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January 13, 2017

Provider Status Bill Reintroduced in Senate with Strong Bipartisan Support

Paul W. Abramowitz, Pharm.D., Sc.D. (Hon.), FASHP

IT IS WITH GREAT PLEASURE that I can announce that on Thursday evening, Senators Charles Grassley (R-Iowa), Robert Casey (D-Pa.), and Sherrod Brown (D-Ohio), along with 24 other original co-sponsors, reintroduced the Pharmacy and Medically Underserved Areas Enhancement Act (S. 109). This legislation is the same as last year’s provider status bill, with the exception of the new bill number, S. 109. This is significant not only because of the quick timing of the reintroduction, but also because of the high number of Senators who have signed on as original co-sponsors. The Patient Access to Pharmacists’ Care Coalition (PAPCC), in which ASHP serves on the steering committee, set a goal late last year of introducing the new bill in 2017 with 20 co-sponsors. We are pleased to see that this goal was not only met but exceeded.

On the House side we expect reintroduction soon. Our lead sponsor to the House bill, Rep. Brett Guthrie (R-Ky.), has been leading the charge and will reintroduce the bill with the same bill number as last Congress, H.R. 592. Again, the language will be same as last year. We expect the House bill to be reintroduced with approximately 90 co-sponsors.

We are greatly encouraged to see the momentum from last session carry over to the new 115th Congress, and we remain steadfast in our commitment to passing this important legislation. As a lead member of the PAPCC, ASHP will be working diligently to help facilitate passage of the legislation, most likely as part of a larger Medicare package later this year. In fact, early discussions between the PAPCC and key congressional staff are already occurring, as we seek to position the legislation to be a part of a larger Medicare bill.

I will continue to update you on the progress on provider status as new developments arise. Thank you so much for being a member of ASHP. It’s because of you that we are the premier organization in pharmacy.

Sincerely,

Paul

January 5, 2017

The New Joseph A. Oddis Global Headquarters of ASHP Is Now Open for Business

Happy New Year!

ASHP’s headquarters, 4500 East-West Highway, Bethesda, Md.

The ASHP staff team kicked off 2017 this week in our new office space at the Joseph A. Oddis Global Headquarters of ASHP in Bethesda, Md.

Our new home is a beautiful, state-of-the-art, LEED Platinum certified building located just a few blocks from our former headquarters. Our new facilities will accommodate our growing membership and provide our staff with enhanced capabilities and resources to help us better serve you and advance our public health mission.

To us, ASHP headquarters is more than a building. It is the heart of our professional association, and it reflects the success of our members in providing care to the patients that you serve.

Twenty-five years ago, the purchase of our former headquarters — The Joseph A. Oddis Building — symbolized ASHP’s leadership in helping to facilitate your success as clinically oriented patient care providers and leaders in pharmacy practice. The ideas and effort behind so many of our signature programs and initiatives took place in the offices, conference rooms, and hallways of that building.

Our change of address signals an exciting new era for our organization. We look forward to a promising future of innovation, vision, leadership, and hard work that will help you accomplish your mission to help people achieve optimal health outcomes.

ASHP staff tour the new building.

Please update your records with our new address — 4500 East-West Highway, Suite 900, Bethesda, Maryland 20814. The phone numbers and email addresses for ASHP staff remain the same.

I welcome you to come tour our new space the next time you’re in town visiting or serving on an ASHP member committee. ASHP is your professional home, and we would love to see you!

Best wishes for a happy and healthy new year. Thank you so much for being a member of ASHP!

Sincerely,
Paul

November 16, 2016

ASHP’s Role with the New Congress and Administration

Paul W. Abramowitz, Pharm.D., Sc.D. (Hon.), FASHP

Paul W. Abramowitz, Pharm.D., Sc.D. (Hon.), FASHP

AS ANOTHER ELECTION SEASON comes to a close and we look ahead to the new administration and the 115th Congress in 2017, ASHP is again positioning itself as a credible resource to policymakers on issues impacting the profession of pharmacy and public health. While elections create change among those in government, ASHP’s public policy priorities remain the same: advancing provider status legislation, protecting the 340B program, and working with both sides of the aisle and with the administration to address the growing problem of skyrocketing drug prices and their impact on our patients and the healthcare system.

