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ACCP Report - June 2014

Washington Report: ACCP Medicare Initiative Update

Written by John McGlew
Director of Government Affairs



Update from Capitol Hill

According to the current congressional calendar, the House of Representatives will be in session for less than 40 days between now and the November election. Lawmakers have already acknowledged the unlikelihood of any major legislative initiatives advancing during what is left of the 113th Congress.

Looking ahead to November, decades of partisan redistricting mean that of the 435 House seats being contested, only 14 are considered truly competitive (rated “toss-up” by the Cook Political Report) and an astonishing 356 seats are considered either solidly Republican or solidly 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 these “toss-up” races and a further 20 seats from races considered “leaning toward” or “likely” to result in a Republican win in order to gain control of the House while retaining control of all the seats they currently hold. In short, when the 114th Congress is sworn in, the Republican Party is widely expected to control the House.

On the Senate side, where the Democrats hold a serviceable 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 14 races for seats currently held by Republicans. In addition, six of the races for the Democratic-held seats are considered “toss-ups” compared with just two races for the Republican-held seats.

Overall, the Democrats face an uphill battle to retain control of the Senate, despite holding a five-seat cushion. However, much can change between now and November, and both parties publicly profess confidence.

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 consistently been well received by House and Senate offices from both political parties. Moreover, according to feedback obtained 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 the societal costs associated with the failure to meet these goals are widely understood on Capitol Hill. Policy leaders have identified integrated, team-based patient care and payment models that reward value and outcomes, rather than volume, 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 providers ideally positioned to deliver this service.
  • The Part D Experience: Part D medication therapy management (MTM), even though it receives some political backing, is recognized as a limited and structurally flawed benefit that is administrative rather than clinical in nature. The inclusion of an MTM benefit within Part D established an important precedent by adding a patient care service component to accompany prescription drug coverage. However, there is growing acceptance—as highlighted recently by comments submitted to the Centers for Medicare & Medicaid Services by MedPAC (the Medicare Payment Advisory Commission)—that Part D MTM, as it is currently structured, cannot achieve the full potential of robust medication management care. Furthermore, the fact 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 stated that an essential provision is the requirement that patient care be delivered under formal collaborative practice agreements. This structure ensures that care is truly team based and that the effort is aimed at securing payment for pharmacists as part of integrated health care teams, rather than pharmacists 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 PCPCC (Patient-Centered Primary Care Collaborative) 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 comprehensive medication management (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 behavior conditions face in appropriately managing medication therapies and the particular importance of making a Part B CMM benefit available to this patient population.

Medicare Initiative Advocacy

During the summer, and particularly during the August congressional recess, members of Congress will spend less time in Washington and more time at home in their states or districts by conducting tours of businesses, meeting with constituent groups, and interacting with local officials.

ACCP members should take advantage of opportunities during the summer months to engage with their members of Congress and help generate support for our Medicare Initiative to establish a CMM benefit under Part B of the Medicare program. With that in mind, here are four things you can do to help this effort:

  1. Invite your lawmakers to tour your practice setting.
    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 of establishing an ongoing constructive dialogue with your congressional representative or senator, and his or her 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 jmcglew@accp.com.

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

  2. Schedule meetings with your members of Congress or their staff.

    As the ongoing debate over Medicare physician payment reform shows, health care remains a priority on Capitol Hill. The August recess presents an ideal opportunity to schedule meetings with your elected officials to discuss your practice, your patients, and the importance of establishing a Medicare CMM benefit. Click here to enter your zip code and obtain contact information for your elected officials.

  3. Find and attend a town hall meeting.

    To find out when and where these are being held, check your members’ Web sites, Facebook and Twitter accounts, or local newspapers, or call their offices directly. Some town hall meetings are held online or via conference calls. These town hall meetings provide an excellent forum in which to address the issue of health care delivery reform and the future of the Medicare program. Clinical pharmacists should take advantage of this opportunity to discuss ACCP’s Medicare Initiative.

  4. Send a letter to your lawmakers.

    We have prepared a letter to Congress describing our Medicare Initiative that you can review and edit. You can send this letter in just a few easy clicks, but for maximum impact, we encourage you to personalize the letter by sharing some additional information about your clinical practice and the patients you care for.

    Simply click here to visit our Legislative Action Center and follow the instructions to send your message to your representative and senators.

Your Contribution to ACCP-PAC Can Help Advance Our Medicare Coverage Initiative

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 districts and states well beyond the Beltway.

The single biggest obstacle we face in advancing our Medicare Initiative pertains to the cost of establishing a new CMM benefit under Medicare Part B. Although there is a general consensus that establishing a Medicare CMM benefit would generate significant savings elsewhere in the Medicare program by averting hospitalizations, emergency department visits, and other costly encounters, the “score” or price tag Congress attaches to such a bill would include only the cost of delivering the CMM service.

In what is clearly a difficult budgetary environment, the challenge of gaining support for an initiative that will result in upfront costs (despite the significant long-term savings) to the Medicare program is significant. However, ACCP believes that there is a growing willingness in Congress to take a more global view of the present Medicare payment policy and seriously examine opportunities to contain Medicare program costs by improving the overall quality of care delivered to America’s seniors.

Nevertheless, elected officials are aware that support for our initiative may result in political attacks from well-funded “Super PACs” that advocate for across-the-board cuts in government spending. The fact that keeping patients out of the hospital by “getting the medications right” will ultimately save money may be lost amid rhetoric attacking our friends in Congress for adding a new benefit to the financially troubled Medicare program. Quite simply, we must be able to demonstrate to our political champions that we will back them in their bids for reelection in the face of any criticism they encounter in their support for our initiative. A well-funded political action committee (PAC) will give ACCP the resources it needs to support its friends on Capitol Hill.

ACCP-PAC is the only PAC dedicated to electing members of Congress who are committed to advancing our Medicare Initiative. 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 14,000 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. If each ACCP member were to contribute just $25, ACCP-PAC would raise $350,000. All ACCP members should consider donating at least $25 to ACCP-PAC. CLICK HERE to support your PAC today.

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
jmcglew@accp.com