ASHP InterSections ASHP InterSections

June 18, 2018

Underserved Patients Rely on Pharmacists to Fill Care Gap

Filed under: Ambulatory Care,Clinical,Feature Stories,Innovation,Managers,Provider Status,Quality,Regulation,Residents,Specialties,Students — Tags: , , , , , , , , , , — jmilford @ 4:42 pm

Nazia S. Babul, Pharm.D., BCACP, Clinical Pharmacist and Clinical Assistant Professor at the University of Illinois College of Pharmacy, counsels patients at CommunityHealth, a free clinic in Chicago.

PROVIDING HEALTHCARE TO UNINSURED AND UNDERINSURED INDIVIDUALS is a challenge that continues to grow. With rising premium costs, the threat of major insurers on the verge of withdrawing from health exchanges, and the potential for reductions in coverage, three health systems — Yale-New Haven Health, Ascension, and the University of Illinois Hospital and Health Sciences System — are calling on clinical pharmacists to help address gaps in care.

Ambulatory Care at Yale-New Haven Health
“Our pharmacists teach underserved patients about their medications, optimize their dose, determine if they’re really receiving the best medication given their particular situation, and find the lowest-cost options for them,” explained Lee Ann Miller, Pharm.D., Director of Clinical Pharmacy Services at Yale-New Haven Health in Connecticut. “These are all steps that can improve adherence and outcomes while also reducing healthcare resource utilization and lowering the overall cost of care.”

Although pharmacists at Yale-New Haven Health provide beneficial care to patients, funding is a concern. Dr. Miller explained that, although pharmacists at ambulatory care clinics often spend up to an hour with a patient, a lack of provider status means they bill Medicaid and Medicare at the lowest-level evaluation and management incident-to code, which reimburses $20 on average.

This financial picture makes it difficult to make a case for expanding the clinical pharmacist workforce beyond the eleven pharmacists who are embedded across the health system’s roughly 200 ambulatory care offices and clinics, explained Dr. Miller. “Moving to value-based payment structures and having provider status would certainly give us the help we need to offer this same level of service at other clinics,” she added.

Ascension’s Social Mission
Despite the low level of reimbursement currently available, pharmacists continue to provide important care. Ascension, the largest nonprofit health system in the country, with facilities in 22 states, offers free medications to those who can’t afford them through one of 45 Dispensary of Hope locations. The Dispensary of Hope program collects medications donated by pharmaceutical manufacturers and distributes them to certain pharmacies and safety-net clinics. At some Dispensary of Hope locations, health leadership may purchase additional medications as part of a safety net formulary for their institutions.

The pharmacy team at the Medical Mission at Home provides medications and counseling to underserved patients.

“In the fourth fiscal quarter of 2017, our Dispensary of Hope pharmacies served 6,460 unique patients,” said Lynn Eschenbacher, Pharm.D., FASHP, National Director of Pharmacy Operations at the Resource Group, which is part of Ascension.

Another Ascension initiative, the Medical Mission at Home project, features daylong community health events that provide patients with primary and speciality care services. As part of the initiative, underserved individuals also receive medications and counseling about their medications, explained David Neu, Pharm.D., MSHSA, Vice President of Pharmacy at Saint Thomas Health, a member of the Ascension network in Nashville, Tenn. According to Dr. Neu, Nashville is host to the largest of the four annual Medical Mission at Home days and recently provided care to more than 750 patients during a single day.

“We see a lot of people with untreated hypertension, diabetes, asthma, or chronic obstructive pulmonary disease — or people who are not adherent to their medication regimen — so pharmacists have an opportunity to make an important impact on their care,” Dr. Neu explained.

Patients are assessed by a nurse and triaged to the appropriate health caregiver, whether that is a physician, pharmacist, or nurse practitioner. Prescriptions can be written and filled onsite using both Dispensary of Hope medications and subsidized medications purchased by the participating Saint Thomas Health hospital, noted Dr. Neu. All medications are provided at no cost to patients during the event.

