Throughout 2015, ACCP’s Washington office remained focused on its 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. This effort is centered on a clearly defined, comprehensive clinical pharmacy service provided by practitioners delivering care as members of interprofessional teams with established collaborative drug therapy management (CDTM) agreements or formal clinical privileges granted using local credentialing processes.

Our focus on the service (the “what”), rather than on 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 the progress we have made 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 awarding $2.5 million in grant funding to the University of North Carolina’s Eshelman School of Pharmacy to study the impact of 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.

Within this context, ACCP has highlighted some important developments occurring in 2015 that we believe represent important progress in the College’s efforts to position clinical pharmacists to participate in evolving care delivery and payment models.

Daniel S. Aistrope, Pharm.D., Named ACCP Director of Clinical Practice Advancement

Daniel S. Aistrope, Pharm.D., was named ACCP Director of Clinical Practice Advancement after a national search. Aistrope joined the ACCP staff on February 16 and currently oversees the planning, development, and delivery of key components of the College’s clinical practice transformation programs and services.

Aistrope received his Pharm.D. degree from the Creighton University School of Pharmacy and Health Professions and completed residency training in pharmaceutical care leadership at the University of Minnesota. Before joining ACCP, he served on the faculty of the University of Missouri-Kansas City School of Pharmacy at the University of Missouri, Columbia campus. In this capacity, he developed and maintained primary care practices at multiple clinical sites and carried out academic duties as a full-time clinical faculty member. He also served as an adjunct assistant professor of medicine at the University of Missouri School of Medicine. Aistrope has been a member of ACCP since 2008 and has served as a member of both ACCP and ACCP PRN committees. He has presented and published on issues related to clinical practice development, educational assessment, pharmacotherapy, and leadership.

“I’m excited to join ACCP as a member of its staff and look forward to contributing to the College’s new and innovative practice development services for clinical pharmacists,” Aistrope commented, adding:

As a practitioner who has established several patient-centered practices in team-based settings, I have a true appreciation for the need to provide high-quality, cutting-edge tools that will be useful to today’s clinician. I’m eager to continue to collaborate with others to serve the membership and advance clinical practice through the work of ACCP.

“We are thrilled to have Dan join our staff and help lead the development of ACCP’s practice advancement offerings,” said ACCP Associate Executive Director C. Edwin Webb, adding:

He brings a wealth of patient care and clinical practice development experience to this position. In addition, as a member of the College, he shares ACCP’s professional vision and core values.

Congress Tackles Complex Health Care Legislative Initiatives

Movement on several key health care initiatives on Capitol Hill indicates that this Congress, after years of partisan bickering over the Affordable Care Act, is willing and able to successfully tackle challenging and controversial health care issues. Of importance, conversations with congressional staff steering these initiatives indicate that ACCP’s advocacy efforts around health care transformation are closely aligned with evolving Medicare payment policy structures that measure and pay for quality and value, not simply volume of services, and fully incentivize care that is patient centered and team based.

SGR Repeal Legislation Is Signed into Law

That policy-makers in Congress were able to successfully agree on a legislative package that will permanently repeal the Medicare sustainable growth rate (SGR) came as a surprise to all who have observed the fiercely partisan tone that has come to characterize congressional activities.

The Medicare SGR system was put into place as a result of the Balanced Budget Act of 1997 and was designed as a means for the Centers for Medicare & Medicaid Services to regulate spending on Medicare physician services by linking payment levels to economic growth. In recent years, the formula used as part of the SGR system recommended drastic cuts to payments for Medicare physicians. To avoid this situation, Congress, on 17 separate occasions, stepped in with temporary fixes to avoid these cuts. Most health policy experts agree that the SGR approach is fundamentally flawed because it provides no incentives for providers to restrain volume or improve quality. However, the cost of eliminating the SGR (currently estimated at $175 billion) and debate over how to pay for it has blocked previous congressional attempts to reach a consensus around a permanent repeal. In 2014, a bipartisan, bicameral repeal package won the endorsement of the American Medical Association, but passage stalled in the House over concerns about the proposal’s impact on the budget deficit.

ACCP expressed support for the SGR repeal legislation in comments submitted to the House Energy and Commerce Committee. The comments called on Congress to enact reforms to the Medicare Part B program that provide for coverage of CMM services provided by qualified clinical pharmacists as members of the patient’s health care team within its broader payment reform efforts as part of the process of reforming the Medicare payment system. Click here to read ACCP’s comments in full.

Under the new Medicare payment system approved by Congress, the SGR will be replaced with an approach focused on rewarding high-performing providers while supporting alternative payment models such as accountable care organizations and patient-centered medical homes. To help facilitate this shift from volume- to value-based payment, a merit-based incentive payment system (MIPS) will be established beginning in 2019 that includes a combined value-based payment program assessing the performance of each eligible provider on the basis of quality, resource use, clinical practice improvement activities, and meaningful use of certified electronic health record technology. Click here to read more about the new Medicare physician payment methodology.

ACCP is confident that its Medicare Initiative is consistent with the overall structure of this payment approach, and we will continue to work with our friends and allies on Capitol Hill to integrate coverage for CMM services within the evolving Medicare program.

