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10/9/1998

Credentialing Initiatives Questions and Answers

Why does the profession need this Council on Credentialing in Pharmacy? 

Pharmacy lacks a leadership body to help give guidance and direction to post-licensure certification programs and other recognition mechanisms offered to pharmacists. Pharmacy practice and education are changing as therapeutics becomes increasingly complex and patients require new services to manage medications. This is requiring that those pharmacists educated and licensed over many years look to educational institutions, associations and other entities for training programs and recognition processes to gain and validate new skills. These organizations are responding to that demand from pharmacists by providing a variety of educational opportunities (e.g., certificate training programs, residency experiences, nontraditional degree programs). There is also a need for valid and reliable certification processes, which are ideally offered on a voluntary basis by independent certification agencies. The Council has been created to serve as a guiding voice and resource, both for those within the profession and from outside, to help guide the development and assure the quality of pharmacy’s post-licensure credentialing efforts.

Who has been invited to join in this effort? Have NACDS, NCPA, and NABP been invited? 

As noted in the October 2, 1998 press release, positions on the council are open to all organizations interested in and committed to assuring that the profession’s certification programs are legally defensible, psychometrically sound and provide an indicator of quality practice. This includes professional and trade associations, educational institutions, and regulators. NACDS, NCPA and NABP are explicitly included in this invitation. We also will extend invitations to those outside the profession (e.g., representatives of medicine and nursing, payers and the public) who are key stakeholders in the issues discussed by the Council.

Will the boards of pharmacy play a role in the governing body of the Council on Credentialing? 

The boards of pharmacy and their association, NABP, have vested interests in assuring that the profession’s credentialing activities are sound. Therefore it is important that they be involved in the work of the Council on Credentialing. Boards of pharmacy are called upon by public and private payers to affirm the qualifications of pharmacists who provide unique services (e.g., nuclear pharmacists, consultant pharmacists). The profession does feel strongly, however, that certification in areas called advanced practice or pharmaceutical care should be directed by the profession through independent and voluntary certification programs rather than by the boards of pharmacy and that boards could recognize pharmacists with appropriate credentials.

How is this announcement different from the plans announced by NABP, NACDS and NCPA for the National Institute for Standards in Pharmacist Credentialing? Does this duplicate their effort or compete with it? 

The founders of the Institute have stated that its focus is the creation of standards that form the foundation for examinations to credential pharmacists in specific disease states. That is very different from the focus of the Council on Credentialing and it differs as well from the effort to form a certification process for general pharmaceutical care. There is no duplication or competition, in fact these efforts complement each other.

Is this new organization a result of the Institute founders not inviting all of the professional organizations to be part of its governing body? 

Although the lack of involvement by a greater number of professional organizations in the governance of the Institute is a concern for some state and national associations, that is not the reason the Council on Credentialing was created. Those involved in the formation of the Council have been working together for months to define the scope of their collective efforts to address concerns from pharmacists and pharmacy leaders regarding the right strategies to pursue in post-licensure credentialing. This is the exciting culmination of those discussions.

What is the relationship between the Council and the existing credentialing organizations in pharmacy? 

While no formal relationships have yet been established, the Council sees a very direct and cooperative relationship evolving with such organizations. These include the ASHP Commission on Credentialing (residency program accreditation), the Board of Pharmaceutical Specialties (specialty certification), the Pharmacy Technician Certification Board (technician certification), and the Commission for Certification in Geriatric Pharmacy (geriatric practitioner certification). While not a certification body, the Council also hopes to build a relationship with the National Institute for Standards in Pharmacist Credentialing to address the disease-specific component of certification activities.

Why is the phrase “legally defensible and psychometrically sound” so important to the work of the Council and to others? 

Just as in other pursuits, there are standards of quality that are important in the conduct of certification enterprises. While pharmacy certification is voluntary, it is nonetheless important in areas such as career opportunities and advancement, privileging within networks and institutions, and qualification for pay scale increases and reimbursement for services. It is also important that pharmacy pursue its credentialing activities in a manner that earns the understanding and support of the public, other health professions, and the government. Given the serious nature of these issues it is clear that pharmacy must assure that its credentialing programs meet the highest standards of defensibility and rigor.