“Pharmacists also provide counseling and patient education such as inhaler training,” he explained. They assist individuals who need help paying for medications, whether that means obtaining a coupon voucher, connecting with a patient assistance program, or pointing patients to a Dispensary of Hope location. “There’s an aspect of social work to the care our pharmacists provide during these events, which is important as uninsured and underinsured patients have a hard time navigating our health care system to meet their medication needs,” reflected Dr. Neu.

Caring for Chicago’s Poor
At the University of Illinois Hospital and Health Sciences System (UI Health), ambulatory care pharmacists help some of the poorest and most vulnerable communities in Chicago,” said ASHP member Sandra Durley, Pharm.D., Senior Associate Director of Ambulatory Care Pharmacy and Clinical Assistant Professor at the University of Illinois College of Pharmacy, Chicago. “Many of these individuals lack insurance and convenient access to healthcare services and are considered to be medically underserved.” Care is available at UI Health’s on-campus pharmacies and at 20 outpatient clinics and four pharmacy-based clinics staffed with 38 full-time clinical pharmacists.

At Mile Square Health Center, a federally qualified health center that is also part of UI Health, a clinical pharmacist works alongside physicians and nurse practitioners to care for patients with diabetes and other illnesses, many of whom are underinsured or uninsured, explained Dr. Durley. And in an institutional collaboration, two University of Illinois College of Pharmacy clinical pharmacists work four days each week at CommunityHealth, the largest volunteer-based free clinic in the country, she added.

Like Dr. Eschenbacher, Dr. Durley is concerned about the future of underinsured and uninsured patients. Although pharmacy services help improve health outcomes among the underserved, pharmacists are not always compensated. However, she also struck an optimistic note, pointing to the Pharmacy and Medically Underserved Areas Enhancement Act, which, if passed, would recognize pharmacists as healthcare providers under Medicare Part B in medically underserved areas. “That is an important first step in getting compensation for pharmacist services,” Dr. Durley said.

 

By David Wild

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May 7, 2018

Provider Status and Opioids Legislation Update

Filed under: Ambulatory Care,Clinical,From the CEO,Managers,Provider Status,Regulation,Residents,Specialties,Students — Tags: , , , , , , , — jmilford @ 6:09 pm

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

I WOULD LIKE TO UPDATE YOU on ASHP’s ongoing efforts to advocate for passage of legislation that would recognize pharmacists as patient care providers in the Medicare program, as well as legislative efforts related to the opioid epidemic.

As the 115th Congress begins to shift focus to the November elections, opportunities for healthcare legislation are limited. We anticipate that any healthcare-related legislation will be mainly focused on the opioid epidemic. As a lead member of the Patient Access to Pharmacists’ Care Coalition, ASHP is working to determine ways in which provider status language might be addressed in the pending opioid bills. However, given that the focus of these bills is mainly on opioids, our efforts for now may need to shift to articulating how pharmacists can play important roles in helping to solve this major public health problem.

Efforts to obtain provider status are part of ASHP’s larger vision that medication use will be optimal, safe, and effective for all people all of the time. Our intent is to enhance our members’ ability to provide care as part of the interprofessional patient care team.

As states look to expand their scope of practice laws to promote the direct patient care roles of pharmacists, ASHP is supporting state-level efforts of our members and working at the federal level to include these direct patient care roles in Medicare. We also want to make sure our members are well-positioned to align their efforts with Medicare modernization, which is now focused on moving toward value-based models that align payment with quality and outcomes. ASHP members are in an excellent position to lead efforts to optimize medication therapy through value-based models, and ASHP will be there to make sure that Congress, Medicare and Medicaid, states, and others understand the many advanced practice models our members are engaged in as well as the direct patient care roles they play.

As we continue to work with Congress, states, and public and private payers to recognize pharmacists as patient care providers, we will keep you apprised of these activities and our many advocacy efforts on your behalf — addressing persistent drug shortages, rising drug costs, and threats to the 340B Drug Pricing Program, as a few examples.

Thank you for your support and your continued engagement as we work together to help our patients achieve optimal medication therapy outcomes and to advance pharmacy practice.

