Transcript Analysis of CMS Consultant Pharmacist Independence Proposal

April 2012 Policy & Advocacy Briefing
Analysis of CMS Consultant Pharmacist
Independence Proposal
ASCP’s Policy & Advocacy Department
[email protected]
www.ascp.com/ltcrule
Summary
• No requirement for January 1, 2013
• CMS believes any requirement needs to be broader in
scope
• LTC community expected to voluntarily improve
transparency immediately
• Measurable improvement on prevalence of unnecessary
drugs, overutilization
• CMS plans a future notice and comment rulemaking
• Public comments due 60 days from Federal Register
publication
Overview: Independence Policy
• CMS believes public comments justified concerns over
conflicts of interest
• Does not believe CP-SNF employment represents
conflict of interest
• Pharmacy employment relationship = financial
relationship that exerts pressure
• Oct. 2011 proposal disproportionately targets consultant
pharmacists
• Must consider broader changes than CP independence
for a future rulemaking
Definition of Independence
• CMS did not respond directly to their
definition or alternatives submitted through
public comments
• No indication of whether CMS would
consider modifying this definition
Alternative Approaches to
Independence
• ASCP suggested separate contracts, fair market
rates, pharmacy attestation to CP clinical
independence, disclosure statements
• CMS considered finalizing requirements which
would have included: separate contracts, fair
market rates, pharmacy attestation to CP clinical
independence, disclosure statements
Alternative Approaches to
Independence
• CMS believes requiring independence is part of
the right approach
• However other factors contribute to conflicts of
interest, drug overutilization, unnecessary drugs
• Strongly encourages the industry to voluntarily
adopt these recommendations to improve
transparency
Measures for CP Performance
• CMS suggests industry collect data
– Number of interventions
– Type of interventions
– Outcomes
• Work with PQA to develop performance
measures
LTC Settings with Difficulty Complying
with Proposed Independence
• ASCP recommended a waiver option for
certain settings including rural, Tribal,
closed-systems, charitable, others
• CMS will consider comments in a future
rulemaking
Relationships with Pharma
• Public comments did not change CMS’s belief
that CP-pharma relationships should be banned,
if CP is practicing
• Believe that CPs receiving remuneration from
pharma may be influenced
• Cited exchange of scientific, educational
information at event supported by pharma
• Service in Ad boards, speaker bureaus
Timeline for Implementation
•
•
•
•
•
CMS not finalizing at this time
Changes as proposed would be disruptive
Will seek a targeted less disruptive approach
Expects voluntary changes from industry
In the absence of measurable improvement,
CMS will use future rulemaking
Cost Impact
• CMS acknowledges that an independence
requirement would be highly disruptive to
the marketplace
• Would result in higher costs to the nursing
homes
Profession Response to the Proposal
• CMS did not respond specifically to the
findings in ASCP’s survey
• Says they were swayed by comments
from current and former CPs, patient
advocates
• Believe that change is necessary
Use of Antipsychotics in NH
• CMS acknowledges other factors
contribute to overprescribing,
overutilization
• CMS must consider broader changes
• Will propose those changes in a future
rulemaking
DRR Best Practices
• CMS says resident safety is at risk if CPs don’t
have enough time to conduct a proper DRR
• DRR not currently yielding intended outcomes,
beneficiary protections
• Questioning the purpose of CP DRR
• CMS may consider changes to the requirement
to explore alternative approaches
• Expects industry to demonstrate value of CP
DRR to resident quality of care
CMS Solicitation for Public
Comments
Enhancing medication management and the
effectiveness of medication review
1. What actions/steps should be taken to strengthen attending
physician (and other prescribers) medication management and
prescribing practices to ensure the best quality of care for the
nursing home resident?
2. What is and should be the role of nursing home medical director in
overseeing the attending physician (or other prescribers)
medication management activities?
3. What actions, if any, should the medical director take when
attending physicians (or other prescribers) fail to engage in
appropriate/adequate medication management activities?
Enhancing medication management and the
effectiveness of medication review
4. What actions/steps could be undertaken to establish and ensure
the independence and effectiveness of a consultant pharmacist in
conducting their medication reviews on behalf of nursing home
residents?
5. What training and best practice models would assist all nursing
home staff to better understand behavior signs and symptoms and
respond appropriately and effectively in assisting and caring for
nursing home residents?
Data collection and use
6. What data are needed to enable and support the Medicare and
Medicaid programs and others in monitoring the appropriateness
and adequacy of medication management activities, including the
use of antipsychotics drugs?
7. What data are needed to enable CMS to study the effectiveness of
consultant pharmacist medication reviews?
8. What data are needed to create public performance metrics
regarding the independence of consultant pharmacists and
prescribers from pharmacies and drug manufacturers/distributors?
9. Are data needed on the number and type of interventions
recommended by consultant pharmacists and on the outcomes of
those recommendations? If so, how could such data be used and
by whom?
Increasing transparency
10. What information is needed to assess the independence and
adequacy of physician (and other prescriber) medication
management and oversight on behalf of nursing home patients?
What metrics could be used to assess the adequacy and
appropriateness of prescriber response to consultant pharmacist
recommendations?
11. What metrics could be used to describe the adequacy and
appropriateness of a LTC facility's medication management
program?
12. Describe the incentives and other arrangements that create the
conflict of interest in LTC that contributes to overutilization and
inappropriate drug use in LTC facilities. How can the conflict of
interest stemming from these incentives and arrangements be
contained
Increasing transparency
10. What specific details regarding the financial (and other) What
metrics could be used to describe the adequacy and
appropriateness of a LTC facility's medication management
program?
11. Describe the incentives and other arrangements that create the
conflict of interest in LTC that contributes to overutilization and
inappropriate drug use in LTC facilities. How can the conflict of
interest stemming from these incentives and arrangements be
contained
[email protected]
www.ascp.com/ltcrule
703-739-1316
Lynne Batshon x141
Angelina Panettieri x151
Arnie Clayman x178