Federal auditors in 2019 suddenly began enforcing new and confusing requirements on postgraduate year 1 (PGY1) residency programs, putting at risk the Centers for Medicare & Medicaid Services (CMS) funding that is a key source of support for residency programs. CMS offered little clarity on what programs could do to stay in compliance and avoid devastating financial consequences to their operations.

Pharmacy residencies are essential to performing many patient care services and are even required for positions within specialties such as solid organ transplant, psychiatry, substance use disorder, and oncology. We have spent nearly 50 years building a strong pharmacy residency system in this country. Draining our programs of a significant source of funding risks limiting the number of pharmacists who can fill gaps in these critical areas.

ASHP has met several times with CMS staff to discuss the arbitrary nature of these audit findings, which appear to be based on a far-reaching interpretation of the requirement that a specific hospital operating a program retain direct control over every program facet. Many of the issues cited by auditors appear unreasonable. Hospitals that operate these programs are not standalone institutions but part of health systems. We argued that it was unfair, for example, that a hospital loses funding because the name of the health system, rather than just the hospital, appears on residents’ completion certificates.

What we have sought most from CMS, however, is clear guidance so programs can easily comply with the law. However, CMS continued to decline to spell out its requirements, so we took our efforts elsewhere. We filed a friend-of-the-court brief in a federal district court case in which the Medical University of South Carolina successfully sued the federal government over the new cost disallowances for its PGY1 program. We also went to Capitol Hill. Three Congressional members — Sen. Tina Smith (MN), Sen. Tim Scott (SC), and Rep. Buddy Carter (GA) — requested clarification on our behalf. But they, too, received scant information.

I recently sent a letter to the Department of Health and Human Services Secretary Xavier Becerra, CMS Administrator Chiquita Brooks-LaSure, and Domestic Policy Council Director Neera Tanden requesting CMS, at long last, provide the guidance our programs need and deserve. My letter to federal officials points out that these audit findings have been so inconsistent that residency programs have little idea of how to structure a compliant program.

But we know our residency programs can’t wait much longer for clear answers. Today, I am pleased to let you know that ASHP is developing a compliance toolkit for residency programs, based on input from those programs that have managed to satisfy auditors’ requests. We know it’s not foolproof, but we want everyone to benefit as much as possible from the experiences of our colleagues. Additionally, ASHP continues to work one-on-one with programs as they move through the audit process, helping them address potential problems.

That said, protecting our residency programs should not be left to crowdsourcing efforts. As I note in my letter to federal officials, public health will be better off if we increase funding for these PGY1 programs, not decrease it.

We owe it to our patients to grow — not limit — the number of pharmacists available to provide care.

Thank you for all you do for your patients and our profession.

Sincerely,

Paul

Posted on November 9, 2023