Community pharmacies will soon face the decision of whether to become accredited by the Center for Pharmacy Practice Accreditation (CPPA), URAC or to forego accreditation—at least for now. Supporters of the push for accreditation claim it will raise the overall quality of the profession, whereas opponents argue it is duplicative of existing state and federal laws, and overly burdensome in terms of cost, time and effort.
Last summer, both URAC (formerly known as the Utilization Review Accreditation Commission) and CPPA, the most recent entrant into the accreditation arena, held public comment periods on proposals to establish accreditation programs for community pharmacies—from independents, chains, and mail-order pharmacies, to outpatient pharmacies associated with health systems and hospitals. More recently, CPPA released consensus-based standards in an attempt to identify pharmacies that are focused on advancing patient care, safety and quality. The nonprofit organization is a partnership between the American Pharmacists Association (APhA), the National Association of Boards of Pharmacy (NABP) and the American Society of Health-System Pharmacists (ASHP).
A Strong Base of Support
The importance of instituting a community pharmacy accreditation program reflects the ongoing shift from a dispensing mode of practice to one that is more focused on clinical services and improving patient outcomes, Ms. Mahaney said. Many pharmacy practices are providing services and programs that CPPA wants to see grow, such as immunization, patient adherence and smoking cessation.
“What we’re doing matches up with what’s going on in the U.S. health care environment,” she said. “There’s a huge demand and need for the type of cost-effective quality care that pharmacists can provide.”
In order to help pharmacies through the accreditation process, Ms. Mahaney said she’s willing to speak at state association meetings and talk with group purchasing organizations and community pharmacy alliances. CPPA’s website, which is under development, expects to go live in early July. Ms. Mahaney said the site will provide information on continuous quality improvement tools, best practices and literature references. The group also plans to add instructional offerings such as webinars to the website.
URAC an Established Player
URAC, a health care accreditation, education and measurement organization, is also developing community pharmacy standards. Terri Smith Moore, PhD, RPh, senior manager of product development at URAC, explained what she sees as the distinguishing factor between her group and CPPA. “We don’t align with one particular segment. We represent and work with [a cross-section] of stakeholders because community pharmacies touch a variety of players—consumers to payers, Ms. Moore said. “Is that an advantage? Let the marketplace decide.”
Ms. Moore also pointed to URAC’S experience in the field of health care accreditation. “URAC historically has tremendous experience in the accreditation space, developing standards and operational processes that truly meet the needs of an organization,” she said. “We have a longstanding track record in [this martket] with our pharmacy benefit management, specialty pharmacy and mail service pharmacy accreditations.”
Ms. Moore said most of URAC’s proposed standards focus on the patient care services that community pharmacies should provide, such as comprehensive medication management, adherence consultations, immunizations, wellness and health screenings, and chronic disease management.
However, some community pharmacy groups, such as the National Community Pharmacists Association (NCPA), oppose CPPA and URAC’s push to establish accreditation programs. The NCPA sent letters outlining its concerns about the programs to both organizations. The group argues that the programs are costly; duplicative of current state and federal laws and regulations; and rely largely on documentation of policy and procedures instead of actual practice improvements. The NCPA also believes the standards are focused on subjective procedures and goals—which leaves members to wonder how compliance with the draft standards will be measured. Yet another concern is that although accreditation is voluntary at this point, it may become a requirement in the future. “Ultimately, NCPA is concerned that (accreditation) would become a carrot for larger entities, but a stick for smaller independent businesses,” the letter sated.
Douglas J. Scheckelhoff, MS, vice president of ASHP’s Office of Professional Development, agreed that, over time, payers are likely to look to accreditation to verify that the level of services offered meets their standards. “There comes a point where it becomes the market standard to have accreditation status,” Mr. Scheckelhoff said. “If I’m going to use a pharmacy, I want one that’s meeting a high standard. It’s the same as choosing a cardiologist, a hospital or any other medical service. I would want the one that has passed the test of an external review.”
In the meantime, CPPA and URAC are moving forward with their accreditation programs. URAC is doing more testing and validation before it releases its standards. “We don’t have a specific launch date, but we’re aggressively ... working on our program,” Ms. Moore said.
CPPA’s accreditation program documents are drafted, and Ms. Mahaney said she anticipates opening application for accreditation in June or July.
Both organizations understand that some community pharmacies believe that the accreditation process can be overly taxing and provides no guidance. But Ms. Moore said URAC takes an educational and interactive approach to the process that can be transformational. “Accreditation allows organizations to step back and look at themselves more deeply. It allows them to get recognition from payers or those that look closely at quality,” she said. “We want organizations to benefit from the experience and find the process rewarding and helpful.”
Ms. Mahaney agreed that “accreditation can be an administrative burden, and we’re mindful of that by harmonizing our standards with existing quality standards and other accreditation standards such as the ASHP community pharmacy residency. But we firmly believe accreditation is the right thing to do, because our first obligation is to take care of patients.”
Ms. Mahaney, Ms. Moore and Mr. Scheckelhoff declared no relevant financial conflicts of interest.