ACCP Washington Office: PRN Update, August 2014

Advocacy Programming at the ACCP Annual Meeting

ACCP Medicare Initiative: Updates from Capitol Hill
Monday, October 13, 2014 from 9:15 a.m. to 11:15 a.m.
Convention Center, Meeting Room 16

Learn about the progress ACCP has made in our legislative initiative to secure Medicare Part B coverage for comprehensive medication management (CMM) services provided by qualified clinical pharmacists as members of the patient’s health care team. Hear the latest from Capitol Hill and the outlook for 2015. Find out how you can get involved through grassroots advocacy and the ACCP-PAC to help move this initiative forward in Congress.

Ambulatory Care PRN Focus Session—Implications of the Affordable Care Act on Ambulatory Care Clinical Pharmacy
Monday, October 13, 2014, from 1:30 p.m. to 3:30 p.m.
Available for 2.0 hours of CPE credit

• The Status of the Affordable Care Act and Ambulatory Care Clinical Pharmacy: Where We Are and What Is Still to Come. Speaker: Gary R. Matzke, Pharm.D., FCCP, FASN
• Practice Opportunities and Risks of the Affordable Care Act. Speaker: Stuart T. Haines, Pharm.D., BCPS, BCACP, BC-ADM
• Ambulatory Care Clinical Pharmacists as Part of the Health Care Team: Where We Are and How to Advocate for Your Profession. Speakers: Seena L Haines, Pharm.D., BC-ADM; and Curtis E. Haas, Pharm.D., FCCP, BCPS

Click here to learn more about the Ambulatory Care PRN Focus Session.

ACCP Submits Comments on Two Senate Finance Committee Initiatives

With Congress out of session until September and the November elections already looming, congressional staff acknowledge that it is unlikely that any major legislative initiatives will advance this year. But the Senate Finance Committee is already looking ahead to the 114th Congress and has begun preliminary work on some important health care initiatives that could in 2015. ACCP recently provided comments on two issues under consideration.

Future of Health Care Data

Finance Committee Chairman Wyden (D-OR) and Senator Grassley (R-IA) invited health care stakeholders to provide input on ideas that will enhance the availability and utility of health care data while maintaining and strictly protecting patient privacy.

In a press release, the senators noted,

Health care-related data, specifically, is a growing but largely untapped resource for accelerating improvements in health care quality and value. These data have great potential for use by consumers who can be empowered to choose providers that best fit their specific needs; by providers who can improve and deliver higher-quality care; and by payers who can design the most efficient and effective delivery models.

Click here to read ACCP’s comments.

Chronic Illness: Addressing Patients’ Unmet Needs

On July 15, the Finance Committee held a full hearing into addressing the challenges of chronic illness. In his opening statement, Chairman Wyden noted that more than two-thirds of Medicare beneficiaries are now dealing with multiple chronic conditions and that their care accounts for almost all—93%—of Medicare spending. Chairman Wyden went on to highlight issues that arise when patient care, particularly related to medication use, is uncoordinated with different providers operating in silos.

Click here to read more about the Senate Finance Committee Hearing.

Click here to read ACCP’s comments submitted to the Committee.

Outlook for ACCP’s Medicare Initiative

With time running out for major legislative activity in 2014, it would be unrealistic to expect any significant movement on our Medicare Initiative before 2015. As the 113th Congress winds down, congressional staff are already looking ahead to next year and the new Congress. For the remainder of this year, ACCP will continue to work with elected officials on both sides of the aisle to secure additional support for our initiative and position it for consideration as part of the larger Medicare payment reform discussion.

To date, our proposal has been consistently well received by House and Senate offices from both political parties. According to feedback we have received from our conversations with congressional staff, several areas related to our proposal have been highlighted as particular strengths:

• The Need for Robust Medication Management Services. The challenge of managing complex, chronically ill Medicare beneficiaries to clinical goals and the financial and societal costs associated with the failure to meet these goals are widely understood on Capitol Hill. Integrated, team-based patient care and payment models that reward value and outcomes rather than volume have been identified by policy leaders as the solution to this growing health care crisis. As part of this conversation, the need for coverage of robust medication management services is recognized, and qualified clinical pharmacists are considered the health care provider ideally positioned to deliver this service.
• The Part D Experience. Part D medication therapy management (MTM), although enjoying some political backing, is recognized as a limited and structurally flawed benefit that is administrative rather than clinical in nature. Even though the inclusion of an MTM benefit within Part D established an important precedent in including a patient care service component to accompany the coverage of prescription drugs, there is a growing acceptance—as highlighted recently by comments made by the Medicare Payment Advisory Commission (MedPAC) submitted to Centers for Medicare & Medicaid Services (CMS)—that Part D MTM, as it is currently structured, cannot achieve the full potential of robust medication management care. Furthermore, that 30% of Medicare seniors are not enrolled in Part D and lack access to any medication management service is recognized as a significant gap in Medicare coverage.
• Collaborative Practice Agreements. Congressional staff have indicated that the requirement for patient care to be delivered under formal collaborative practice agreements is an essential provision. This structure ensures that care is truly team based and that the effort is truly aimed at securing payment for pharmacists as part of integrated health care teams, rather than directly billing for services provided in a siloed, fee-for-service structure. In addition, the collaborative practice approach provides support for our position that organized medicine is, in general, comfortable with the model of care we are trying to advance.
• Evolving Payment Models. Congressional staff have been encouraged by our efforts to align our proposal with the evolving, team-based, integrated delivery models that Medicare hopes to adopt. That our proposal is consistent with the model of care endorsed by the Patient-Centered Primary Care Collaborative (PCPCC) provides additional credibility to support this position. Although there is a natural reluctance in Congress to expand Medicare under the current, flawed, fee-for-service system, staff recognize that until Medicare payment policy shifts entirely to a bundled or capitated payment model, coverage under the existing Part B structure will be necessary to ensure coverage for and delivery of CMM services.
• Partnership with CPNP (College of Psychiatric and Neurologic Pharmacists). Mental and behavioral health issues are currently considered a priority on Capitol Hill, admittedly in the absence of a meaningful bipartisan consensus on what a legislative package addressing these issues should include. However, several congressional offices have noted the additional challenges that patients with mental or behavioral conditions face in appropriately managing medication therapies and the particular importance of making a Part B CMM benefit available to this patient population.

For complete information on ACCP’s advocacy effort, visit our Medicare Coverage Initiative page at http://www.accp.com/govt/medicare.aspx.

To find out how you can get more involved in our grassroots effort, visit our Legislative Action Center at http://capwiz.com/accp/home/.

November Congressional Election Preview

Decades of partisan redistricting, combined with an increasingly polarized electorate, have created a situation in which only 14 of the 435 House seats being contested in November are considered truly competitive (rated “toss-up” by the Cook Political Report), and an astonishing 356 seats are considered either solidly Republican or Democratic. Because House Republicans hold a 33-seat majority (234 seats to the Democrats’ 201 seats), Democratic challengers would need to win all 14 of those “toss-up” races, as well as 20 seats from races considered “lean” or “likely” Republican, while retaining control of all the seats they currently hold to win control of the House. In short, the Republican Party is widely expected to control the House when the 114th Congress is sworn in.

On the Senate side, where the Democrats hold a 55:45 seat majority (including two Independents who caucus with the Democrats), the outlook is less clear. Democrats must defend 21 of the 36 Senate seats being contested, compared with 15 races for the seats currently held by Republicans.

The GOP requires a net gain of six seats to secure control of the Senate. As things currently stand, polls indicate that Republicans should pick up seats in Montana, South Dakota, and West Virginia. Both South Dakota and West Virginia are open contests because incumbent Democratic Senators Tim Johnson (SD) and Jay Rockefeller (WV) are retiring. In Montana, incumbent Democratic Senator John Walsh was appointed to the seat after long-standing Senator Max Baucus stepped down to become the U.S. ambassador to China. Senator Walsh is embroiled in a scandal regarding accusations that he plagiarized a research paper while attending the U.S. Army War College in Pennsylvania and has confirmed that he will not seek reelection.

In as many as eight other states, the Senate election looks increasingly favorable for Republicans to pick up seats currently held by Democrats. Incumbent Democratic Senators Pryor (AR), Landrieu (LA), Hagen (NC), and Begich (AK) all face tough races in states that generally lean Republican, whereas the open seat in Iowa vacated by retiring Senator Tom Harkin is rated “too close to call” but is considered “winnable” by Republican strategists. The only hope for Democratic pick-ups are in Kentucky (where Republican Minority Leader McConnell faces Secretary of State Alison Lundergan Grimes) and the open seat in Georgia (where Republican businessman David Purdue faces Democrat nonprofit CEO Michelle Nunn).

With Republicans looking strong in seven or eight races for seats currently held by Democrats, their path to the majority looks fairly clear. To retain power in the Senate, Democrats would need to hold onto at least three of the eight states where they are considered vulnerable, or squeak an unlikely victory in the two states identified as possible Democratic gains. Of course, a long road remains between now and November, and as history has proven, candidates from either party could see a seemingly unassailable lead evaporate between now and then.

Advancing Our Medicare Initiative Through Grassroots Action

We believe that our investment in our Washington office and advocacy activities during the past dozen years leaves us well placed to advance our Medicare Coverage Initiative. But our success ultimately lies in the engagement of ACCP members to help their elected officials understand the importance of “getting the medications right” as part of patient-centered, team-based models of care delivery.