Over the last few years ASHP has increased its presence in Washington by spearheading legislative efforts aimed at curbing drug shortages and ensuring safer compounding practices. These are issues that impact all Americans regardless of political affiliation, and ASHP input was instrumental in developing policy solutions.

The new landscape on Capitol Hill and at the White House is an opportunity for ASHP to forge new partnerships, educate new stakeholders, and highlight ASHP’s expertise in public health issues. Healthcare legislation will once again be back on the agenda, and issues related to Medicare and Medicaid are likely to be in play. As we look ahead to advancing provider status, 2017 may provide legislative vehicles that could include pharmacists as providers in the Medicare program.

ASHP remains committed to working with the new administration and the new Congress to address our public policy goals. Currently we are planning outreach efforts to the Trump transition team and will begin educating the freshman congressional class on how ASHP members improve the health and wellness of their patients by ensuring safe and effective medication use and advancing healthcare. Although change in Washington is inevitable, ASHP stands firm on its commitment to its members and the public at large.

We look forward to continuing to engage you and represent your professional interests in 2017 and beyond. Thanks so much for being a member of ASHP, and for everything you do for your patients.

Sincerely,
Paul

August 15, 2016

In an Anticoagulation Clinic, Unrelated Interventions Abound

Melanie Boros, Pharm.D., BCPS, meets with a patient at Cleveland Clinic Akron General's outpatient anticoagulation clinic.

Melanie Boros, Pharm.D., BCPS, meets with a patient at Cleveland Clinic Akron General’s outpatient anticoagulation clinic.

IT’S WELL KNOWN that when pharmacists guide anticoagulation treatment, patient outcomes are better. International normalized ratio (INR) levels are within the target range more of the timei and hemorrhage rates are lowerii, compared to the usual care.

But what about the care pharmacists provide in anticoagulation clinics that is not directly related to the primary purpose of the visit?

A new study published in AJHP found that pharmacists offer significant additional care outside the purview of anticoagulation by helping patients avoid adverse events and receive timely treatment for other health concerns, and by improving their continuity of careiii.

Med Rec Reveals Important Picture of Patient Health

Michael Hicho, Pharm.D., BCPS

Michael Hicho, Pharm.D., BCPS

“Pharmacists, whether they’re in the anticoagulation clinic or in any other setting, can make a significant positive impact on patients’ care if they take advantage of each interaction they have with a patient,” said primary author Michael Hicho, Pharm.D., BCPS, who was a PGY1 pharmacy practice resident at Akron General Medical Center, Akron, Ohio, at the time of the study. Dr. Hicho is currently Inpatient Clinical Manager, Pharmacy Service, at Louis Stokes Cleveland VA Medical Center, Cleveland.

“As our findings show, these interactions may not necessarily always involve starting, stopping, or adjusting a medication but can, for example, include collaboration with other healthcare providers to ensure that patients are receiving appropriate care,” he said.

Dr. Hicho drew these conclusions from a retrospective analysis of records from 5,846 pharmacist encounters with 268 patients treated at the Akron General Medical Center’s pharmacist-managed ambulatory anticoagulation clinic between January 2012 and November 2013. The clinic served patients referred by 30 physicians during the study period.

Dr. Hicho’s team classified interventions not directly related to anticoagulation into six major categories (see TABLE below) and 33 subcategories. They found that pharmacists conducted a striking 2,222 interventions not directly related to patients’ primary reasons for visiting the anticoagulation clinic. Nearly 75% of patients received four or more unrelated interventions and almost 14% received 10 or more of these interventions.

Medication reconciliation was the most common intervention not directly related to anticoagulation. During those interactions, pharmacists identified 1,591 medication list discrepancies, including inaccuracies in the medication list for 89% of these instances.

They also found 107 instances in which a patient was taking his or her medication incorrectly and an additional 74 cases in which there was a possibility a patient may have been taking his or her medication incorrectly.

