The news of House Speaker John Boehner’s resignation came abruptly but was not entirely unexpected. The announcement came shortly after the emotional and historic visit of Pope Francis to Capitol Hill and ended the Ohio Republican’s 25-year career in Washington.

Boehner was admired as a pragmatic legislator by moderates from both political parties, a sentiment expressed by House Minority Whip Steny H. Hoyer (D-MD), who called Boehner’s resignation—and the circumstances behind it—a “big loss for the country and a loss for this institution.”¹ But Boehner’s tenure as speaker was largely defined by his struggle to reconcile the demands of the conservative faction of the Republican Party with the logistical challenges of working with the Obama White House.

Since retaking the majority in 2010, House conservatives have pushed Boehner and his leadership team to take a more confrontational approach with President Barack Obama over issues such as government spending, abortion, immigration, and Obamacare, a stance that more moderate Republicans believe is completely unrealistic in a divided government. Faced with the possibility of a second government shutdown on his watch, the speaker’s resignation was considered a selfless decision aimed at avoiding potentially bruising battles both within the GOP itself and across party lines. Boehner commented, “My first job as speaker is to protect the institution…. It had become clear to me that this prolonged leadership turmoil would do irreparable harm to the institution.”²

However, the race to replace Boehner was plunged into chaos when perceived frontrunner, House Majority Leader Kevin McCarthy (R-CA)—who shares Boehner’s center-right Republican politics—dropped out of the running just hours before his party was due to vote on its candidate for speaker. McCarthy, currently No. 2 in the House hierarchy, was originally considered a safe bet to take over as speaker but faced challenges from Rep. Jason Chaffetz (R-UT), the incumbent chairman of the House Oversight and Government Reform Committee, and Daniel Webster (R-FL), who unexpectedly won the backing of a group of 30–40 hardline conservatives, known as the House Freedom Caucus.

To claim the speaker’s chair, the Republican candidate would have to secure a majority in a full vote on the House floor, scheduled for October 29. Without Democratic support, a Republican nominee for speaker can’t afford to lose more than 29 GOP votes—a distinct possibility if the Freedom Caucus delivers on its threat to vote as a bloc to oppose the more moderate McCarthy.

With the House leadership contest thrown into disarray, it remains unclear how the party will proceed. There is speculation that Boehner will stay on in the position until his party can agree on a replacement. House Ways and Means Committee chairman and former vice presidential candidate Paul Ryan (R-WI), the top choice of many Republicans to fill the speaker position, continues to reiterate that he is not interested in the job. Meanwhile, moderate Republican Representative Charlie Dent (PA) suggested the formation of a “bipartisan coalition” with Democrats to elect the next speaker and avoid having to appease the “rejectionist wing” of his own party, which he said has made the House ungovernable by insisting on “unreasonable demands.”³

Although the chaos surrounding the House Republican leadership will likely divert energy away from efforts on the Hill to develop a health care legislative package in the coming months, recent events have also lessened the possibility of an imminent government shutdown. On the Democratic side, Senate Minority Leader Harry Reid (NV) urged Republican leaders to quickly advance legislation that would lift the government’s debt limit, which the Treasury Department estimates will be hit around November 5. ACCP staff in Washington, D.C., will monitor the situation closely and prioritize outreach to the newly elected leadership.

2015 ACCP Global Conference on Clinical Pharmacy—Connecting Medicare Part B Coverage Initiative and Practice Transformation

Daniel S. Aistrope, Pharm.D., BCACP – Director, Clinical Practice Advancement

In keeping with the organization’s core values and mission, ACCP is fully committed to an organization-wide priority of clinical practice advancement and practice transformation. With the assistance of its members, the College is engaged in an ongoing evaluation of the landscape of clinical pharmacists’ needs related to the evolving health care policy initiatives. The College is committed to supporting members in translating theory and policy to implementable strategies to “get the medications right” and improve patient care.

For the past 3 years, ACCP’s Washington office has been focused on an advocacy effort that calls on Congress to enact legislation to provide Medicare patients with coverage for comprehensive medication management (CMM) within the Part B medical benefit. The College has established itself as a prominent leader in this area of health care policy, advocating for a patient-centered, interprofessional and collaborative approach to health care delivery and practice transformation that removes existing professional silos.

Our focus on the service (the “what”), rather than the provider (the “who”), and our requirement that these services be delivered under formal collaborative practice agreements or clinical privileges granted by the health care setting in which the pharmacist practices have played a significant role in facilitating our progress on Capitol Hill and our ongoing outreach to the physician community. These efforts in Washington, D.C., are connected components of ACCP’s organization-wide commitment to clinical practice advancement toward patient-centered, team-based care. This commitment includes the recent announcement of $2.5 million in grant funding to demonstrate the effective implementation and scalability of CMM services in primary care medical practices. This augments our ongoing work with medical organizations, private payers, innovative health systems, and other key stakeholders to support the development, advancement, and positioning of clinical pharmacists as integrated direct patient care providers within team-based medical practices and delivery systems.

Our Medicare Initiative is designed to position clinical pharmacists to participate in evolving care delivery and payment models. The process of care we propose is consistent with the vision for CMM in the patient-centered medical home (PCMH) endorsed by the multidisciplinary Patient-Centered Primary Care Collaborative and is a necessary component to achieve many of the quality measures that accountable care organizations (ACOs) must meet.