Sincerely,

Paul

February 15, 2018

AJHP’s Top 25 Articles Address Critical Practice Issues

Filed under: Ambulatory Care,Clinical,From the CEO,Innovation,Managers,Quality,Regulation,Residents,Specialties,Students — Tags: , , , , , , , , — jmilford @ 12:29 pm

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

WITH A CIRCULATION OF 45,000, ASHP’s peer-reviewed scientific journal, AJHP, is the most widely recognized and respected pharmacy journal in the world. As part of our year-end review in late 2017, the editors of AJHP assembled a list of the Top 25 most frequently accessed articles on www.ajhp.org. What they found was compelling: The articles read most by you and your colleagues address some of the most critical issues facing the profession and healthcare at large. This connection is no accident. From its early days as The Bulletin to its current iteration, AJHP has sought to provide pharmacists with the latest, most relevant practice information available.

AJHP has undergone a comprehensive transformation in recent years in both design and content, including a new approach to cutting-edge clinical topics and an enhanced digital experience. These changes represent a continuation of the journal’s vital role in equipping pharmacists to guide medication-use and healthcare delivery at the patient, population, and policy levels.

A look at the most-accessed content clearly illustrates this principle. The Top 25 list includes articles that predict future directions for practice, offer guidance for strategic planning, and examine the challenges faced by women seeking greater leadership opportunities. Also featured are discussions about the training needs of pharmacy technicians, guidelines on preventing diversion of controlled substances, and approaches for caring for diverse patient populations. The Top 25 list also contains several articles that address important clinical practice issues related to the care of the critically ill as well as patients with cancer, diabetes, infectious diseases, pulmonary hypertension, and thrombotic disorders. This collection of most frequently accessed AJHP content addresses pressing issues for our patients, for our profession, and for our times.

AJHP’s mission to advance science, pharmacy practice, and health outcomes can be realized only when pharmacists take what they’ve learned and apply those findings in their practices. The Top 25 articles, and all of AJHP’s content, can be used to:

  1. Advance ASHP members’ approaches to patient care.
  2. Support pharmacists’ and pharmacy technicians’ professional development activities and approaches to delivering patient care.
  3. Inform proposals for educational offerings at ASHP’s meetings as well as state affiliate-based educational programs.
  4. Supplement educational initiatives with students and residents in the classroom, at the bedside, and through journal clubs and seminars.
  5. Prepare for policy discussions with legislators and other policymakers at the local, state, and federal levels.

I encourage you to take some time to read or revisit the findings in these valuable articles and consider how you can use AJHP to impact patient care at your organization. The full list of the Top 25 most-accessed articles is available as a collection on www.ajhp.org.

Thank you for all that you do on behalf of your patients, and for being a member of ASHP.

Paul

January 29, 2018

Preserving 340B Is Essential to Our Most Vulnerable Patients

Filed under: Ambulatory Care,Clinical,From the CEO,Managers,Quality,Regulation,Residents,Specialties,Students — Tags: , , , , , , , , , — jmilford @ 3:04 pm

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

ORGANIZATIONS PROVIDING CARE TO MEDICALLY UNDERSERVED rely on the 340B Drug Pricing Program, and ASHP is committed to fighting ongoing threats to the program that could have serious consequences for our patients. ASHP has a long history of support for the 340B program, and many of our members have seen firsthand the benefits of the program to the patients they serve. As Congress considered overhauling the nation’s healthcare system last year, ASHP developed Principles on Healthcare Reform that included our support for the 340B program. We continue to collaborate with numerous stakeholders, including our longstanding partners at the American Hospital Association (AHA) and 340B Health, to prevent cuts to program eligibility and scope.

Last August, the Centers for Medicare & Medicaid Services (CMS) released a proposed rule that cuts Medicare Part B reimbursement for drugs purchased through the 340B program from ASP plus 6 percent to ASP minus 22.5 percent. Along with the AHA and many other like-minded stakeholders, ASHP submitted comments to CMS opposing the cuts. In addition to the comments, ASHP lobbied on Capitol Hill to garner signatures to a Dear Colleague Letter from Congress to CMS urging the agency not to go through with the cuts. During ASHP’s annual Legislative Day in September, over 100 ASHP members met with their members of Congress to discuss, among other issues, the importance of the 340B program to their organizations and the critical role it plays in their ability to provide care to the medically underserved.