The Continuity of Care Equation

According to Dr. Hicho, pharmacists helped ensure continuity of care by assessing patients’ overall health, sending physicians medical information they collected, recommending primary care physician follow-up, and, in some cases, calling a physician for an immediate onsite visit or urging patients to visit the emergency department.

Amy Rybarczyk, Pharm.D., BCPS

Amy Rybarczyk, Pharm.D., BCPS

Measuring the clinical and financial value of interventions like these is difficult, said co-author Amy Rybarczyk, Pharm.D., BCPS, Pharmacotherapy Specialist in Internal Medicine, Cleveland Clinic Akron General. “At the moment, there is no standardized method for quantifying pharmacist interventions,” said Dr. Rybarczyk, who was Dr. Hicho’s research advisor at the time of the study. “It’s hard to measure the value of ensuring that a patient gets an antibiotic for a diabetic foot infection that is detected by a pharmacist, for example. A tool like that would be beneficial for our profession to have.”

Collaborative Practice Agreement Buoyed by Findings

The team’s results were so impressive that they were included in a letter to the Ohio Legislature in support of House Bill 188, which called for an expansion of pharmacists’ services as part of collaborative practice agreements. The legislation passed in December 2015.

“We believe the comprehensive care provided to patients in our disease state management clinic helped in this effort to expand pharmacists’ clinical services,” explained Dr. Rybarczyk.

“We believe the comprehensive care provided to patients in our disease state management clinic helped in this effort to expand pharmacists’ clinical services.” — Amy Rybarczyk, Pharm.D., BCPS

Co-author Melanie Boros, Pharm.D., BCPS, Pharmacotherapy Specialist in Internal Medicine at Cleveland Clinic Akron General and Dr. Hicho’s research advisor at the time of study, suggested that one of the important takeaway messages is the trust that patients place in their pharmacists. “When we see a patient with a therapeutic INR, and there are no changes that need to be made to his or her anticoagulation regimen, we can still make a significant impact by simply clarifying what their dose of insulin should be or teaching them about appropriate use of nonprescription medicines, for example,” she said, adding that pharmacists are well-positioned to answer patients’ questions and proactively identify other health issues.

“Like our entire department, pharmacists in the clinic have always made it a priority to care for the whole patient,” she emphasized.

–By David Wild

i J Throm Thrombolysis 2011; 32:426-430
ii Pharmacotherapy 195; 15:732-739
iii AJHP Residents Issue 2016; 73 (Supp 3):S80-87


September 21, 2015

Kaiser Refill Protocol Expands Pharmacist Scope of Practice

Pharmacy technicians Laurie Diment, CPhT, and Krista Moore, CPhT, examine a patient’s refill request.

Pharmacy technicians Laurie Diment, CPhT, and Krista Moore, CPhT, examine a patient’s refill request.

NEW HEALTHCARE NEEDS resulting from a growing elderly population, the advent of the Affordable Care Act, and dramatic shifts in how healthcare is now being delivered are opening up new patient care opportunities for pharmacists.

One such opportunity at Kaiser Permanente Northwest (KPNW) is ensuring that patients get the care they need when they need it.

A medication refill protocol instituted at 16 medical offices and specialty clinics, including cardiology, neurology, rheumatology, and OB/GYN, and involving nearly 600 internal medicine and family practice providers, allows pharmacists to address their patients’ drug therapy management needs.

The result? Better patient care, greater efficiencies, increased accuracy, and more time for physicians to spend with their patients.

“With the increasing number of patients who now have access to healthcare, it’s more important than ever to relieve physicians of work that can be done by pharmacists,” said Tabitha Fridriksson, R.Ph., manager of the pharmacy department refill protocol program at KPNW, Vancouver, WA.

Better Care, Rising HEDIS Scores

Created under a collaborative drug therapy agreement stipulating that pharmacists can independently approve prescription refills on behalf of a prescriber, the protocol immediately began returning dividends in terms of patient health.

Tabitha Fridriksson, R.Ph.

Tabitha Fridriksson, R.Ph.

“Right away, we discovered that pharmacists were also monitoring and following up with patients more consistently than primary care providers for things like blood pressure, lab tests related to the patient’s medication, and any procedures or other tests relevant to their drug therapy,” said Ms. Fridriksson.

