Transcript Care Transitions for Medication Safety in the Community

Care Transitions for
Medication Safety in the
Community
Lauren E. Glaze, PharmD
Assistant Professor of Pharmacy Practice
UAMS South Family Medical Center
Objectives
• Define transitional care and its impact on healthcare
outcomes and expenditures
• Describe the development of a Transitions of Care (TOC)
service
• Identify medication-related strategies to decrease hospital
readmissions
• Review examples of pharmacist-led interventions to enhance
transitions of care in rural communities
Transitions of Care
“The movement of
patients between
health care locations,
providers, or different
levels of care within
the same location as
their conditions and
care needs change.”
-National Transitions
of Care Coalition, 2008
Source: Healthy Transitions Colorado, 2015.
Barriers to Successful Care Transitions
Multiple providers
Different EMRs
Medication discrepancies
Poor communication
Lack of patient/family education
Inadequate planning and goal setting
Why focus on care transitions?
Improve patient safety
and health outcomes
Reduce readmissions
and healthcare costs
2011 Readmission Costs
$41.3 billion in hospital costs for 3.3
million adult 30-day readmissions
– Medicare $4.3 billion
– Medicaid $839 million
– Private Insurance $785 million
Source: Hines AL, et al. 2014. http://www.hcup-us.ahrq.gov/reports/statbriefs/sb172-Conditions-Readmissions-Payer.pdf.
Source: New England Journal of Medicine, 2009 Centers for Medicare & Medicaid, 2012
Source: HCUP Statistical Briefs #153 and #154: http://www.hcup-us.ahrq.gov/reports/statbriefs/statbriefs.jsp
Source: HCUP Statistical Briefs #153 and #154: http://www.hcup-us.ahrq.gov/reports/statbriefs/statbriefs.jsp
CMS Data
• 64% of Medicare patients received no post-acute
care between discharge and readmission
• 76% of readmissions may be preventable
• Medicare beneficiaries report greater dissatisfaction
in discharge-related care than any other aspect of
care CMS measures
U.S. Department of Health & Human Services. New HHS Data Shows Major Strides Made in Patient Safety,
Leading to Improved Care and Savings. May 7, 2014 .
Hospital Readmission Reduction
Program (CMS)
YEAR
READMISSION DIAGNOSIS PENALTY
2013*
Acute MI, CHF
2015
COPD, TKA, THA
2016
CABG surgery
2017
Aspiration pneumonia, sepsis
* CMS Transitional Care Billing introduced
The Bottom Line
Poorly coordinated care transitions
Decreased quality of care
Decreased health outcomes
Increased hospital readmissions
Increased costs
Improve
quality
outcomes
Reduce
hospital
readmission
rates
Reduce of
adverse
drug events
Transitions of Care Service
 Patient-Centered Medical
Home (PCMH) and Rural
Health Clinic (RHC)
 7 counties in South
Arkansas
 Adult Primary Care,
Pediatrics, Senior Care,
OB/GYN
 Family Medicine faculty
physicians, residents, and
students
Development of TOC Service
Key Players
Hospital
• Physicians
• Pharmacist
• Case Managers
• Nurses
Clinic
• Physicians/APRNs
• Pharmacist
• QI Coordinator
• Care Coordinators
• Nurses
• Behavioral Therapist
• Health Educator
UAMS readmission stats
PharmD Impact
stats
UAMS South TOC Workflow
Inpatient
Care/
Discharge
• DAY 0-1
Follow-up
Phone Call
• DAY 2-3
Follow-up
Clinic Visit • DAY 7-14
TOC Billing • DAY 30
Inpatient Care
• Medical Team includes attending physician,
UAMS medical residents, students, PharmD, and
scribe who perform daily rounds
• PharmD assists in medication selection, duration,
and dosing
• PharmD focuses on UAMS patients medication
discrepancies
• Discuss inpatient care and plans for discharge
Discharge
• UAMS patients identified by PharmD and hospital
case managers
• Brief discharge counseling and verification of
information performed by PharmD or PharmD
student
• Hospital Nurse provides updated medication list
to patient and preferred community pharmacy*
• Hospital Nurse calls UAMS South to schedule
Follow-up Clinic Visit
Follow-up Phone Call
• UAMS South discharged patients emailed to QI
Nurse and PharmD daily
• Led by PharmD or PharmD student within 48
hours of discharge
• Call to patient’s community pharmacist
• Call patient or patient caregiver (2 attempts)
• TOC phone script utilized
Phone Call Script
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How are you feeling?
