ACCP Urges Physicians Serving in Congress to Amend SSA to Cover Clinical Pharmacists’ Services

A bipartisan group of members of Congress, led by leaders from the House Doctors Caucus, invited ACCP to provide feedback on actions that Congress could take to stabilize the Medicare payment system, without adding to the Medicare spending deficit, while ensuring the establishment of successful value-based care incentives. ACCP took this opportunity to urge Congress to amend the Social Security Act (SSA) to specifically authorize clinical pharmacists to serve as full members of Medicare patient care teams.

• Click here to read ACCP’s comments to Congress urging coverage and payment for pharmacists’ clinical services.

Background

In 2015, the bipartisan Medicare Access and CHIP Reauthorization Act (MACRA) was signed into law. MACRA established a new system for paying Medicare providers under a Quality Payment Program, consisting of a new Merit-Based Incentive Payment System and processes to adopt Advanced Alternative Payment Models. MACRA shifted Medicare’s approach to physician payment – paying providers on the basis of the quality, value, and results of care delivered rather than the number of services provided.

ACCP firmly believes that the MACRA payment environment should serve as a pathway for pharmacists to be integrated into value-based models in team-centered practices. For example, MACRA provides an economic rationale for practices to pay a salary for pharmacists to be part of their team to drive health outcomes and generate value-based revenue for the practice. In addition, pharmacists can be embedded in primary care practices through a co-funded partnership between the practice and a health system or pharmacy school. Organizations may also create a shared resource contractual agreement in which the pharmacist provides medication management services for multiple practices that share the overhead costs.

However, the Medicare payment policy currently limits full participation in value-based care teams to the eligible providers listed within Section 1861 of the SSA. ACCP recognizes that “provider status” alone does not ensure that pharmacists’ clinical services will be covered. But as it stands, the failure of CMS to include qualified clinical pharmacists as eligible providers is a barrier to integrating these proven patient care services.

ACCP is committed to a team-based approach to care that aligns perfectly with this vision for a value-based Medicare payment system. ACCP urges Congress to incorporate the direct patient care services of clinical pharmacists as members of the patient’s health care team. Specifically identifying the essential objectives for a modernized, cost-effective, and quality-focused Medicare program, ACCP is calling on Congress to enact Medicare reforms that would:

• Facilitate clinical pharmacists’ full integration into patient care teams
• Achieve clinical outcomes to meet quality metrics by recognizing clinical pharmacists’ contributions in quality performance measures
• Develop health information technology resources to optimize the exchange of clinical information among members of the health care team, including clinical pharmacists

In its letter to Congress, ACCP specifically highlights this issue and directly calls on Congress to amend the SSA to allow the integration of clinical pharmacists into patient-centered care teams incentivized under the MACRA process.

• Click here to read ACCP’s comments to Congress urging coverage and payment for pharmacists’ clinical services.