In November, CMS finalized the rule, and the reimbursement cuts were set to begin this year. AHA has filed a lawsuit challenging CMS’s authority to impose the cuts on the federal 340B program, and ASHP is supportive of AHA’s efforts. We are extremely disappointed that the rule putting the cuts in effect was finalized, and we remain committed to advocating for overturning this rule.

To that end, ASHP supports legislation (H.R. 4392) that would block the CMS-imposed cuts. Sponsored by Representatives David McKinley (R-W.V.) and Mike Thompson (D-Calif.), the bill currently has 181 co-sponsors in the House. In addition to our letter of support, ASHP has created a grassroots letter of support for our members to send using our electronic letter-writing platform.

We know that there will be additional threats to the 340B program in 2018. For example, recently introduced legislation (H.R. 4710) would impose a two-year moratorium on disproportionate share hospitals applying to become covered entities within the federal 340B program. This bill would also require additional reporting requirements, including reporting of the number of insured patients, total cost of charity care provided, reimbursement for all drugs, and a listing of all third-party vendors associated with the 340B program. ASHP has strong concerns over this legislation, and we expressed our opposition in writing to the bill’s sponsors. Similar legislation (S. 2312), was introduced in the Senate, and ASHP will oppose that bill as well.

We expect to see additional legislation later this year. The House Energy and Commerce Committee last week released a report on the 340B Drug Pricing Program. The committee has been examining the structure, operation, and oversight of the program over the past two years through stakeholder meetings, committee hearings, and document collection. Further, Committee Chairman Greg Walden (R-Ore.) has stated that there will be legislative efforts to change the 340B program this year to focus on definition, transparency, and oversight. ASHP developed an issue brief summarizing that report and the potential legislative options that may result.

ASHP remains committed to supporting the 340B Drug Pricing Program, and we will continue to do so through assertive advocacy on Capitol Hill, grassroots advocacy, comments to federal agencies, and meetings with agency officials. Further, ASHP will continue working with other program supporters such as AHA and 340B Health to protect the program from threats, both legislative and regulatory.

Thanks so much for continuing to advocate on behalf of your patients and the profession, and for being a member of ASHP.

Sincerely,

Paul

January 8, 2018

Drug Shortages Harm Patients

Filed under: Ambulatory Care,Clinical,From the CEO,Managers,Quality,Regulation,Residents,Specialties,Students — Tags: , , , , — jmilford @ 3:51 pm

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

ASHP AND OUR COLLEAGUES AT THE UNIVERSITY OF UTAH have been leaders in providing ASHP members, policymakers, and the entire healthcare community with timely information on drug shortages for nearly 15 years. We have also worked hand in hand with numerous stakeholders to find solutions to help minimize or prevent drug shortages. These efforts have included passing federal legislation and holding numerous multidisciplinary summits on drug shortages, with the most recent stakeholder summit taking place on November 6, 2017, at ASHP headquarters.

Today, although progress has been made, drug shortages are still significantly threatening the ability of ASHP members and their healthcare colleagues to provide care to patients. It is unacceptable in the United States that drug shortages can happen as frequently as they do — and certainly not acceptable for them to harm patients. Regardless, the problem persists and grows, with the most recent being the severe shortage of small-volume parenteral (SVP) solutions.

Soon after we became aware that an SVP shortage had emerged, ASHP and the University of Utah released a resource on the conservation and management of SVPs. This resource has proven useful to ASHP members and other providers, and its use has been encouraged by the FDA Commissioner.

We have also been working on a daily basis with the FDA, Congress, and numerous other concerned organizations to find solutions for all drug shortages and advocate for needed changes. Further, we are working to keep the entire shortage situation on the radar of the media. ASHP also immediately conducted a survey to better understand the magnitude of SVP and other shortages, and to use that survey data in our advocacy and media outreach on behalf of our members and their patients.

