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Making the Case for H.R. 4190 with the Cleveland Clinic C-Suite

Oct 08, 2014
Cleveland Clinic

Large healthcare systems like the Cleveland Clinic can often wield substantial political clout on important patient care issues like provider status.

THE IMPORTANCE OF H.R. 4190 and reimbursement for pharmacy services in outpatient clinics is clear to pharmacists. But, understandably, other healthcare providers and members of the C-suite may be unaware of its potential benefit for the entire healthcare system.

Yet I believe that interdisciplinary support, as well as support from hospital systems themselves, is a critical element in ensuring that H.R. 4190 becomes law. That’s why I, along with my colleagues, set out to convince the Cleveland Clinic’s executive leadership to support the bill. The process took about eight months, but I think the time and effort will pay off.

Leveraging the Political Muscle of Large Healthcare Systems

Several years ago, I learned first-hand about the substantial political power wielded by large hospitals—and the even greater influence of hospital coalitions—when I was involved in a national effort to add language to the FDA Safety and Innovation Act, which became law in July 2012.

The change we advocated and, which ultimately succeeded, allows multi-facility health systems to repackage and transfer shortage drugs within their networks but without having to register as repackagers. Avoiding that substantial bureaucratic and operational burden has been crucial for hospitals trying to manage acute drug shortages.

The political muscle of a national coalition of hospitals was instrumental in making that happen. Legislators pay attention to hospitals. Every congressional district has one, and large flagship systems employ thousands of constituents… all of whom are potential voters.

A similar coalition is important for the future of H.R. 4190. But before we could join such a coalition, we had to gain buy-in from the leaders of our own institution. That meant demonstrating convincingly why provider status for pharmacists will benefit not only the pharmacy department, but the entire Cleveland Clinic and its patients.

Making the Case

Of course, we couldn’t simply walk in to the C-suite and expect them to take our word for it. We painstakingly gathered and organized sufficient information to support our case, including data from recent independent studies about the impact of expanding clinical pharmacy roles.

Then I arranged a meeting with three key decision makers: the chair of the Cleveland Clinic Medicine Institute, who is in charge of our clinic system; the chief government and community relations officer; and my boss, the chief of medical operations.

Accompanying me was one of our pharmacists, a clinical specialist in ambulatory care who works closely with physicians to care for patients requiring careful medication management for disease states such as hypertension, diabetes, and hyperlipidemia. The high level of credibility she had earned among physicians added another dimension to our argument.

Scott Knoer, M.S., Pharm.D., FASHP

With the help of a PowerPoint presentation, I illustrated some of the many benefits—general and specific—that would accrue from provider status. For example: For every 10 patient visits to a clinical pharmacists, 8.2 physician/prescriber visits are avoided, with a resulting cost savings per patient projected at nearly $700.

I also emphasized that what we’re proposing for pharmacists in ambulatory care is the same thing we’ve been doing for years on hospital units, where pharmacists routinely round with physicians and are members of interdisciplinary teams.

We succeeded, and the Clinic’s leadership gave the green light for our government relations professionals to reach out to their counterparts at other health systems and to Brian Meyer, ASHP’s director of legislative affairs, to begin the process of building a coalition of health systems to push our legislative agenda in Congress.

What Can You Do?

The success we had in gathering the might of a world-renowned hospital system behind ASHP’s efforts to enact H.R. 4190 is not an exception. Anyone who is in a management position can do what we’ve done.

First, I suggest getting to know your hospital’s government affairs professional. Start a dialogue… maybe take them to lunch. Meanwhile, begin to educate your boss about how provider status for pharmacists can reduce costs and improve patient outcomes. Build your case, gather data, and educate decision makers about what pharmacists can do across the continuum of care.

But the ability to enact provider status doesn’t end at the C-suite. Staff pharmacists can do their part by solidifying relationships with physicians and proving their worth every day through collaborative patient care. Your professional expertise and ability to improve outcomes and reduce costs will show our non-pharmacy colleagues why our vision of an expanding clinical role for pharmacists in ambulatory settings is a critical step in the evolution of effective and efficient patient care.

 –By Scott Knoer, M.S., Pharm.D., FASHP, Chief Pharmacy Officer, Cleveland Clinic, Cleveland, Ohio



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