Pharmacists reflect on HCR as House takes up Senate bill
Politics aside, bill could open huge doors for MTM as future of pharmacy practice
For more than a year now, the health care reform (HCR) debate has been smoldering among the Obama administration, Congress, health care providers, and the public alike. The politics of the issue have yet to be reconciled. But many providers, pharmacists included, have reached consensus that reform of some kind is needed to repair a broken system.
Many who have been tuned into the debate think it shone new light onto the medication therapy management (MTM) roles of the pharmacist in the health care spectrum. In interviews with pharmacist.com as Congress prepared for final votes on the bills, here’s what some pharmacists had to say about HCR and MTM.
Rally and consensus
“I think the most profound thing that has affected us as a whole is that organizations have rallied around a common theme, which really hadn’t happened prior to this time,” said Gary Matzke, PharmD., FCCP, FCP, professor and associate dean for clinical research and public policy at Virginia Commonwealth University. “This is one of the first times that pharmacy organizations have united around this common theme.”
There may not be agreement on all issues, but the professor said he gives APhA and the other representative organizations an “A” grade overall. This is due to their diligence in reinforcing the three principles put forth in the debate: the need for appropriate infrastructure and access to health information technology; improvement of drug quality and safety and appropriate reimbursements; and patient choice of providers.
Creating these principles came from APhA and pharmacy coalition partners getting together and taking an inventory of major issues, said Kareem Karara, a third-professional-year student pharmacist at the University of the Sciences in Philadelphia.
“One of the most fantastic things is that people are talking about what the problems are and what are their solutions,” he said. “We need action, but at this point, the most positive thing is talk.”
This talk was effective because pharmacy was able to create a united front, said Helene Levens Lipton, Ph.D., a professor of health policy in the University of California San Francisco School of Pharmacy.
“In my long years of working with pharmacy policy I’ve learned that policymakers don’t like to work with fractured professionals at odds with each other,” she said. “Pharmacy groups went to great pains to create consensus documents to move the profession forward.”
Because of this, there was some agreement on issues such as MTM grants and pharmacy’s involvement in medical homes.
“It was a stunning example of how the profession has moved forward,” she said.
Along with reaching some compromise, the organizations have spent a great deal of time educating members, said Karara, who spent the summer working at the American Society of Consultant Pharmacists. He wrote a newsletter on HCR and read numerous materials from other organizations as well. He saw a jump in member participation, with pharmacists calling and asking questions as well as visiting the organization’s website for resources. Even at his school, students took part in political policy education events.
Philip Hritcko, PharmD, CACP, said it is disappointing that pharmacy has to constantly justify its role within the greater health care system. The Assistant Department Head of Pharmacy Practice at the University of Connecticut School of Pharmacy said the debate has helped create a conversation and collaboration with other health care professionals.
“We have been letting others know the value of our services,” he said. “As long as we are on the forefront of the reform movement and letting them know pharmacy is part of the total health care team, that is a good thing.”
Levens Lipton agreed with the importance of pharmacy talking to other caregivers to move forward their agenda of creating a team-based model like a medical home setting.
“There is a system-wide primary care shortage,” she said. “It can’t be dealt with in a vacuum, and this is where pharmacists can work with physicians and nurse organizations to transform the practice of primary care through increased use of other health professionals.”
Matzke said he was pleased to see that in the end, both the House and Senate listened to pharmacists and recognized them as one of the professionals needed on an interdisciplinary health care team.
“There was language in both bills that address the expectations of pharmacists,” he said. “It clearly creates expectations that pharmacists should meet to implement MTM and provides funding for these types of services.”
John Michael O'Brien, a pharmacist, professor, and health policy consultant in Washington, DC, said the inclusion of the MTM grants in the House and Senate bills were probably the biggest “home run” for pharmacy.
If some sort of reform does pass, Levens Lipton said pharmacists should be active when it comes to ensuring that the levels of appropriation are appropriate for MTM grants and community health teams in medical homes.
Another area to focus on is information technology initiatives. As these efforts move forward, she said it will be important to keep pharmacy active in the process in areas such as electronic prescribing.
Congress has laid down a framework for what they support moving forward for pharmacists. The impetus will now be placed on providers to “incorporate this opportunity into their clinical practice,” Matzke said.
He said it is imperative that pharmacists continue to remain informed about the debate and legislation being undertaken.
Professional organizations may have stepped up to make their voices heard during the past year, but O'Brien said individuals need to do their part in the future as well.
“I think owe [the professional lobbyists of the pharmacist associations] a real debt of gratitude,” he said. “At the same time, we need to make sure more pharmacists pay more attention and get more involved. Either get into politics or get out of pharmacy.”
The reform debate changed dramatically after the Massachusetts election of Scott Brown to the U.S. Senate. He was a state legislator prior to being elected; that is one reason O’Brien said it is important for pharmacists to build up relationships with their neighbors, patients, and government representatives.
Overall, Hritcko said he was happy with the way the largest pharmacist organizations kept everyone abreast of what was going on, helping to advocate locally and nationally and supporting a grassroots movement.
“I think it is just the start for us as a profession,” he said.