien said individuals need to do
their part in the future as well.
“I think owe [the professional lobbyists of the pharmacist
associations] a real debt of gratitude,” he said. “At the
same time, we need to make sure more pharmacists pay more attention and
get more involved. Either get into politics or get out of
pharmacy.”
The reform debate changed dramatically after the Massachusetts
election of Scott Brown to the U.S. Senate. He was a state legislator
prior to being elected; that is one reason O’Brien said it is
important for pharmacists to build up relationships with their
neighbors, patients, and government representatives.
Overall, Hritcko said he was happy with the way the largest
pharmacist organizations kept everyone abreast of what was going on,
helping to advocate locally and nationally and supporting a grassroots
movement.
“I think it is just the start for us as a profession,” he
said.
Related resources on www.pharmacist.com:
Tammy Worth (pt@aphanet.org)
Contributing writer
Posted March 15, 2010
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