What happens to pharmacy credentialing operations that do not join the Council on Credentialing? Will the Council have the power to keep an organization from providing a credential? 

Cooperation between credentialing organizations and the Council is purely voluntary and will be a decision made by the governing bodies of each respective organization. We certainly hope that the spirit of cooperation will prevail and have every reason to believe it will. The Council has no enforcement power to restrict credentialing organizations’ activities. The goal is for the profession and the public to respect the opinion of the Council that certification programs in pharmacy are credible and based on sound psychometric practices. Council members have the collective expertise to render such judgments.

Will the standards established by the Council all be at the specialty level (i.e., equivalent to BPS criteria)? 

No. The profession’s certification programs have evolved to encompass a broader range of credentialing activities. This includes residency and fellowship programs, nonspecialty certification (e.g., geriatric practice certification) and specialty certification. The Council sees a role for all of these and will address each within the scope of its efforts.

Will the Council on Credentialing be reviewing or approving certificate training programs or providers? 

No. The American Council on Pharmaceutical Education (ACPE) has accepted responsibility for this, as was strongly recommended by those state and national organizations participating in the August 1998 conference on certification programs hosted by ACPE and AACP.

Have any payers or the public stated their support of these new initiatives? How do you know that there is a demand for this activity? 

There are several sources of validation for these efforts. An informal alliance of state and national organizations commissioned a study by a certification consultant who conducted key informant interviews with many of the profession’s leaders. The need for professionwide cooperation and leadership for credentialing activities was articulated by these leaders and served as the basis for recommendations in the report. Those participating in the Summit on Credentialing in Pharmacy, sponsored by state and national pharmacy associations in mid-September, echoed the call for both the formation of a coordinating body and the establishment of a new certification process in pharmaceutical care Pharmacists and payers, such as those involved in patient care pilots in Iowa, Maryland, Minnesota, Mississippi and elsewhere, are on record indicating that certification is an important aspect of these activities.

Will other health professions, payers and the public have equivalent seats on the Council? 

While no decision has been made with regard to the nature of these group’s participation, a recommendation from the Summit on Credentialing held in mid- September is that these entities serve in an advisory capacity. That decision will be made soon by the Council.

Why is there a need for pharmaceutical care, or advanced practice, certification? Hasn’t pharmacy divided itself over the degree issue and don’t licenses provide pharmacists and the public with adequate assurance of practice quality? 

Practice is taking on new and varied dimensions. When this occurs, questions regarding who is qualified to deliver unique new services are naturally raised. One mechanism to answer such questions is training (e.g., contemporary degrees and residency training); another is through voluntary certification programs. Pharmacists and payers, such as those involved in patient care pilots in Iowa, Maryland, Minnesota, Mississippi and elsewhere, are on record indicating that certification is an important aspect of these activities. It is in the best interest of all to forge a coordinated, defensible and practical approach to new recognition mechanisms. That is why these organizations have come together.

Aren’t two different approaches being pursued with respect to pharmacist certification, general versus disease specific? 

Yes, and there are strong proponents for both. This will be one issue that the Council and those involved in developing the certification program must discuss to determine how the general care and disease-specific strategies either fit together or co-exist.

Have the Minnesota Pharmacists Association and the Commission for Certification in Geriatric Pharmacy programs been used as recognition programs by practicing pharmacists? 

Yes, both are currently being used to assess pharmacists. Each examination/assessment has been administered to several hundred pharmacists.

How much will it cost pharmacists to obtain the new certification offered through this collaboration? 

That has not yet been established and will depend upon several factors, including the exact nature of the examination process, projected demand and other market forces.

We know that payment programs have been announced for disease state management but are there any for general pharmaceutical care? 

There are several pilots either underway currently or soon to be launched that pay for services that are not disease-specific. Also, numerous hospitals and integrated health care systems are currently pursuing their own approaches toward credentialing in pharmaceutical care. They are likely to defer to a standardized national process for this purpose.