ASHP believes that it is time for Congress to get involved to stop this threat to safe and effective patient care. ASHP recently led the development of a congressional call to action with other key stakeholders. In that letter, ASHP and our partners asked Congress to examine the following questions to address the underlying causes of shortages:

  • Should manufacturers be required to disclose to the medical community their manufacturing sites and the products produced in those sites, in terms of volume and percentage of product line?
  • Should sole-source products be allowed to be produced in a single plant?
  • Should there be redundancy in production of critical products?
  • Should the FDA identify a list of “critical medications” that would require manufacturers to develop a reasonable contingency plan in the event of a production interruption or shutdown?
  • What incentives could be developed for other manufacturers to increase production when drug shortages occur?
  • What can be done to determine the best locations of pharmaceutical plants in addition to ensuring that backup systems can quickly accommodate needs in the event of a disaster, given there are several types of natural disasters that can occur?

We strongly believe that the current drug shortage situation is unacceptable and unsustainable. It threatens harm to patients, wastes valuable healthcare resources, causes great uncertainty, and disrupts the healthcare system. Congress should not wait to take action on drug shortages until the current crisis worsens even further. The time for leadership and action is now.

ASHP will continue to be the leader on this critical patient care and patient safety issue until we and our partners find solutions that ensure that no patient is ever affected as a result of a drug shortage. Please contact your member of Congress through ASHP’s call to action, and please continue to review ASHP’s website and other communications for updates. Also, please don’t hesitate to contact us if you have any questions or need assistance from our drug shortages staff team. ASHP is looking for both short-term relief to current shortages and long-term solutions. Therefore, fixing the drug shortage problem will remain a top priority for ASHP until meaningful and systemwide solutions are identified and implemented.

Thanks so much for being a member of ASHP, and for everything that you do for your patients.

Paul

August 21, 2017

Happy 75th Anniversary, ASHP!

Filed under: Ambulatory Care,Clinical,From the CEO,Innovation,Managers,Provider Status,Quality,Regulation,Residents,Specialties,Students,Topics — Tags: , , , , , , , , — jmilford @ 11:37 am

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

I AM HONORED to have the privilege of writing this message to you in celebration of ASHP’s 75th anniversary. On this day in 1942, ASHP was founded by an exceptional group of leaders who envisioned a future where pharmacists would be the medication therapy experts on what we now refer to as the interprofessional patient care team. In reflecting on the past 75 years, it is clear that ASHP and its exceptional members created a future that far exceeded the expectations of our visionary founders.

Over the course of 75 years, ASHP has been a leader in:

  • Conceptualizing and advancing pharmacy as a clinical profession.
  • Establishing standards of practice.
  • Creating accredited residency training.
  • Supporting pharmacist specialization.
  • Advancing the roles of pharmacists in ambulatory clinic settings.
  • Advocating for the effective utilization of pharmacy technicians.
  • Creating the modern drug formulary system.
  • Developing evidence-based drug information.
  • Advocating for the entry-level doctor of pharmacy degree.
  • Being the first organization to hold a national conference dedicated to high-level clinical education — the ASHP Midyear Clinical Meeting.

These are just a few of the many areas where ASHP has been the leader in helping to move pharmacists closer to the patient in the interest of improving patient care and medication safety.

ASHP is proud of these accomplishments; however, we are now focused on creating a future where all patients have access to and receive the appropriate level of comprehensive medication therapy management in all care settings. ASHP’s vision is that medication use will be optimal, safe, and effective for all people all of the time, and we are steadfast in our resolve to achieving this bold vision.

Being a member of ASHP has always been about being part of something much bigger. It’s been about working collectively to help pharmacists achieve their full potential and, in doing so, improving the lives of the patients we serve.

I hope you will join me in December at the ASHP Midyear Clinical Meeting in Orlando for the grand finale of our 75th anniversary year celebration. We’ve planned a great event that includes the best educational program, opportunities to network with over 25,000 colleagues, an anniversary celebration space called 75th Street, and the chance to hear a very special guest at our opening session. And, we’ve reserved the entire Universal Studios Florida Theme Park for our closing party. We can’t wait to see you there!

We want to thank each and every one of our nearly 45,000 members for making ASHP the best organization in pharmacy, and for the contributions you have made to our collective efforts to advance pharmacy practice and improve patient care. You are all a very special part of something wonderful that our founders would be truly amazed by and proud of. Thank you so much for being a member of ASHP and for everything you do for your patients.

Sincerely,

Paul

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