Pursuing provider status

This month, I'm taking the opportunity to share with you, the progress CPNP has made in our Government Affairs efforts. Approximately 1 year ago, CPNP made a decision to increase its government affairs efforts with focus on obtaining provider recognition for clinical pharmacists.

Many of you have seen the press releases from CPNP and ACCP describing our partnership to advocate for and pursue “recognition for the direct patient care services of qualified clinical pharmacists as a covered benefit under the Medicare program …. The initiative promotes and advocates for comprehensive medication management as part of a team-based practice structure and emphasizes the importance of ‘getting the medications right'….” CPNP's Board of Directors and our revamped Government Affairs Council discussed this partnership extensively and the elements of the initiative.

Some entities and groups have questioned the emphasis on the term “Comprehensive Medication Management (CMM)” versus use of the term “Medication Therapy Management (MTM).” Concerns have been expressed about possible confusion being generated by different groups' use of these two terms and the processes they describe. Therefore, I want to address some important aspects of this initiative to seek provider status.

I'd first like to share material recently posted on the APhA MTM listserve by Dr. Carla Cobb (CPNP Past President and Chair of CPNP's Government Affairs Council). Carla has an active practice using the Comprehensive Medication Management model. This material was posted to address the question of how to best promote MTM.

1. What do we mean when we say “MTM”? It means different things to different people. Does it mean point of care therapeutic substitution from brand to generic to reduce cost? Does it mean calling a physician to discuss a duplication in therapy or adverse reaction? Does it mean providing direct patient care within a medical practice to help a patient meet clinical goals of therapy? All of the above? Vastly different but all very important activities. How do we explain this to legislators and payers? We need to agree on a lexicon and descriptions that everyone (including ourselves) can understand and explain to others.

2. What are we hoping to accomplish by providing patient care? We need to keep our focus on improving patient outcomes. This is accomplished by a variety of means. Much of it can be done through interventions in the pharmacy. Some of it is too complex to be done while dispensing and demands a private setting with adequate time to do a comprehensive medication review. Not all patients require this high level of service but our focus should be on improving patient outcomes.

3. Why are we fighting about this? Our patients need all of these services at a variety of levels to meet their needs. Just like we have same day care, primary care, emergency departments, and hospitals, generalists and specialists, for different levels of patient need, we need patient education, generic substitution, therapeutic drug monitoring, and comprehensive medication management at the right time for the right patient. We need it all! Our patients need all of our help at many different levels. Let's not fight about what it's called.

   In summary and in my opinion, first we need to tackle Babel and agree upon the lexicon. We need to focus on how pharmacists can help improve patient outcomes at all levels. There are a number of tactics that can help but we need to start with these as a foundation.

CPNP's Board of Directors has endorsed Comprehensive Medication Management (CMM). In our evaluation and discussions of this endorsement, we realized that CMM is a clearly-defined, evidence-based model for ongoing direct patient care provided by clinical pharmacists. CMM includes “face-to-face” evaluations with patients to ensure that their medications are appropriate, effective, safe, and convenient. The purpose is to improve outcomes by ensuring that patients are meeting clinical goals of treatment. This is done through a process of performing a patient assessment, developing a care plan and following-up to assess progress. It is a patient-centered/patient unique, reiterative process that is team-coordinated. As Dr. Jerry McKee (CPNP Past President and Incoming Chair of CPNP's Government Affairs Council) eloquently and succinctly stated in response to concerns raised about the distinction between CMM and MTM:

“It is the vision of CPNP and ACCP and perhaps soon, other organizations, that CMM is the way of the future and much more patient-centric than MTM. Further, CMM is endorsed by the PCPCC which is physician driven. In order to be successful, this is the group that CPNP sees as the most likely to get us where we want to go so that pharmacy is in a better position to impact patient care in a positive way.”

CPNP, and ACCP as our partner, certainly hope that pharmacy can present a united and consistent message to legislators and payors in our pursuit of provider recognition. We will continue to work with all groups in hopes we can present these consistent messages. Perhaps recognition of the relationship between MTM and CMM will help.

In last month's President's Message, I mentioned the formation of a new Government Affairs Council (GAC). GAC was formed by blending our former Legislative Committee and our Comprehensive Medication Management Reimbursement Task Force. Members of GAC for 2013-2014 include: Jerry McKee (Chair), Carla Cobb (Past Chair), Charlie Caley (Foundation Liaison) Carey Potter (CPNP Government Affairs consultant), Ray Love (Board Liaison), Brenda Schimenti (Staff Liaison), Julie Dopheide (CPNP President), Rex Lott (CPNP Past President), Steve Burghart (Incoming President-Elect), Kelly Lee, Dean Najarian, and Lisa Goldstone. Several additional CPNP members have agreed to serve as subcommittee members within GAC. Subcommittees will focus on areas such as stakeholder relationships, education and substantiating the value of pharmacist contributions to the healthcare team. The graphic below depicts activities of GAC and its members:

Also illustrated in the GAC diagram above are two additional activities that we believe will impact legislative efforts on a longer term basis. Dr. Kelly Lee and a GAC subcommittee are developing a research proposal with ACCP's Practice-Based Research Network (PBRN). This study is planned to assess the value of pharmacist involvement in an ambulatory care setting on screening for diabetes and cardiovascular disease in patients treated with antipsychotics. Dr. Lisa Goldstone and subcommittee members are working to develop a white paper that will document the value of psychiatric pharmacists.

CPNP is investing a great deal of talent, time and resources in our government affairs efforts. All of this has an ultimate goal of improving the care of patients by positioning pharmacists as recognized providers who are active members of health care teams. CPNP's focus, of course, is on improving care and outcomes for patients with neuropsychiatric disorders. We anticipate a great deal of discussion regarding these efforts – both within our organization and between CPNP and other groups with interest in this effort.

I hope this information and update is as exciting to you as CPNP members, as it is to the CPNP leadership team and the GAC. We believe that the future is, indeed, now.

I look forward to seeing many of you at our upcoming 16^th Annual Meeting in Colorado Springs, Colorado from April 21 – April 24. This promises to be an energized and exciting meeting.

Until then,

Rex Lott