2023 ACCP Annual Meeting Advocacy Opportunities
Registration is now open for the 2023 ACCP Annual Meeting, November 11–14, in Dallas, Texas! ACCP’s Government and Professional Affairs team in Washington, D.C., is particularly excited about the following advocacy-focused sessions that may be of interest to PRN leaders.
ACCP Advocacy Action Alert! Urge Congress to Permanently Maintain and Enhance Telehealth Flexibility
The growth of telehealth services during the pandemic rapidly opened new opportunities for patients to access vital health care services, particularly for those living in rural or medically underserved areas. ACCP endorsed the CONNECT for Health Act of 2023 to expand coverage of telehealth services through Medicare, make permanent COVID-19 telehealth flexibilities, improve health outcomes, and make it easier for patients to connect with their providers.
Click here to action today to tell Congress to pass this important bill!
Background: ACCP’s Advocacy to Advance Clinical Pharmacy Telehealth on Capitol Hill
Improved access to health care services through increased availability of remote health care delivery has proven especially beneficial to older adults and those living in rural, medically underserved locations. During the COVID-19 pandemic, use of telehealth increased dramatically as patients sought care without risking potential exposure. However, remote and telehealth care was on the rise before the pandemic because of various factors, including increased access to affordable technology, demographic trends including the aging population, the increasing burden of chronic illnesses, and a shortage of health professionals – especially in underserved and rural areas.
More insurers are embracing remote health care delivery to reduce the cost of hospitalizations and emergency department visits. The goal of using remote health care delivery to prevent patients from entering more expensive health care settings has led the Centers for Medicare & Medicaid Services (CMS) and several commercial insurers to embrace reimbursement policies that incentivize the adoption of these services. As a result, patients with heart failure using the MedSentry remote drug monitoring system experienced an 80% reduction in the risk of all-cause hospitalization and length of stay compared with standard care. In another study, the average cost of a telehealth visit was $40–$50 compared with an in-person emergency department visit of $136–$176, translating to an estimated minimum payer savings of $126 per telehealth visit.1
Tell Congress to pass CONNECT for Health Act of 2023!
Policymakers on Capitol Hill have been working on various legislative proposals to build on pandemic-era telehealth provisions, including permanently eliminating geographic and originating site waivers. Senators Brian Schatz (D-HI), Roger Wicker (R-MS), Ben Cardin (D-MD), John Thune (R-SD), Mark Warner (D-VA), and Cindy Hyde-Smith (R-MS) led a bipartisan group of 60 senators in reintroducing the Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act. ACCP endorsed the CONNECT for Health Act and is calling on all ACCP members to get involved to support its passage through Congress.
This legislation, aimed at eliminating barriers to telehealth coverage, would:
- Remove geographic requirements for telehealth services
- Expand originating sites to include the patient’s home and other clinically appropriate sites
- Expand the authority for practitioners eligible to furnish telehealth services
- Improve Medicare’s process to add telehealth services
- Permanently allow federally qualified health centers and rural health clinics to furnish telehealth services as distant site providers
- Remove restrictions for facilities of the Indian Health Service and Native Hawaiian Health Care
- Repeal the 6-month in-person visit requirement for telemental health services
- Permanently allow for the waiver of telehealth restrictions during public health emergencies
The Consolidated Appropriations Act of 2023 (2023 CAA) (Public Law 117-328), signed into law on December 29, 2022, extended authorization through December 31, 2024, for certain key telehealth flexibilities established during the COVID-19 public health emergency (PHE). Although this fell short of making permanent all PHE telehealth flexibilities, the 2023 CAA decoupled or untied telehealth from the continued existence of the PHE. This is significant for the long-term future of telehealth as the PHE instituted during the pandemic unwinds. Click here for a comprehensive summary of telehealth flexibilities addressed in the CAA from ACCP’s colleagues at McDermott+Consulting.
Tell Congress to pass CONNECT for Health Act of 2023!
Support ACCP-PAC in 2023
Telehealth is just one of many issues ACCP is currently advocating for on Capitol Hill. The College’s top advocacy priority is still to establish Medicare coverage for comprehensive clinical pharmacy services that optimize medication use for patients.
With the 118th Congress well underway and the 2024 presidential elections already on the horizon, there is a clear opportunity to raise ACCP’s profile on Capitol Hill by providing financial support to policymakers who work with the College to advance its issues. It is vital that ACCP support these friends on Capitol Hill in order to ensure that leaders remain in Washington to advance policies that meaningfully address the health care issues the nation currently faces.