With more than 15,000 members, not to mention their professional colleagues and patients, ACCP does have the potential to exert considerable influence on Capitol Hill. But to realize this potential, we need the active participation of all members as grassroots advocates.

Identifying Political Champions

In seeking to identify potential champions to advance our initiative in Congress, we need to find elected officials who share our vision of a more patient-centered, team-based, and quality-focused approach to Medicare who also sit on the congressional committees of jurisdiction over the Medicare program itself.

In the House of Representatives, jurisdiction over Medicare is shared between the Energy and Commerce Committee and the Committee on Ways and Means. In the Senate, the Finance Committee oversees Medicare issues. Members who sit on these committees are best placed to introduce legislation on behalf of ACCP and work to ensure its passage into law.

• Click here to view the members of the Senate Finance Committee.
• Click here to view the members of the House Energy and Commerce Committee.
• Click here to view the members of the House Ways and Means Committee.

In addition, legislation would ideally be introduced in a bipartisan manner, meaning a Republican and a Democrat from a committee of jurisdiction would work together to cosponsor a bill on our behalf. Although we acknowledge the challenge of identifying bipartisan cosponsors from the key committees of jurisdiction, we have taken care to ensure our legislative proposal is entirely nonpartisan and focused on issues that members from both parties can agree on—improving quality and lowering costs in the Medicare program.

To determine whether your elected officials sit on a committee of jurisdiction, visit our Legislative Action Center and enter your zip code to view your congressional delegation. Check your work zip codes as well as your home address—especially if you practice in several sites. Members of Congress will be interested to learn about innovative, cost-saving care delivery going on in their district, even if you are not a constituent residing in that district.

ACCP’s Guide to Hosting a Visit of Elected Officials to Your Practice

Hosting a visit of your elected officials to your practice is perhaps the single most important thing you can do to help lawmakers understand what team-based, patient-centered clinical practice is all about—and to generate their support for recognition and payment for clinical pharmacists’ services.

A visit also serves as a means to establish an ongoing constructive dialogue with your congressman or senator, and their staff, on issues important to the delivery of team-based, patient-centered care.

A comprehensive guide to inviting a member of Congress to tour your practice site is available on our Legislative Action Center. If you would like to discuss the process of hosting a lawmaker at your practice site, please contact John McGlew at (202) 621-1820 or [email protected].

All ACCP members are urged to consider inviting their elected officials to learn more about their practice through a tour of their practice site.

Advancing Our Medicare Initiative Through the ACCP Political Action Committee (ACCP-PAC)

Political contributions are an essential component of our grassroots advocacy toolkit, helping to raise our profile on Capitol Hill and show our support for members of Congress who share our vision for clinical pharmacists in an evolving Medicare program.

A well-funded PAC can be used to demonstrate the support within the profession for our legislative initiative and the importance ACCP members attach to moving it forward in Congress.

ACCP-PAC depends entirely on the support of ACCP members. Although several PACs are representing various segments of the pharmacy profession, ACCP’s is the only PAC dedicated to advancing the practice of clinical pharmacy.

We call on the PRNs to reach out to their members to encourage participation in the PAC. If each ACCP member contributed just $25, ACCP-PAC would raise $300,000. All ACCP members should consider donating at least $25 to ACCP-PAC. CLICK HERE to support your PAC today!

Now Accepting Applications—ACCP/ASHP/VCU Pharmacy Policy Fellow Program

The Congressional Healthcare Policy Fellow Program is a collaborative effort of ACCP, the School of Pharmacy at the Medical College of Virginia/Virginia Commonwealth University, and the American Society of Health-System Pharmacists.

The program provides a unique health care policy learning experience designed to demonstrate the value of pharmacy-government interaction and to facilitate practical contributions to the effective use of scientific and pharmaceutical knowledge in government policy development. Fellows spend a month with each of the professional organizations as members of their respective government and professional affairs staff. In November of the fellow year, fellows begin working in a legislative environment requiring health care input on the staff of an individual senator or representative or a relevant congressional committee.

The program is an enriching opportunity for the Fellow to develop legislative evaluation and policy development skills, improve research and writing skills and integrate practical policy experience with theory. The Fellow will be expected to undertake a wide array of responsibilities including researching and preparing briefs on health care issues, assisting with policy decisions, drafting memoranda, planning, and organizing and carrying out program and management objectives.

The congressional office (personal or committee) placement should ideally be with one of the committees that predominantly deal with health issues such as the Senate Health, Education, Labor, and Pensions (HELP) Committee and Senate Finance Committee or the House Ways and Means or Energy and Commerce Committees.

Applications for 2015–2016 Pharmacy Healthcare Policy Fellow Program

Interested candidates should visit the Pharmacy Healthcare Policy Fellow program’s Web site for more information and instructions on submitting an application.

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 NW
Suite 400
Washington, DC 20004-1017
(202) 621-1820
[email protected]