Since the launch of this initiative, ACCP has made significant progress on Capitol Hill, resulting in meaningful interest from a bipartisan group of lawmakers who recognize the value of a truly patient-centered, team-based approach to health care and understand that “getting the medications right” through consistent CMM is a vital component of evolving payment and care models both in Medicare and across all payers and delivery systems. At the same time, Congress has demonstrated that it is both willing and able to move forward on a series of key health care policy initiatives, including the passage of legislation that permanently repeals the flawed Medicare SGR (sustainable growth rate) formula and that will, in the coming years, transition Medicare payment policy to a system that measures and pays for quality and value, not simply volume of services, and that fully incentivizes patient-centered, team-based care.

ACCP’s advocacy efforts around health care transformation align with the College’s ongoing and ever-expanding clinical practice advancement initiatives. These include issue briefs, products, services, and educational resources essential for integrating clinical pharmacy services into contemporary team-based health care delivery. The content and mode of delivery are focused on providing clinical pharmacists with actionable tools, knowledge, and skills to bring about meaningful transformation through practice management and leadership development.

One notable example of this work is focused on billing practices for clinical pharmacy services. New billable service codes such as chronic care management (CCM) and transitions of care management (TCM) offer practitioners a bridge over the chasm between fee-for-service and value-based reimbursement. By implementing these programs, practices will develop internal processes critical to population health management while receiving fee-for-service payment to support those activities. In recognizing members’ needs in this area, ACCP’s first Practice Advancement issue brief focused on payment methods in team-based practices. This and other resources align with health care transformation initiatives focused on operationalizing a shift from volume to value by putting policy into action.

Learn more about our progress to date and how you can get involved in this effort at the following sessions to be held during the Global Conference on Clinical Pharmacy in San Francisco, California.

Advocacy and Practice Transformation: Updates on ACCP’s Medicare Initiative

Monday, October 19, 2015, from 9:15 a.m. to 11:15 a.m.

Learn about the progress ACCP has made in its legislative initiative to secure Medicare Part B coverage for 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 2016. Find out how you can get involved through grassroots advocacy and the ACCP-PAC to help move this initiative forward in Congress. Understand how our work in Washington relates to ACCP’s commitment to practice transformation and the College’s longer-term strategic goals.

ACCP Business Meeting and Town Hall

Sunday, October 18, 2015, from 2:30 p.m. to 4:15 p.m.

Learn about ongoing efforts and priorities of the College and the Research Institute from board, committee, and staff members, including a discussion of the CMM Grant Award.

Keynote Address: Measuring Quality in Patient-Centered Care—Challenges and Opportunities

Monday, October 19, 2015, from 7:45 a.m. to 9:00 a.m.

“Measuring Quality in Patient-Centered Care—Challenges and Opportunities”: Michael S. Barr, M.D., MBA, FACP, Executive Vice President, Research, Performance Measurement and Analysis, National Committee for Quality Assurance

Innovations in Practice Technology

Monday, October 19, 2015, from 9:15 a.m. to 10:45 a.m.

New practice technologies are available that may expand or enhance patient care. This session will describe new practice technologies and their actual and potential roles in delivering patient care. The session will incorporate evidence on the effectiveness of new technologies as well as clinician experience and will forecast potential roles of technologies within the practice of clinical pharmacy.

Clinical Administration PRN Focus Session—Patient Monitoring Prioritization and Productivity Measurement to Grow and Sustain Pharmacy Services.

Monday, October 19, 2015, from 1:30 p.m. to 3:00 p.m.

As quality outcomes become increasingly more important in the evolving world of health care, health systems and pharmacy departments must identify key metrics that drive efficiency and manage workflow, in addition to capturing clinical work and identifying patients in need of a clinical pharmacist’s intervention. This session will discuss opportunities and metrics in pharmacy, as well as how to use productivity dashboards in electronic health records to drive changes in pharmacy practice.

Advancing Clinical Pharmacy Practice: Innovative Models

Tuesday, October 20, 2015, from 10:15 a.m. to 11:45 a.m.

Practice innovation is a major focus in the current health care environment. This session will describe the impact of clinical pharmacists in the implementation of innovative health care practices in various settings. The session will specifically showcase projects recognized through the Centers for Medicare & Medicaid Innovations Awards and other national awards where pharmacists play a major role.

Adult Medicine PRN and Ambulatory Care PRN Focus Session—Transitions of Care Management: Best Practices

Tuesday, October 20, 2015, from 1:30 p.m. to 3:00 p.m.

Patient movement across health care settings introduces the risk of medication and communication errors, and clinical pharmacists on interprofessional teams can assist in bridging these dangerous gaps. In this session, learn how to put systematic transition principles into practice from both inpatient and ambulatory care experts, as well as how to integrate trainees into the service.

Ambulatory Care PRN Focus Session—Billing Practices in Ambulatory Care Pharmacy: Developing, Implementing, and Sustaining Ideal Models

Tuesday, October 20, 2015, from 3:15 p.m. to 4:45 p.m.

As health care systems evolve, so do compensation models to support the sustainability and growth of clinical services provided to patients. Attend this session to learn about the best practices, challenges, and realities of implementing both well-known and emerging billing methods to ensure that your clinical pharmacy practice excels in providing CMM.

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]

¹Washington Post article. “House Speaker John Boehner to Resign at End of October.” Accessed October 6, 2015. Available here.
²New York Times article. “John Boehner, House Speaker, Will Resign from Congress.” Accessed October 6, 2015. Available here.
³Washington Post article. “House Majority Leader Kevin McCarthy Drops Out of Race for House Speaker.” Accessed October 8. Available here.