May 3, 2013

AACP Policy Framework
AACP Issue Briefs
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Budget and Appropriations Tables
Letters to Congress and the Administration
Academic Pharmacy Now - Capitol Hill News
AACP Advocacy Updates and Alerts

May 3, 2013 

President’s budget released: On April 10th, the President released his budget recommendations for FY14. The using both program funding decreases and revenue increases the President continues to present a balanced budget approach that reduces the deficit and replaces the funding lost due to the sequester of FY13 discretionary spending. The President reminds Congress and the public that $2.5 trillion has already been removed from the discretionary budget over the last two years and that the additional $1.8 trillion in additional deficit reduction over the next ten years provided in this balanced approach is sufficient to place the US on a course of fiscally responsible spending.

You can find the details of the funding amounts recommended by the President for a number of programs of interest to academic pharmacy by reviewing the tables AACP staff have made available on the AACP advocacy Web pages dedicated to FY14 appropriations.

Each agency of the federal government develops and submits to Congress a document referred to as its budget or Congressional justification. These documents include FY14 funding levels for programs, projects and activities administered by that agency. These documents are much easier to read and find appropriate funding level information than many of the complete budget recommendation documents on the Office of Management and Budget site. The justifications also include statements reflecting the support or lack of support a particular program may have within that agency and the rationale for that support or lack thereof. Below you will find links to some of the budget justifications for some of the agencies of interest to academic pharmacy:

Both the House and Senate have created and passed their respective, non-binding budget resolutions. The respective budgets, with spending limits of significant difference, are not expected to be combined through conference, as the House refuses to appoint conferees until this difference is discussed and lessened.

FY14 sequestration of funds: Unless the "grand bargain" occurs, the continued decrease of non-defense discretionary (NDD) funding for many of the programs of interest to academic pharmacy continue through 2021. Unlike sequestration of funds in FY13, FY14 sequestration will be included in the total amount of funding that appropriators will be able to allocate to the twelve appropriations committees. For FY 14 the NDD spending amount is currently limited, by law, to $967 billion. The Budget Control Act set FY14 funding at $1.066 trillion in the Budget Control Act (BCA). The BCA used a new category of funding definition: non security funding, which included a few additional programs not included in the traditional definition of NDD. The American Taxpayer Relief Act (ATRA) (PL 112-240) used the traditional non-defense/defense discretionary category thus reducing the BCA total by $4 billion. The BCA cap is further reduced in ATRA $94 billion which leaves FY14 discretionary funding at $967.

The Office of Management and Budget report to Congress dated April 10, 2013 provides a more detailed presentation, including tables of this discretionary funding reduction.

Agency FY13 operations plans: All federal agencies are subject to the sequester authorized in the Budget Control Act of 2011 (PL 112-25). In a series of reports to Congress, the Office of Management and Budget presented the 2 percent reduction of FY13 total funding that would apply to all the programs, projects and activities (PPA) of the federal agencies. The federal agencies have now released FY13 operating plans that present the actual amount of FY13 reductions for PPAs. Some agency plans are more complete than others. The links to some agencies of interest to academic pharmacy:

PCPCC document on team-based care: The Patient Centered Primary Care Collaborative (PCPCC) has released a study that refers to team-based care as the "most critical element of primary care practice transformation." Another key finding from the study was that clinical leaders have varying preferences and face different environmental conditions and, therefore, need a multitude of options to consider for practice transformation."

The study, conducted by faculty at the George Washington University, Department of Health Policy, was supported by a grant from the Agency for Healthcare Research and Quality (AHRQ). The authors of "Team-Based Care: A Critical Element of Primary Care Practice Transformation," offer recommendations to health services researchers "to continue to examine what team-based care models are most effective, what makes it possible to create and sustain these models, and how effective models can be disseminated to the majority of primary care practices in the United States."

Additional thoughts on a reorganized health system: This week the Engelberg Center at the Brookings Institute released the third report in its "Bending the Curve" series. Authored by a number of health policy experts including former Senator Tom Daschle, former governor Mike Leavitt, and former CMS administrator Mark McClellan, the report provides a series of reform recommendations to health payers including Medicare and Medicaid and to providers premised on four consensus issues:

  • Integrated care is better than uncoordinated care,
  • Risk-based systems are better than fee-for-service based systems,
  • Choice is preferred to mandate,
  • Real, score-able savings are preferred to estimated savings.

The report, "Bending the Curve, Patient-Centered Health Care Reform: A Framework for Improving Care and Slowing Health Care Cost Growth," using what the authors state as very conservative economic assumptions, provides recommendations that could reduce healthcare costs by as much as $200 billion over the next decade. Allowing all clinicians to practice at the top of their license is one aspect that leads to these savings.

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Founded in 1900, the American Association of Colleges of Pharmacy (AACP) is a national organization representing the interests of pharmacy education and educators. Comprising all accredited colleges and schools of pharmacy including more than 6,400 faculty, 57,000 students enrolled in professional programs and 5,700 individuals pursuing graduate study, AACP is committed to excellence in pharmacy education.

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