Provider status for pharmacists, legislation on medication therapy management (MTM), and a care transitions initiative were among the topics of a briefing hosted by the Congressional Community Pharmacy Caucus on June 6 in Room 122 of the Cannon House Office Building in Washington, DC.
Pharmacists’ patient care services are “a very smart spend in Washington that pays off in a big way,” Jonathan G. Marquess, PharmD, CDE, CPT, a member of the APhA Board of Trustees, said at the briefing as part of his example of an elevator speech for provider status. “Patients need to have access to pharmacists’ services both on the federal and the state levels but also within these employer groups all across the country.”
As the hour-long briefing began, Rep. Austin Scott (R-GA), Co-Chair of the caucus, rushed down the center aisle of the packed room and up to the lectern in front of a bright window lined with heavy red curtains. “What you’ll find from Democrats and Republicans alike is that we share a lot of common goals and sometimes we have different ideas about how to get there,” Scott told the crowd. “But one of the things that we all understand is how important the individual health care provider is in patient care.”
Rep. Peter Welch (D-VT) is the other caucus Co-Chair. “The House Community Pharmacy Caucus has been established on behalf of the millions of patients whose lives the nation’s independent community pharmacists touch everyday,” Welch told Pharmacy Today. “Community pharmacies are finding it extremely difficult to serve the people who have depended on them for years—sometimes because of federal laws and policies and sometimes because of the lack of them. The caucus will advocate for important issues facing community pharmacies and serve as a clearinghouse for members, staff, and other interested parties about the important role community pharmacies play in the delivery of health care.”
The briefing featured three panelists. The first panelist, Ed Kaleta, a lobbyist for Walgreens, was introduced by the National Association of Chain Drug Stores and pushed for cosponsors on the MTM Empowerment Act of 2013 (H.R. 1024/S. 557). The proposed legislation would bring the number of chronic conditions needed for eligibility down to one and require the bill to be budget neutral, Kaleta said.
As of June 9, H.R. 1024, introduced by Rep. Cathy McMorris Rodgers (R-WA), had accumulated 59 cosponsors. Kaleta cited two developments that have helped the legislation gain support in recent months.
First, in November 2012, the Congressional Budget Office announced a change in its estimating methodology, namely that a 1% increase in the number of prescriptions filled by Medicare beneficiaries would cause Medicare spending to fall by 0.2%.
Second, a January 2013 interim report on MTM in a chronically ill population that was prepared for the CMS Center for Medicare and Medicaid Innovation “showed that where the MTM program focused on chronic disease, chronic disease management, and consultations with patients, dollars were saved … in the Medicare Part B program as a result of what was going on in the Medicare Part D program,” Kaleta said.
The second panelist, Cynthia Reilly, BSPharm, Director, Medication and Safety Quality Division, American Society of Health-System Pharmacists (ASHP), described the Medication Management in Care Transitions (MMCT) joint initiative between ASHP and APhA.
Transitions of care are a critical juncture where problems are more likely to arise, leading not only to a negative impact on patient outcomes but also to substantial increases in costs to the health care system, Reilly said at the briefing.
Reilly explained that 18% to 20% of Medicare patients are readmitted within 30 days of hospital discharge, accounting for $15 billion to $17 billion per year, according to a 2007 Medicare Payment Advisory Commission report to Congress, and that approximately half of these patients have not seen any health care provider between the hospital discharge and readmission, according to a 2009 New England Journal of Medicine paper.
Pharmacists are accessible and can address this gap in care by providing MTM, providing patient education, and addressing issues associated with medication access, Reilly said. For MMCT, the goals included helping patients during transitions such as from the hospital to the home or from the hospital to a long-term care facility, and reducing readmissions.
The final panelist was Marquess, who noted that all of the day’s speakers represented groups in a provider status coalition of 14 national pharmacy organizations.
In addition to serving on the APhA Board of Trustees, Marquess is also a member of the National Community Pharmacists Association, President and CEO of the Institute for Wellness and Education, a specialist in diabetes care, and a co-owner of six Health Mart Pharmacies in Georgia. He said that Scott has “always been supportive of pharmacy issues.”
Pharmacists are not listed in section 1861 of the Social Security Act, which “holds back a lot of pharmacists who do want to save money for health care,” Marquess said. “I know on a personal level in Georgia, I’m actually being held back a little bit in these accountable care organizations being formed because they will say well great, we’ve got a physician, we’ve got a nurse—oh, wait a minute, pharmacists aren’t listed as providers.”
Marquess continued, “Employers play a big role in this” too. He added that state Medicaid departments were another way of being involved with provider status. “By pharmacists being providers,” Marquess said, “this could help increase the care that those patients get and lower the costs.”
On May 29, the California state Senate approved its pharmacist provider status bill (SB 493) that would expand the scope of practice for pharmacy and would specifically name pharmacists as providers, but would not address payment. SB 493 now moves to the California State Assembly for consideration.
The proposed state legislation is intended to help address California’s shortage of primary care services, according to its sponsor.
“The significance of the current legislative step is two-fold,” California Pharmacists Association (CPhA) CEO Jon R. Roth, CAE, told Pharmacy Today. “First, it has been voted out of the Senate, the bill’s house of origin. In order to achieve that step, we had to work to remove all the active opposition to the bill. That will allow the bill to be viewed more favorably as it moves over to the California Assembly.”
The legislation was introduced on February 21 as part of a package of bills by California State Sen. Ed Hernandez, OD, a practicing optometrist and Chair of the state Senate Health Committee. Hernandez also introduced legislation involving other providers—nurse practitioners (SB 491) and optometrists (SB 492). A parallel bill introduced for physician assistants is being carried by another author.
The bills would address the “current primary care physician workforce shortage” that will be compounded when 4.7 million more Californians become eligible for health insurance starting in 2014 under the Affordable Care Act, according to a fact sheet released by Hernandez’s office. The number of primary care physicians actively practicing in California is at the very bottom range of or below the state’s need, and the distribution of these physicians is also poor.
SB 493 would amend California state law to read that the practice of pharmacy is a profession; that “pharmacy practice is a dynamic, patient-oriented health service that applies a scientific body of knowledge to improve and promote patient health by means of appropriate drug use, drug-related therapy, and communication for clinical and consultative purposes”; that “pharmacy practice is continually evolving to include more sophisticated and comprehensive patient care activities”; and that “pharmacists are health care providers who have the authority to provide health care services.”
Examples of new authorities for pharmacists in California would include furnishing self-administered hormonal contraceptives, prescription smoking cessation drugs, and prescription drugs not requiring a diagnosis that are recommended for international travelers; ordering and interpreting tests to monitor and manage the efficacy and toxicity of drug therapies; and independently initiating and administering routine vaccinations.
The integrity of the bill has largely been preserved as it has proceeded through the California state Senate, Roth said.
Californians for Accessible Healthcare, the coalition supporting SB 491, SB 492, and SB 493, includes CPhA, the California Society of Health-System Pharmacists, California Association of Nurse Practitioners, and California Optometric Association. On the other side, Coalition for Patient Access and Quality Care, comprising the California Medical Association (CMA) and several other provider groups, oppose the legislation, according to a May 30 CMA news release.
“CPhA member pharmacists have been extremely active in making their voice heard at the capitol,” Roth said. “While much of the negotiation with the opposition was done by CPhA staff and consultants, it was the members’ outreach to legislators that helped affirm the importance of this legislation to the patients of this state. Many pharmacists met with their legislators, wrote letters, or made phone calls asking for a ‘yes’ vote on this bill.”