Perioperative Care Wins ACCP-PAC PRN Challenge!

Congratulations to the Perioperative Care PRN for winning the ACCP-PAC PRN Challenge. ACCP launched the challenge to determine which PRN could provide the greatest level of support for ACCP-PAC. As winners, the Perioperative Care PRN will be awarded a coveted Monday timeslot for PRN business meetings at the next two ACCP Annual Meetings. The PRN Challenge raised more than $7500 for ACCP-PAC, and we extend our sincere thanks and gratitude to all PRN members who participated in the challenge and supported the PAC.

Final Leaderboard

The full standings are as follows:

1. Perioperative Care
2. Endocrine and Metabolism
3. Central Nervous System
4. Clinical Administration
5. Pharmaceutical Industry
6. Nephrology
7. Cardiology
8. GI/Liver/Nutrition
9. Pain and Palliative Care
10. Ambulatory Care
11. Pharmacokinetics/Pharmacodynamics/Pharmacogenomics
12. HIV
13. Critical Care
14. Pediatrics
15. Women’s Health
16. Adult Medicine
17. Infectious Diseases

ACCP-PAC 2015 Financial Report and 2016 Outlook

ACCP-PAC is pleased to announce that 2015 was our most successful year on record. Thanks to the generosity of 275 ACCP members, the PAC raised over $19,000 to be distributed to candidates for the U.S. Senate and U.S. House of Representatives.

As we head into the 2016 election season, the PAC has almost $58,000 cash on hand to support elected officials and candidates who are committed to a care delivery system where clinical pharmacists, working within integrated medical practice, are responsible for providing significant portions of medication management and for helping to achieve clinical goal attainment for patients’ medication use.

ACCP’s advocacy efforts in Washington, D.C., related to our Medicare Initiative are perfectly aligned with the College’s ongoing and ever-expanding clinical practice advancement initiatives essential for integrating clinical pharmacy services into contemporary team-based health care delivery. As an organization, we are entirely focused on providing clinical pharmacists actionable tools, knowledge, and skills to make meaningful transformations in practice management and leadership development.

However, the political reality is that a legislative initiative cannot move forward purely on the strength of its own merits—grassroots advocacy and financial contributions are key to showing support for our initiative from elected officials’ own districts and states.

A well-funded PAC will help provide the necessary resources to support our friends on Capitol Hill. Contributions from ACCP-PAC to members of Congress will raise our profile on Capitol Hill, improve our standing among key lawmakers, and provide unique opportunities to discuss our initiative with potential congressional champions. Our PAC will also help ensure that elected officials who support our initiative remain in office to advance the goals of the proposal in the future.

Only ACCP members are eligible to contribute to the PAC and allow us to make these vital political contributions. With its more than 17,000 ACCP members, ACCP is in a position to become one of the most prominent pharmacy PACs in Washington. To do this, we need the widespread support of our membership. Click here to contribute to ACCP-PAC today!

2016 Presidential Candidate Health Care Policy Platform Overview

As the 2016 presidential primary process gathers pace, the following is a short summary of the health care policy platform proposed by each of the major candidates for their party’s nomination. Although Republican candidates have focused largely on defunding and eventually repealing the Affordable Care Act (ACA), the leading contenders for the Democratic nomination have presented markedly different plans for how to improve the American health care system.

Republican Candidates

Senator Ted Cruz

• Repeal Obamacare and propose commonsense reform that makes health care personal, portable, and affordable.
• Expand competition in the marketplace, empower consumers and patients to make health care decisions with their physicians, and disempower the government from getting in between physicians and their patients.
• Open insurance markets across state lines, expand Health Savings Accounts (HSAs), and delink health insurance from employment.

For more information, visit https://www.tedcruz.org/about/.

Governor John Kasich

• Repeal Obamacare and replace it with efforts that improve access by lowering health care costs without interfering with Americans’ personal health care decisions or imposing punishing burdens on job creators.
• Improve primary care, focusing on patient-centered primary care that helps promote long-term good health instead of just reacting when someone gets sick.
• Rewarding value instead of volume (episode-based payments), incentivizing providers to work as teams to control costs and maximize quality.

For more information, visit https://johnkasich.com/healthcare/.

Donald Trump

• Repeal and replace Obamacare.
• Expand access to HSAs.
• Save Social Security, Medicare, and Medicaid “without cutting it to the bone” by “making the country rich again.”
• Infuse more competition into the market to let citizens purchase health care plans across state lines.

For more information, visit https://www.donaldjtrump.com/issues/.