What appointments do you have ?
What imaging/labs/exams are scheduled?
Where you able to get your new medication(s)?
How are you taking your new medication(s)?
What issues/concerns do you have with your
new medication(s)?
• What questions do you have for me? Your
provider? Your case coordinator?
Phone Call Documentation
• TOC Phone Note completed by PharmD or
PharmD student
• Includes discussed appointments, medications,
concerns, etc.
• Hospital discharge note copied to UAMS note
• Update UAMS EMR to reflect Hospital discharge
medication reconciliation
• Note sent to PCP for review before Follow-up
Clinic Visit
Follow-up Clinic Visit
• Led by PCP within 7 to 10 days of discharge
• PharmD performs medication education, verifies
adherence, and addresses concerns
• Follow up appointment scheduled for 1-3 months
• PCP completes clinic visit note with TOC billing
code
TOC Billing
• UAMS coder bills TOC codes at day 30-post
hospital discharge for MEDICARE PATIENTS
• CPT Code 99495 – Transitional care management
services with moderate medical decision
complexity (face-to-face visit within 14 days of
discharge)
• CPT Code 99496 – Transitional care management
services with high medical decision complexity
(face-to-face visit within 7 days of discharge)
CMS TOC Rules
• Must include:
• Date of discharge
• Date of Interactive Contact (phone call, email, or
face to face) with beneficiary or caregiver
• Non-face to face services*
• Date of Follow-up Visit (face to face or
telemedicine)
• Complexity of medical decision making
(moderate or high)
CMS TOC Rules
• Discharge from:
• Inpatient Acute Care Hospital
• Inpatient Psychiatric Hospital
• LTAC
• SNF
• Inpatient Rehab
• Hospital Outpatient Observation
CMS TOC Rules
• Discharge to:
• Home
• Nursing Home
• Assisted Living
CMS TOC Rules
• Only 1 health professional may report services of 1
billable TOC service per beneficiary within 30 days
• Same healthcare provider can perform discharge,
phone call, and follow-up visit
• Follow-up visit may not take place the same day as
reported discharge
• May not bill TOC codes and CCM, ESRD, or Care
plan oversight services code
Why Involve the Pharmacist?
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Prevent medication errors
Address medication concerns
Avoid Adverse Drug Events
Provide medication counseling
Assess medication adherence and efficacy
Pharmacist Interventions
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Improper drug selection
Subtherapeutic dosages
Supratherapeutic dosages
Medication non-adherence
Therapeutic duplications
Therapeutic omissions
Drug interactions
Drugs with no indications
Treatment failures
UAMS Outcomes
• Completed ___ TOC services since September
2015 (___ weekly discharged patients)
• Billed 14 Medicare patients
• Billed Medicaid for ____ patients on EOY
reports
Clinical Outcomes
• QI results
QI Group Benefits
• ACT Southwest
Partnership Feedback
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Hospital
Home health
SNF/Assistant Living
Community pharmacists
Patient Success Stories
Future Endeavors
• Discharge med rec sent to patient’s preferred
pharmacy
• Monthly adherence checks with community
pharmacist and at subsequent PCP clinic visits
Future Endeavors
Future Endeavors
• Expand to other South Arkansas Hospitals
• Med rec at admission by inpatient pharmacist
• “Meds to Beds” program
• Follow-up face to face visits in patient’s home
Question
• Which of the following is not a barrier to
successful care transitions?
A.
B.
C.
D.
E.
Different EMRs
Multiple providers
Medication discrepancies
Great communication
Lack of patient education
Questions?
TOC Resources
Care Transitions for
Medication Safety in the
Community
Lauren E. Glaze, PharmD
Assistant Professor of Pharmacy Practice
UAMS South Family Medical Center