Where We Stand
On December 12, 2011, the American Society of Consultant Pharmacists submitted comments to the Centers for Medicare & Medicaid Services (CMS) on a proposed regulation that would require consultant pharmacists who serve nursing facilities to be independent of the pharmacy that supplies medications to the residents of that facility. Since our submission, our staff, Board of Directors, and I have been closely following feedback on our comments and reviewing the comments submitted to CMS by other organizations.
Recently, I fielded two phone calls from members. Both complimented us on a job well done for such a complex and potentially polarizing issue. Interestingly, one of these individuals had interpreted our comments as opposing the proposed rule, while the other thought we were in support of the agency’s "proposal for separation." At the same time, we had external sources interpret our comments both as supportive and in opposition to the CMS proposal. There appears to be some confusion -- perhaps even misinterpretation -- of our comments.
Since October 2011, when the "separation" proposal was made public, the ASCP staff, our Advocacy Committee, and the Board of Directors, have devoted countless hours in preparing our comments on this critical issue. As you might imagine, this was not an easy task. We were very analytical, cautious, and methodical in developing our informed approach. We conducted member surveys, focus groups, town hall meetings; had numerous conference calls; and set up a Web site portal for comments to help give our members a voice and to gather vital information needed in our response to CMS.
At all times, two very important elements were kept in the forefront while crafting our comments: 1) the importance of patient safety, and 2) that ASCP represents all consultant pharmacists -- irrespective of their employment status. ASCP is not a trade association, but rather a professional society that represents pharmacists who take care of older adults -- independent consultants and those consultants employed by pharmacies, facilities, and institutions.
If you have not done so yet, I encourage you to read our entire response to CMS  (PDF) -- not just the summary. In our comments, we indicate that pharmacists should be free to make recommendations and act in the best interest of their patients, at all times. They should be free from any conflict of interest or undue influence or bias. Essentially, regardless of their employment status, pharmacists should be independent in exercising their judgment when providing patient care services. CMS proposes that separation of the consultant from the long-term care pharmacy will help remove conflict of interest. ASCP has a number of members who practice in a “completely independent” (i.e., separate) model, and we strongly support our members who have implemented and maintain this type of practice. However, we have members who practice in other models who have provided excellent quality of care for their patients for years. Therefore, in our comments, we strongly suggested to CMS that the reduced conflict of interest that the agency seeks be achieved through other approaches -- in other words, separation is not the only means by which to ensure that pharmacists are able to practice without undue influence or pressure. We also offered to help CMS develop measures for ensuring quality consulting services for all models of practice.
Based on the feedback that we have received, I recognize that many of you are upset because of the way CMS characterized our profession -- making it seem as though unethical practices were rampant. Although this was painful to read, we know that CMS values the role of the consultant pharmacist. If you take a step back and think about it, we want to be the association that works closely with CMS when potential regulatory changes are proposed. We certainly do not want others -- who do not understand all of the nuances of our practice -- making these decisions for us. In addition, this is a very complex industry for which CMS has proposed a simple one-size-fits-all solution. In our comments we pointed out a number of alternate practice environments where patient safety would be jeopardized if CMS decides to implement separation across the board. We also address the potential negative impact to patient care that may result from non-compete clauses within many consultants' contracts. Should sudden, sweeping implementation of separation be implemented, facilities may have to turn to less-experienced pharmacists (i.e., those with no prior long-term care experience or geriatrics training).
CMS' response to comments is expected in March. At this point in time, we do not know what direction or recommendations CMS will adopt. In the interim, it is important for ASCP to continue to offer to serve as a resource for CMS and to prepare for various scenarios: no separation, imposed separation, or some hybrid variation. Regardless of which option CMS chooses, ASCP will be prepared to serve as a resource for our members.