PAC contributions are a constitutionally protected part of the U.S. political system under the First Amendment’s guarantee of free speech. ACCP-PAC is the only means through which the College can provide financial support for candidates for Congress. With its almost 17,000 members, ACCP is in a position to become one of the most prominent pharmacy PACs in Washington. To do this, the College needs the widespread support of its membership. If each ACCP member contributed just $50, ACCP-PAC would instantly establish itself as the most powerful pharmacy PAC in the entire country. All ACCP members should consider contributing at least $50 to ACCP-PAC. CLICK HERE to support your PAC today!
Background to Telehealth Advocacy: ACCP’s Ongoing Efforts to Advance Clinical Pharmacy Telehealth on Capitol Hill!
Telehealth use surged in 2020 when CMS waived many statutory restrictions on telehealth to ensure continued access to health care during the COVID-19 PHE. Older adults and individuals from underserved communities benefited the most from expanded telehealth access. Policymakers on Capitol Hill are now developing legislation to build on certain pandemic-era telehealth provisions, including permanently eliminating geographic and originating site waivers. There are now multiple competing legislative initiatives, each featuring unique congressional champions and sponsors. Within this potentially confusing environment, here’s how ACCP is working on behalf of clinical pharmacists to ensure the voice of the profession is heard on Capitol Hill.
Current Outlook
Since 2021, Medicare beneficiaries’ telehealth use has stabilized at 15%, and overall health care use is level, indicating that telehealth often substitutes for in-person care.1
With telehealth flexibilities set to expire at the end of 2024, beneficiaries will lose access to care, including requirements that permit beneficiaries to receive telehealth services only if they live in rural areas and near certain clinical sites. Permanent changes to Medicare’s coverage of telehealth services are critical to protect access to care and fully integrate telehealth into care delivery.
Legislation Under Consideration in the 118th Congress
H.R.3432 - Telemental Health Care Access Act of 2023
Legislation to remove barriers to high-quality, virtual mental and behavioral health care for Medicare beneficiaries:
- Specifically, this bill would remove the requirement that physicians must see Medicare beneficiaries in person within 6 months of being treated virtually for mental and behavioral health concerns. Eliminating this arbitrary in-person requirement would ensure patients could fully leverage telehealth to get the care they need from home.
H.R.134 - To amend Title XVIII of the Social Security Act to remove geographic requirements and expand originating sites for telehealth services
This legislation would permanently eliminate the originating site and geographic limitations for using telehealth, which would in turn help patients continue to receive care through telehealth services regardless of the location of the provider or the patient.
CONNECT for Health Act in the 118th Congress (introduced as S.1512/H.R.2903 in the 117th Congress)
This legislation (still in draft form and awaiting introduction in this Congress) is aimed at eliminating barriers to telehealth coverage by:
- Removing geographic requirements for telehealth services
- Expanding originating sites to include the patient’s home and other clinically appropriate sites
- Expanding the authority for practitioners eligible to furnish telehealth services
- Improving Medicare’s process to add telehealth services
- Permanently allowing federally qualified health centers and rural health clinics to furnish telehealth services as distant site providers
- Removing restrictions for facilities of the Indian Health Service and Native Hawaiian Health Care
- Repealing the 6-month in-person visit requirement for telemental health services
- Permanently allowing for the waiver of telehealth restrictions during public health emergencies
S. 731– Telehealth HSA Act of 2023/H.R.1843 - Telehealth Expansion Act of 2023
This legislation would amend the Internal Revenue Code of 1986 to make permanent the permissible first-dollar coverage of telehealth services for purposes of health savings accounts.
Get Involved!
As we advance a coordinated telehealth response, working with our pharmacy colleagues and other external stakeholders, we need to hear from you about how telehealth has improved your practice. If you are currently delivering care to patients using telehealth services, reach out to our Government Affairs team by contacting [email protected]. We are looking to compile evidence and anecdotal accounts of how clinical pharmacists are improving patient care and outcomes as part of virtually integrated care teams.
Support Clinical Pharmacy’s Political Action in 2023
ACCP’s top advocacy priority on Capitol Hill is to establish Medicare coverage and payment for comprehensive clinical pharmacy services that optimize medication use for patients. ACCP’s Political Action Committee (PAC) allows the College to participate in political campaign activities that strengthen its relationships with key policymakers on Capitol Hill. Providing financial support for influential leaders in Congress helps raise the profile of clinical pharmacy and demonstrates ACCP’s ideological commitment to its core mission.
To maximize its impact, ACCP must be strategic in targeting its limited resources on the health policy leaders best placed to advance the College’s agenda. Here’s how ACCP’s leaders decide who should receive financial support:
Consistent with all of ACCP’s initiatives, ACCP-PAC is member driven and is managed by a Governing Council, which is responsible for decisions related to how PAC money is spent.
- ACCP-PAC is nonpartisan – committed to working with health policy leaders across all political parties and ideologies.
- ACCP-PAC supports candidates on the basis of their alignment with ACCP’s mission to advance the profession and improve human health through research, training, and education.
