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What Obamacare Means for Health-System Pharmacists

Pharmacists in hospital and LTC facilities have new patient care opportunities.


A hospital pharmacist confirms a prescription.

Each prescription is conformed by a pharmacist before being dispensed to a hospital patient.

U.S. Navy photo by CWO4 Seth Rossman (030819-N-9593R-082)

The day after Congress passed the Patient Protection and Affordable Care Act in 2010, the American Society of Health-System Pharmacist published a legislative summary that concludes with this statement: “Hospital and health-system pharmacists must be prepared to lead implementation efforts on the numerous medication-use related aspects of the law.”

That remains true in 2012, when this article is being written. It will be true when all the provisions of the law widely referred to as Obamacare take effect in 2014. And it will continue being true for as long as patients take prescription drugs, OTC remedies and dietary supplements.

This led ASHP CEO Paul W. Abramowitz, PharmD, FASHP, to commend the U.S. Supreme Court for upholding the PPACA and “preserv[ing] the law’s health care delivery and payment reforms, which will provide an enhanced role for health-system pharmacists on interprofessional teams.”

Members of Interprofessional Care Teams

Abramowitz was pointing to innovative patient care models such as Accountable Care Organizations designed to offer the highest-quality medical and medication treatments at the least cost and with the fewest complications. An ASHP white paper details responsibilities pharmacists can fulfill in ACOs, and such alternative patient care models are being piloted with grants from the Centers for Medicare & Medicare Services innovation center.

The society’s director of government affairs, Brian Meyer, MBA, pointed out that hospital and health-system pharmacists have been collaborating with doctors, nurses and other health care providers to improve patient outcomes for decades.

“The goal is to get and keep people out of the hospital,” Meyer said. “That’s why hospital pharmacist go out on patient rounds, conduct medication reconciliations, prepare discharge instructions and do counseling sessions to ease transition back to the community. Pharmacists in health-systems work with their colleagues to ensure medication adherence and prevent problems, reduce readmissions and meet quality measures.”

He also said that ASHP has a task force that met recently to plan and promote pharmacists’ participation in new models of patient care. A particularly positive development in this area was a final rule from CMS allowing pharmacists and other health professionals to serve on the medical staff of a hospital.

‘Provider,’ Workforce Issues Remain

Meyer sees the pharmacy-related provisions of the PPACA as natural progressions from earlier federal laws like OBRA ’90 and HIPAA that began to recognize and clarify pharmacists’ role as patient care providers, educators and counselors.

For more than 20 years, he said, “there’s been an implicit recognition of pharmacists as health professionals. What we’re missing in the ACA is a clear statement that pharmacists qualify as what CMS calls ‘nonphysician practitioners.’ All the new patient care models being tried out make obvious the need for pharmacists on health teams and practitioner recognition.”

ASHP has repeatedly called on Congress to fund creation of the National Health Care Workforce Commission envisioned under the PPACA and for including pharmacists on the group’s leadership. According to the society, the workforce commission could identify and help resolve shortages of health professionals in critical disciplines and underserved locations.

Meyer noted that as Medicaid programs expand and private insurance becomes affordable for more patients, demands for medication therapy will increase along with the need for medication therapy management.

“Ensuring we have providers in place to meet the increase in patients and patients’ needs requires creating the workforce commission,” he said. “And having Medicare cover the [PPACA mandated] annual MTM visit for beneficiaries will do a lot to keep people healthy and out of hospitals.”

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