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APhA CEO Blog

Growing recognition of pharmacists at CMS

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November 01, 2016

Anyone who has ever read my blog knows that our focus is getting pharmacists on the team and in the game. And, you’ll know that we’re driving hard to gain federal provider status recognition through the Pharmacy and Medically Underserved Areas Enhancement Act, H.R. 592/S. 314.

But Congress isn’t the only group interested. APhA also communicates with CMS as it further refines how eligible providers are reimbursed in the transition from volume-based care to value-based care. We are actively urging the agency to recognize that quality of care and health outcomes improve and health care costs drop when pharmacists are included on a patient’s health care team. If patients, especially those in underserved areas, had access to and coverage for our services, these patients would be better equipped to achieve their treatment goals!

Pharmacy is strongly united in this quest. APhA, along with colleague organizations, submitted comments in June regarding the CMS proposed rule for the implementation of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). This act not only determines how eligible clinicians (physicians and nonphysician practitioners) are paid, but how quality measurements will be used to drive payment of incentives. Our comments asked CMS to work toward removing barriers that prevent pharmacists from being integrated into Medicare as eligible providers.

CMS appears to be listening. On October 14, CMS released the final MACRA rule, which grants additional flexibility for physicians to choose the amount and frequency of quality improvement activity and advancing care information measures that they will need to report on in order to receive compensation and avoid penalties. While CMS provided that they (CMS) “do not have discretion under the statute to include clinicians who do not meet the definition of an [Merit-based Incentive Payment System, or MIPS] eligible clinician,” they expressed their appreciation for pharmacists’ suggestions, agreeing that pharmacists are an underutilized source of quality patient care.

The final rule also includes quality measures that specifically mention pharmacists. The measures pertain to post-discharge medication reconciliation and population management.

What does this mean for pharmacists? Payment models are changing to pay for outcomes of care, including in the MACRA/MIPS program. Pharmacists should consider reaching out to physicians and other eligible clinicians to explore collaborations to maximize the opportunities within MACRA/MIPS, collaborations that would be further enhanced when pharmacists gain provider status.

And speaking of 2017, we’re going to soon be counting on you again to encourage your Members of Congress and Senators to support H.R. 592 and S. 314. To date, you and your colleagues have generated an unprecedented number (over 40,000) of letters to Congress in support of H.R. 592 and S. 314. Unless Congress acts in the lame duck session after the election, we’ll be making a major push early next year. Importantly, every major piece of health care legislation has passed in the first months of a new presidential administration. With your help, we can make those 40,000 letters look like a drop in the bucket!