In fact, from 2007 (when pharmacy support became an integral part of KPNW’s operational plan), Healthcare Effectiveness Data and Information Set (HEDIS) scores there quickly exceeded scores for other Kaiser Permanente regions in all areas. HEDIS is a tool widely used by health plans to measure patient care performance.

Improvements in HEDIS scores included screenings for cervical cancer (16% increase), breast cancer (17% increase), and chlamydia (54% increase); and medication compliance (15% increase). This is quite an accomplishment considering that the various Kaiser regions consistently score in the top 10 in the nation of all health plans regarding clinical quality HEDIS measures. KPNW is also ranked as the #1 Medicare 5-Star program in the country, which is largely based on HEDIS measures.

“Not only are we improving turnaround times for refills, we also are improving the quality of patient monitoring and enlarging the scope of pharmacist practice,” said Ms. Fridriksson.

Easing Patient Access

Under the protocol, KPNW pharmacists approved an average of 41,000 refills monthly in 2013, which equates to 17 full-time-equivalent physicians and other prescribers and 86,376 office visits annually.

The protocol also alleviated the unintended consequences of a service, begun in 2012, that allows KPNW patients to email their physicians directly. It didn’t go quite as planned.

Precy Moss, Pharm D and Dr. Terry Williams

From left, Precy Moss, Pharm.D., and Terry Williams, M.D., discuss a patient case.

“They got bombarded by emails, thousands of them, many of which were just refill requests. That wasn’t what we had in mind,” said Ms. Fridriksson. During the first year of the service, physicians received nearly 24,000 medication-related emails; by the third year, the number exceeded 50,000.

“A conscientious physician will do the utmost to look up the details for each patient before they sign off on a refill,” said Sean Jones, M.D., who assisted in crafting the refill authorization and is chair of KPNW’s regional formulary and therapeutics committee. “But with that kind of volume (sometimes I received 50 requests a day), it’s simply not realistic. We realized some patients who were asking for refills hadn’t seen a physician in years.”

It was a perfect set up for pharmacists, who stepped in and now resolve about 75% of the email refill requests.

“The KPNW program truly demonstrates the positive impact pharmacists can have on patient care in an ambulatory, team-based environment,” said Justine Coffey, director of ASHP’s Section of Ambulatory Care Practitioners.

Pharmacist-Physician Partnership

The KPNW protocol, which also allows pharmacists to manage refills for patients taking opioids, means that pharmacists now process three quarters of all opioid refills as well as monitor patients on opioid therapy based on criteria established under the collaborative practice agreement. Part of those criteria includes ensuring that patients undergo required drug screening.

It’s a wonderful collaboration between our pharmacists and other providers to improve the quality of patient care.

Under the program, pharmacist monitoring and resulting interventions have resulted in an 80% improvement in timely clinician action and documentation when urine drug screens turn up unexpected results.

“If the pharmacist sees a concern, like a patient who didn’t get their urine test done, or they did but got unexpected results, they follow up with the patient and also bring it to the physician’s attention,” said Dr. Jones.

“It’s a wonderful collaboration between our pharmacists and other providers to improve the quality of patient care.”

–By Steve Frandzel

 

 

August 25, 2015

Creating an Army of Provider Status Advocates: One Member’s Story

Felicity Homsted, Pharm.D., BCPS

Felicity Homsted, Pharm.D., BCPS

AN UNEXPECTED EMAIL REQUEST this past June launched Felicity Homsted, Pharm.D., BCPS, on an unanticipated mission: to muster the support of Maine legislators for the Pharmacy and Medically Underserved Areas Enhancement Act.

If signed into law, the bill, now before congressional committees in the House and Senate, would grant pharmacists provider status in medically underserved areas and make them eligible for reimbursement under Medicare Part B.

“I didn’t hesitate. I just said, ‘Yes!’ and leveraged all of the relationships I’ve built over the years to get more people to push for provider status,” said Dr. Homsted, director of pharmacy at Penobscot Community Health Care in Bangor, Maine.

By the end of the day, she had called or emailed colleagues and administrators at more than a dozen health centers, health advocacy groups, and insurers; handwritten letters to Maine’s four-person congressional delegation; and quickly persuaded the CEO and CMO of her facility to do the same.

