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ACOs should include pharmacists, NCPA tells CMS
June 8th, 2011
ALEXANDRIA, Va. – The National Community Pharmacists Association has urged the Centers for Medicare & Medicaid Services (CMS) to recognize the value of pharmacists in accountable care organizations (ACOs).
NCPA said Tuesday that it has submitted comments submitted to CMS calling for changes and clarifications on several key points in the agency's proposed rule for ACOs and the Medicare Shared Savings Program (MSSP).
ACOs are provider groups that accept responsibility for the cost and quality of care delivered to a specific population of patients.
"Accountable care organizations have the potential to improve health outcomes and ultimately reduce costs through more coordinated care if structured properly," B. Douglas Hoey, executive vice president and chief executive officer at NCPA, said in a statement. "However, those outcomes will be more likely if community pharmacists, with their proven expertise and services, are included in a robust manner. By better incorporating pharmacists, patients and taxpayers will benefit."
In its comments, NCPA said CMS' proposed rule needs to address concerns that ACOs might fail to capitalize on the value offered by pharmacists and pharmacies unless their inclusion in ACOs is explicitly authorized by the agency. And to facilitate medication therapy management (MTM) services, CMS should create mechanisms to help ACOs decide where to allocate resources in advance or adopt a prospective patient assignment system so the resources are targeted appropriately, the association noted.
NCPA also said in its comments that all ACO providers/suppliers should be required to provide patients with specific and clear notification information, so that patients who opt out of an ACO may continue to go to their pharmacy of choice, whether or not it is contracted with that ACO. In addition, the association called on CMS to develop a privacy liability safe harbor mechanism in which ACO pharmacists can receive protected health information regarding potential ACO beneficiaries without inadvertently running afoul of privacy laws, as well as to aid the incorporation of quality measures that encourage ACOs to focus on appropriate management of prescription drug therapy and as part of a successful disease management protocol.
Hoey noted, "The rulemaking process for ACOs must focus on removing logistical and financial impediments that could limit pharmacist participation or hinder the ability of all health care providers to accurately document the successes that should follow."
In December, the National Association of Chain Drug Stores sent a letter to CMS urging the agency to consider the role that pharmacy plays in delivering patient-centered care and lowering health care costs as it devises rules for ACO. NACDS also recommended in the letter, sent to CMS administrator Donald Berwick, that MTM be a core element in an ACO.