- ACCP-PAC strategically targets members of Congress who sit on committees with jurisdiction over health care. In the Senate, ACCP-PAC primarily supports members on the Finance Committee and the Health, Education, Labor and Pensions (HELP) Committee. In the House, ACCP-PAC focuses on those who sit on the Ways and Means Committee and the Energy and Commerce Committee.
- ACCP-PAC is committed to transparency – all contributions are reported to the FEC, and the information is available to the public.
PAC contributions are a constitutionally protected part of the U.S. political system under the First Amendment’s guarantee of free speech. ACCP-PAC is the only means through which the College can provide financial support for candidates for Congress. With its almost 17,000 members, ACCP is in a position to become one of the most prominent pharmacy PACs in Washington. To do this, the College needs the widespread support of its membership. If each ACCP member contributed just $50, ACCP-PAC would instantly establish itself as the most powerful pharmacy PAC in the entire country. All ACCP members should consider contributing at least $50 to ACCP-PAC. CLICK HERE to support your PAC today!
Wasem Gawish, D.Ph., BCPS, BCMTMS, Named 2023–2024 ACCP-ASHP-VCU Congressional Healthcare Policy Fellow
Wasem Gawish, D.Ph., BCPS, BCMTMS, has been selected as the American College of Clinical Pharmacy-American Society of Health-System Pharmacists-Virginia Commonwealth University Congressional Healthcare Policy Fellow for 2023–2024.
The 14-month fellowship, the only one of its kind in the nation, is a joint initiative led by the Government Affairs teams at ACCP and ASHP and the faculty at VCU School of Pharmacy. It provides active mentorship and hands-on experience within the U.S. Congress and offers fellows the opportunity to develop skills in issue prioritization, policy, legislation evaluation, research, writing, and advocacy.
Gawish has been a practicing pharmacist since earning his B.S. degree in pharmaceutical sciences from Cairo University in 2001. In 2022, Gawish completed both his Pharm.D. degree from Shenandoah University and a dual MBA degree from Southeastern Oklahoma State with concentrations in General Management and Healthcare Information Systems.
“I worked in different practice settings including community pharmacy, pharmaceutical industry and clinical/hospital pharmacy,” Gawish said. “This allowed me to perfect my communication proficiency and clinical skills, as well as acquire many competencies that will be crucial to the successful completion of the VCU Congressional Healthcare Policy Fellow Program.”
Gawish previously practiced as a clinical pharmacist at Oklahoma State University Medical Center and now serves as research committee chair of the National Board of Medication Therapy Management (NBMTMS), where he leads cross-sectional national research on the impact of board certification on patient outcomes.
“Becoming a member of the board of directors in the NBMTMS gave me a platform to utilize my skillset in bringing about positive change,” Gawish said, which “led me to gain the confidence and the determination to further educate myself on regulatory and legislative issues.”
Together with his experience with the NBMTMS, Gawish further attributes his interest in health care policy to having witnessed the many negative consequences of COVID-19 on the community. He has already taken steps to engage in issues related to expanding federally funded health insurance programs and granting provider status to pharmacists.
In his application, Gawish wrote:
Observing the unreadiness of our health care infrastructure was both eye-opening and a call for action. I believe that a major overhaul of our health care policies must ensue, and I want to take part in it. The VCU Congressional Healthcare Policy Fellow Program is a great opportunity for me to learn policymaking at a deeper level through hands-on engagement. The expansion of pharmacists’ involvement in patients’ care as well as patient ease of access to care are two important policy areas to me.
About the Healthcare Policy Fellow Program
Launched in 2006, this prestigious program offers a unique, yearlong health care policy learning experience in the U.S. Congress. This provides pharmacists an opportunity to gain insight into health care policy analysis and development through immersion in the congressional environment. The Fellow Program begins in July with an immersive orientation in health policy across 3 weeks each with ACCP’s and ASHP’s government affairs offices, followed by 12 months on Capitol Hill.
Alumni Fellows
After serving in the program, past fellows have gone on to engage in a variety of important roles in health care policy and government:
- Amanda Ferguson, Pharm.D., the 2022–2023 fellow, currently serves as Health Legislative Assistant in the Office of U.S. Senator Tom Carper (D-DE).
- Nimit Jindal, Pharm.D., currently serves as Health Legislative Assistant in the Office of U.S. Representative Diana DeGette (D-CO).
- Tatiana Bujnoch, Pharm.D., M.S., BCPS, currently serves as Health Equity and Policy Associate at Morgan Health.
- Rita (Habib) Livadas, Pharm.D., currently serves as Director, Global Public Health, Life Sciences at Becton, Dickinson and Co.
Applications for 2024–2025 Pharmacy Healthcare Policy Fellow Program
Interested candidates should visit the pharmacy Congressional Healthcare Policy Fellow program’s website for more information and instructions on submitting an application. For more information, click here.