Democratic Candidates

Former Secretary of State Hillary Clinton

• Defend the ACA and build on it to expand affordable coverage, slow the growth of overall health care costs (including prescription drugs), and make it possible for providers to deliver the very best care to patients.
• Lower out-of-pocket costs like copays and deductibles. The average deductible for employer-sponsored health plans rose from $1240 in 2002 to about $2500 in 2013, even though the growth of national health spending has been slowing.
• Reduce the cost of prescription drugs. Prescription drug spending accelerated from 2.5% of overall health care spending in 2013 to 12.6% in 2014.
• Transform our health care system to reward value and quality. Build on delivery system reforms in the ACA that improve value and quality care for Americans.
• Expand access to rural Americans, who often have difficulty finding quality, affordable health care, and explore cost-effective ways to broaden the scope of health care providers eligible for telehealth reimbursement under Medicare and other programs, including federally qualified health centers and rural health clinics.
• Ensure that women have access to reproductive health care, and continue defending Planned Parenthood, which provides critical health services including breast exams and cancer screenings to 2.7 million women a year.

For more information, visit https://www.hillaryclinton.com/issues/health-care/.

Senator Bernie Sanders

• Build on the ACA to achieve the goal of universal health care through a “Medicare for All” proposal.
• Create a federally administered single-payer health care program providing comprehensive coverage for all Americans, including inpatient and outpatient care; preventive and emergency care; primary and specialty care; long-term and palliative care; vision, hearing, and oral health care; and mental health and substance abuse services, as well as prescription medications, medical equipment, supplies, diagnostics, and treatments.
• Eliminate copays, deductibles, and insurance-provider networks, thereby reducing overhead, administrative costs, and complexity. Patients would simply present an insurance card to their health care provider.

Senator Sanders’s plan has been estimated to cost $1.38 trillion per year, paid for by:

• A 6.2% income-based health care premium paid by employers. Revenue raised: $630 billion per year.
• A 2.2% income-based premium paid by households. Revenue raised: $210 billion per year.
• Progressive income tax rates. Revenue raised: $110 billion a year.
• Taxing capital gains and dividends the same as income from work. Revenue raised: $92 billion per year.
• Limit tax deductions for rich. Revenue raised: $15 billion per year.
• The Responsible Estate Tax. Revenue raised: $21 billion per year.
• Savings from health tax expenditures. Revenue raised: $310 billion per year.

For more information, visit https://berniesanders.com/issues/medicare-for-all/.

Senate Finance Chronic Care Working Group Policy Options

On December 18, 2015, the Senate Finance Committee Chronic Care Working Group released an options paper outlining policies being considered as part of the committee’s effort to improve how Medicare treats beneficiaries with multiple, complex chronic illnesses.

Release of the options paper followed a request from Finance Committee Chairman Orrin Hatch (R-UT) and Ranking Member Ron Wyden (D-OR) to health care stakeholders for input on solutions that will improve outcomes for Medicare patients requiring chronic care. The paper organizes policies into several key areas under consideration:

• Providing high-quality health care in the home.
• Improving access to interdisciplinary, team-based health care.
• Expanding innovation in benefit design and access to technology.
• Identifying ways to improve payments and quality for the chronically ill population.
• Empowering patients and caregivers in care delivery.

However, the paper did not properly address the issue of medication use among the chronically ill Medicare population. This omission came despite comments submitted to the committee from ACCP, the College of Psychiatric and Neurologic Pharmacists (CPNP), and a diverse range of organizations including the Pharmaceutical Research and Manufacturers of America (PhRMA), the Biotechnology Industry Organization (BIO), GlaxoSmithKline (GSK), Blue Thorn, Healthcare Consulting, and others, calling for coverage for comprehensive medication management (CMM) as part of the process of developing and implementing policies designed to streamline care coordination, improve quality, and lower Medicare costs.

ACCP will continue its efforts to educate the Senate Finance Committee and other key stakeholders on Capitol Hill on the importance of “getting the medications right” through consistent CMM as part of a truly patient-centered, team-based approach to health care and a vital component of evolving Medicare payment and care models.

Click here to read the Senate Chronic Care Working Group Policy Paper in full.

ACCP Responds to CMS Request for Information Pertaining to Pharmacist Labor Cost

On December 28, 2015, ACCP submitted comments on the pharmacist labor cost component of the direct practice expense (PE) calculation to the Centers for Medicare & Medicaid Services (CMS) in response to a request for information related to the CY 2016 Physician Fee Schedule (PFS) policy revisions on this topic.

The request from CMS was prompted by calls for the agency to include pharmacists as active qualified health care providers for purposes of calculating physician PE direct costs, in recognition of ongoing Center for Medicare & Medicaid Innovation initiatives in which pharmacists are making substantial contributions to redesigning health care delivery and financing. As a result, CMS concluded that the labor costs of pharmacists are not a typical resource cost in furnishing any particular physician service and requested more detailed information regarding the typical clinical labor costs involving pharmacists for particular PFS services.

ACCP’s response was based on information provided by established practices and pharmacist colleagues who are actively engaged in team-based primary care and specialty medical practices. This information reflects a combination of aggregated information of a proprietary nature as well as publicly available data from sources such as the Bureau of Labor Statistics and the Health Resources and Services Administration. Of importance, ACCP’s response was presented in the context of an interprofessional and integrated practice framework and structure and was grounded in a series of established definitions, professional practice standards, and policy documents that more fully define the “scope” (i.e., the “work/labor activity”) of CMM that is being delivered by clinical pharmacists within physician/clinic practices.