21st Century Cures Act

Shortly after President Barack Obama signed the SGR repeal package into law, health policy leaders in Congress refocused their efforts on an initiative aimed at accelerating the discovery, development, and delivery of promising new treatments and cures for patients and maintaining America’s standing as the biomedical innovation capital of the world. This initiative, called the “21st Century Cures Act,” is the culmination of more than a year’s worth of public conversation with patients, innovators, providers, regulators, consumers, and researchers about what steps Congress can take to bridge the gap between advances in science and medicine and how those therapies are regulated. Citing the fact that treatments exist for only 500 of the 10,000 known diseases (7000 of which are rare), the 21st Century Cures Act aims to:

• Bolster resources for the National Institutes of Health and help encourage young and emerging scientists
• Develop policies to unlock the wealth of data available today to help further research and innovation
• Modernize clinical trials and fully realize the promise of personalized medicine

The legislation was approved by a margin of 51-1 at a full hearing of the House Energy and Commerce Committee. Policy leaders are hopeful that the proposal will eventually be signed into law by the end of 2015.

Click here to view H.R. 6, the 21st Century Cures Act in full.

Click here to read a 1-page discussion draft.

Senate Chronic Care Working Group

The Senate Finance Committee’s health care focus in 2015 was a legislative effort aimed at improving the quality of care and outcomes provided to Medicare patients with chronic conditions. Citing staggering statistics, including the fact that treatment of chronic illness accounts for 93% of Medicare spending and more than two-thirds of Medicare beneficiaries have multiple chronic conditions, Finance Committee Chairman Orrin Hatch (R-UT) and Ranking Member Ron Wyden (D-OR) issued a letter to health care stakeholders announcing the formation of a bipartisan congressional working group to begin exploring solutions that will improve outcomes for Medicare patients requiring chronic care.

The response to the committee’s request for input was overwhelming—more than 530 submissions from interested stakeholders across the country provided ideas on ways the Medicare program can better deliver health care to beneficiaries with multiple chronic illnesses. Senate leadership reacted positively to the response from the health care community. In a statement released by Hatch and Wyden, the senators commented:

We appreciate the input from members of the health care community and are thrilled so many weighed in on this important bipartisan issue. We also applaud Senators Johnny Isakson and Mark Warner for their hard work in leading this initiative. Their efforts represent a strong bipartisan desire to find real solutions that provide high-quality medical care to Medicare patients, at greater value and lower cost, without adding to the deficit. We look forward to partnering with our colleagues to review the submissions as we work toward a common goal of developing bipartisan legislative solutions this Congress.

ACCP Comments to the Bipartisan Working Group

In response to the request for input, ACCP, together with its Medicare Initiative partner, the College of Psychiatric and Neurologic Pharmacists (CPNP), submitted a joint statement to the committee. The statement addressed several key issue areas that outline specific policy categories the committee plans to consider as part of its chronic care reform efforts:

• Ways to promote the effective use, coordination, and cost of prescription drugs
• Ideas to effectively use or improve the use of telehealth and remote monitoring technology
• Strategies to increase chronic care coordination in rural and frontier areas
• Ways to more effectively use primary care providers in order to meet the goal of maximizing health care outcomes for Medicare patients living with chronic conditions

In the comment letter, ACCP and CPNP urged the committee to focus on care delivery models that promote and incentivize a truly patient-centered and interprofessional approach to medication-related clinical care and medication safety. The comments called on the committee to advance a quality-focused, patient-centered, team-based approach to health care delivery that helps ensure the safety of medication use by patients and achieves medication-related outcomes that are aligned with patients’ overall care plans and goals of therapy through the provision of CMM.

As part of the process of reforming the Medicare payment system, ACCP and CPNP urged Congress to enact reforms to the Medicare program that provide for coverage of CMM services provided by qualified clinical pharmacists as members of the patient’s health care team within its broader payment reform efforts. They also extended an offer to the committee to provide further information, data, and connections with successful practices that provide CMM services to help further inform the committee about this service in the context of Medicare payment and delivery system improvements that will modernize and sustain the program for the future.

Click here to read the ACCP/CPNP comments in full.

In addition, CPNP submitted separate comments calling for the recognition and implementation of CMM within Medicare Part B with a specific focus on beneficiaries with severe and persistent mental illnesses (SPMIs). Click here to read CPNP’s comment in full.

Additional Opportunities for CMM

As evidence of the growing recognition within the health care policy community of the importance of CMM as part of the process of developing and implementing policies designed to streamline care coordination, improve quality, and lower Medicare costs, ACCP has learned that several organizations also included calls for CMM coverage in their comments to the committee. These organizations include the Pharmaceutical Research and Manufacturers of America (PhRMA), the Biotechnology Industry Organization (BIO), GlaxoSmithKline (GSK), and Blue Thorn, Inc. Healthcare Consulting.

Outlook for 2016

As we look toward the remaining months of the 114th Congress and the final year of the Obama presidency, ACCP approaches 2016 with cautious optimism, given recent evidence that this Congress is willing and able to tackle the challenging and controversial issues of reforming Medicare payment policy and care delivery structures. In a presidential election year, we anticipate a reduced congressional calendar, meaning that the window of opportunity to advance the health care efforts initiated in 2015 is limited. That said, electoral politics will place additional pressure on Congress to deliver substantive policy outcomes to an increasingly frustrated electorate, and the president will be anxious to notch up additional legislative victories in his final months in office.

Beyond the legislative process, ACCP’s staff expansion in the Government and Professional Affairs office will provide the College with exciting new resources to make further progress on the College’s ongoing clinical practice advancement initiatives. These include, to date, the development of 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 make meaningful transformation through practice management and leadership development.

ACCP’s Washington office thanks its members for their support, passion, and commitment to the initiatives and activities the College engages in on behalf of the profession. We wish you a happy holiday season and look forward to a productive 2016.

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]