ACCP Members Support College’s Response to Congressional Initiative on Drug Shortages
On June 12, 2023, Senator Mike Crapo (R-ID) and Representative Cathy McMorris Rodgers (R-WA) issued a bicameral Request for Information (RFI) seeking input on policy solutions to the increase in drug shortages. The RFI follows a U.S. Senate Committee on Homeland Security report that showed a 30% increase nationwide in drug shortages between 2021 and 2022.
The bicameral RFI cited a May 2023 study from the Office of the Assistant Secretary for Planning and Evaluation indicating that drug shortages not only force those living with even the most serious medical conditions to seek out alternatives or experience debilitating lapses in care, but also trigger a variety of direct and indirect detrimental costs for both patients and frontline health care providers.
The RFI requested input on two areas of particular interest to ACCP:
- How can federal agencies, such as CMS, better address the economic forces driving shortages? Are these agencies using their current authorities effectively?
- Are there any guardrails that Congress should consider related to demonstration projects, including via the CMS Innovation Center, that would help protect against drug shortages? Are there any proactive demonstrations that would prevent drug shortages?
ACCP Member Engagement
Like all of its initiatives, ACCP’s work in Washington, D.C., is driven by the College’s members. ACCP leaders have been integral in supporting the College’s Government Affairs team in its efforts to secure key meetings with leaders on Capitol Hill. Thanks to the lobbying efforts of Rex W. Force, Pharm.D., FCCP, BCPS, at Idaho State University, ACCP staff secured a meeting with senior policy advisers to Senator Crapo, who serves as the Ranking Member on the powerful Senate Finance Committee with jurisdiction over Medicare. Thanks also to the following ACCP members who have been instrumental in helping ACCP secure meetings on Capitol Hill with leading Senate offices:
- Jerry L. Bauman, Pharm.D., FCCP, FACC, Journal of the American College of Clinical Pharmacy
- Marie A. Chisholm-Burns, Pharm.D., Ph.D., MPH, MBA, FCCP, FASHP, FAST, FACHE, Oregon Health & Science University
- Vicki Ellingrod, Pharm.D., FCCP, FACNP, University of Michigan College of Pharmacy
- Linda Gore Martin, Pharm.D., MBA, FASHP, BCPS, University of Wyoming
- Suzanne Amato Nesbit, Pharm.D., FCCP, FASHP, The Johns Hopkins Hospital
- Glen T. Schumock, Pharm.D., MBA, Ph.D., UIC College of Pharmacy
ACCP Drug Shortages Response
ACCP took this opportunity to urge Congress and CMS to consider opportunities to integrate coordinated, team-based comprehensive medication management (CMM) provided by clinical pharmacists into Medicare coverage and payment models. Problems related to medication misuse generally fall under three main categories: overuse of medications that don’t improve health and may cause harm, underuse of critical drugs needed for acute or chronic health problems, and misuse of medications such as opioids.
All three are contributing to the growing issue of drug shortages, as well as driving higher costs and adversely affecting patient health. According to the GTMRx (Get the Medications Right) Institute, “To prevent overuse of medications, health care providers shouldn’t start or continue medications without a comprehensive evaluation of the patient’s health issues and medications.”
ACCP highlighted that many of the Medicare MIPS (Merit-based Incentive Payment System) performance measures established under MACRA (Medicare Access and CHIP Reauthorization Act) already directly pertain to medication use. The Comprehensive Primary Care+ (CPC+) Program Year 2 Care Delivery Requirements administered by the CMMI included access to CMM services for patients discharged from the hospital and those receiving longitudinal care management that would include development of an individualized action plan addressing the patient’s medication problem list and a review of the plan with the primary care team.
Clinical pharmacists are also included as integrated team members in CMMI’s Making Care Primary Model – a 10½-year CMMI multi-payer model with three participation tracks that build on previous primary care models, such as the CPC, CPC+, and Primary Care First models, as well as the Maryland Primary Care Program.
ACCP’s comments also highlighted the growing importance of pharmacogenomics (PGx) and precision medicine to ensure safe and effective therapy for each patient. When integrated into CMM, PGx testing allows for targeted treatment decisions according to the unique characteristics of the patient’s genetic profile. The integration of PGx within CMM reduces costs, improves outcomes and access to care, and enhances patient and provider quality of life and satisfaction. To ensure medication optimization, ACCP calls for PGx to be integrated into CMM coverage. Click here to read ACCP’s response in full.
Reference
1. Office of Inspector General. Data Brief. Telehealth Was Critical for Providing Services to Medicare Beneficiaries During the First Year of the COVID-19 Pandemic. March 2022. Available at https://oig.hhs.gov/oei/reports/OEI-02-20-00520.pdf.