Within a week, Dr. Homsted had reached out to directors of pharmacy representing all of the health systems in the state. By the end of the second week, she added three presentations, a television interview, and more emails and calls. The entire PCHC pharmacy staff joined the efforts with technicians, pharmacists and residents all voicing their support. In under a month, she had confirmed that at least 50 support letters from all across the state had gone out to the Maine congressional delegation.

The results of her team’s hard work followed quickly. On July 7, Sen. Susan Collins signed on as a cosponsor of the Senate version of the bill S. 314. Sen. Angus King responded with a declaration of support for the bill.

Persistence Pays Off

The initial email appeal that Dr. Homsted received came from Joseph Hill, director of ASHP’s Government Relations Division. He knows he got far more than he bargained for.

“Felicity has been a pacesetter for the kinds of outreach we need from members to help us drive support for provider status,” said Hill. “The thing I find most inspiring about her advocacy is the persistence she demonstrated in reaching out to people and organizations. Felicity sets the gold standard for grass roots activity. If she can inspire others to do half of what she does, we will definitely get these bills across the finish line.”

Dr. Homsted tailored her pitch for every person she coaxed toward advocacy. “If I had just asked them, ‘Will you support us?’ many people – even many pharmacists wouldn’t understand why this is such a big deal,” she said. “But when I explain how provider status will help improve patient care and reduce healthcare costs on the individual level for their patients or organization, people really begin to understand the value of the legislation.”

Issues that matter-edits

Left, Robert Picone, host of the weekly public television show “Issues that Matter,” invited Dr. Homsted (right) to enlighten his viewers about provider status.

In the midst of Dr. Homsted’s advocacy blitz, another unexpected overture led to the most memorable moments of her campaign. Robert Picone, a board member of the Greater New England Chapter of the National Multiple Sclerosis Foundation and host of the weekly public television showIssues that Matter,” invited her as a guest on the program to enlighten viewers about provider status.

ASHP staff prepared Dr. Homsted for the interview by coaching her to ignore the cameras and take the time to consider each answer. They also recommended that she focus on a few simple, consistent messages and circle back to them at every opportunity; keep her answers succinct so that viewers understand what is at stake; and remember a few on-camera tips, including smiling slightly and avoiding clothing with patterns.

After the show appeared on YouTube, Dr. Homsted said she was amazed by how many people got in touch with her to find out what they could do to help. The most poignant response came from a good friend who texted, “I’ve never really understood what you do until I watched the show. Now I know how important your job is, and I want to thank you for all the things you’re doing to make healthcare better.”

Educating the Public about Pharmacists’ Roles

According to Dr. Homsted, consumers and legislators don’t fully understand the contemporary roles of pharmacists. “People are just beginning to appreciate that we add far more to the healthcare equation than just counting pills,” she noted, adding that educating the public as well as pharmacists about what provider status means is critical for passage of the legislation.

Dr. Homsted (second from far right) is supported in her provider status outreach efforts by her pharmacy residents and other members of her team at Penobscot Community Health Care in Bangor, Maine.

Dr. Homsted (second from far right) is supported in her provider status outreach efforts by her pharmacy residents, members of the Penobscot Community Health Care C-suite, and other members of her pharmacy team.

“Pharmacist provider status goes well beyond reimbursement; it is a mechanism to expedite pharmacist integration into care teams, ultimately improving care value, quality, safety and most importantly patient health.”

Dr. Homsted and her team’s advocacy efforts continue. She recently began enlisting universities and recruiting pharmacy students and residents (within and beyond Maine) to the ranks of active supporters.

“We want to create a small army of pharmacists who can go out and inform people about the importance of provider status,” she said. “I tell them to start with people they know well and with whom they can have an immediate impact, and then let those successes fuel more ambitious targets. Our goal is to get the entire Maine delegation to cosponsor the legislation. Anything else is unacceptable.”

–By Steve Frandzel

Editor’s Note: Want to find out how to support ASHP’s provider status efforts in your state? Check out our advocacy toolkit with a variety of activities to get you started!

 

 

 

 

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