A well-established fact is that patients are at significantly greater risk of adverse drug events and related health complications during transitions in care. A review of the literature confirms that the associated cost of these complications reaches $3 billion annually. So with these facts as a backdrop, I was interested to read that the APhA and ASHP recently convened an expert panel to define the issue of medication reconciliation and optimize the medication reconciliation process (Optimizing Medication Reconciliation).
The panel succeeds in producing a workable definition of medication reconciliation and in summarizing the abundance of evidence that supports the need for improvements in the reconciliation process. The panel continues by correctly linking medication reconciliation with medication therapy management (MTM). Importantly, the panel provides evidence to support the case for pharmacists to take the leadership role in managing the reconciliation process. So far, so good.
What I find to be the most stunning deficiency of the panel’s report is in the analysis of barriers to the reconciliation process. The panel does affirm the high degree of complexity involved with medication reconciliation process. Other common recognized barriers noted include:
But here is where the panel’s report ultimately fails. With the exception of a single phrase that suggests one “potential resolution” to these barriers might include “financial incentives for health care professionals who update and provide medication lists” there is absolutely no mention of the requirement that pharmacists be adequately paid for providing this complicated and valuable service. While the report talks about a “lead role” or “pivotal role” to describe the “critical collaboration” of pharmacists within the process, the panelsimply fails to call for fair and universal payment for the pharmacists who provide this service.
Pharmacists need to demand more from their professional organizations. What exactly is the position of APhA and ASHP if it’s not expressed within the panel’s report? If pharmacists’ own professional organizations cannot clearly advocate for fair and universal payment for med reconciliation, then why would payers recognize this to be a need? Pharmacists who are members of APhA and ASHP should express their disapproval with this flawed report and remain vigilant in their efforts to make payment for pharmacists’ services a necessary and consistent component of medication reconciliation.
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