Click here to read ACCP’s letter in full.

Click here to view the request for information from CMS.

Important New Documents Related to the Integration of Pharmacists in Team-Based Patient Care Practices

On December 23, 2015, the California Department of Public Health (CDPH) released an important white paper titled “Comprehensive Medication Management Programs: Description, Impacts, and Status in Southern California, 2015.” The document reviews CMM pilot programs that were successfully implemented in six health care systems in southern California and resulted in improvements in clinical, fiscal, and quality measures.

CDPH developed the white paper and drafted the California Wellness Plan, a chronic disease prevention and health promotion plan, in response to Governor Jerry Brown’s 2012 call for the improved health of Californians. The white paper aims to describe the current clinical landscape, including the delivery, use, outcomes, benefits, and challenges of CMM in southern California.

Contributing authors to the white paper are as follows:

• Ashley Butler, Touro University, California.
• Steven Chen, School of Pharmacy, University of Southern California.
• Michelle Chu, School of Pharmacy, University of Southern California.
• Matthew Dehner, FrontLine Pharmacy Consulting.
• Loriann DeMartini, California Department of Public Health.
• Ryan J. Gates, FrontLine Pharmacy Consulting.
• Terry McInnis, Blue Thorn.
• Jessica Núñez de Ybarra, California Department of Public Health.
• Caroline Peck, California Department of Public Health.
• Patricia Shane, College of Pharmacy, Touro University, California.
• Marilyn Stebbins, School of Pharmacy, University of California, San Francisco.

The following six programs in southern California contributed CMM pilot program and information to the white paper:

• GEMCare Medical Group.
  • Key findings: Pharmacy services within the medical group initially included 305 patients seen over 12 months in a medication therapy management program, which successfully generated more than $600,000 in medication cost savings, reduced hospitalizations by 20%, and demonstrated high physician and patient satisfaction. After integrating the advanced practice pharmacist into the Comprehensive Care Program, positive economic outcomes included an overall decreased health cost of almost 20% per member per month, with decreases in hospital admission rates by 38%, readmission rates by 32%, and emergency department visits by 29%.
• Greater Newport Physicians Ambulatory Care Clinics
  • Key findings: On average, ACTIVE Diabetes Program participants met their diabetes treatment goals within the first 180 days of enrollment. They also met quality measure goals for blood pressure control, high cholesterol, and nephropathy screening. As a result of the pharmacist-led anticoagulation center, inpatient admissions were reduced by 53% and emergency department visits by 41%. Medical costs for ACTIVE program participants were about $1200 less per patient per year.
• Kern Medical Center
  • Key findings: Almost half of the patients with poorly controlled diabetes achieved the blood glucose treatment goal. There was a 40.1% reduction in emergency department visits, a 22.3% reduction in hospitalizations overall, and a 26.1% reduction in the length of stay, if hospitalized. A clinical pharmacist working as a member of the multidisciplinary team in the Diabetes Care Clinic for 40 hours per week for a mean of 272 days and a mean of 5.9 visits per patient resulted in an estimated cost savings of $256,518 per year.
• Sharp HealthCare
  • Key findings: Patients with heart failure enrolled in the Continuum of Care Network had half as many readmissions as patients not enrolled (12% vs. 24%).
• University of California San Diego Health System
  • Key findings: The annualized cost avoidance with the Transitions of Care program (i.e., inpatient and outpatient) was $503,278. Within the first year of the Community-Based Care Transitions Program, patient readmissions decreased dramatically by about 30% for the Medicare fee-for-service population to a rate of 10.4%.
• University of Southern California School of Pharmacy/AltaMed Health Services
  • Key findings: Over 3 years, pharmacy teams enrolled more than 6000 high-risk and/or high-cost patients. An average of 10 medication-related problems were identified and resolved for each patient. Preliminary return on investment analysis suggests that program costs were outweighed by savings.

Of importance, although the white paper concluded that adopting CMM resulted in improved health care quality measures, allowed better access to health care, offered time savings to other health care providers, reduced drug costs and adverse drug events, and decreased expensive health care resource use, the report also identified several barriers to the widespread deployment of CMM that must be overcome. These include a lack of reimbursement mechanisms, alignment of financial incentives, robust electronic health information exchange, quality and outcomes tracking systems, patient and provider awareness, and adequate staffing and space.

Click here to view the California CMM white paper in full.

Contact Us! For more information on any of ACCP’s advocacy efforts, please contact:

John K. McGlew
Director, Government Affairs
American College of Clinical Pharmacy
1455 Pennsylvania Avenue Northwest
Suite 400
Washington, DC 20004-1017
(202) 621-1820
[email protected]