Transcript Document
Engaging the C-suite to Advance Pharmacy Practice Providing quality patient care through progressive pharmacy practice Safety, Quality, and the Pharmacy Practice Model Initiative: Aligning for Success Erick Sokn, Pharm.D., M.S., BCPS Manager, Transitions of Care/ED Cleveland Clinic Objectives • Provide update since original C Suite series • Describe metrics and a process that can be used to measure the quality of change that occurred and ensure that a positive change has taken place • Describe how organizations have implemented safety and quality principles in daily practice Projected Impact of Healthcare Reform • Affordable Care Act – Increase Access – Improve Quality – Decrease Cost Early Measures of Interest • CMS Readmission Reduction • CMS Hospital Value-Based Purchasing – HCAHPS – Clinical processes of care – Outcome measures – Efficiency Hospital Value-Based Purchasing. Centers for Medicare and Medicaid Services. http://www.cms.gov. Accessed 2014 Oct 20. Readmissions Reduction Program. Centers for Medicare and Medicaid Services. http://www.cms.gov. Accessed 2014 Oct 20. CMS=Centers for Medicare & Medicaid Services HCAHPS=Hospital Consumer Assessment of Healthcare Providers and Systems Readmissions • Impact from CHF, AMI, pneumonia: – Year 1 – 2,217 hospitals penalized for ~$280 million – Year 2 – 2,225 hospitals penalized for ~$227 million – Year 3 – 2,610 hospitals penalized for ~$428 million • October 2014, added total hip/knee and COPD Value-Based Purchasing Fiscal Year Potential Payment Reduction Domains 2013 1% Processes of Care HCAHPS 2014 1.25% Processes of Care HCAHPS Outcomes 2015 1.5% Processes of Care HCAHPS Outcomes Efficiency Reduction increases by 0.25% annually, to maximum of 2% in FY17 HCAHPS Medication Domain Questions • Purpose of new medications explained • Side effects described • Medication Communication – Composite score based on the percent of patients responding ‘Always’ • NEW Transitions of Care domain – Purpose for taking medications at discharge PPMI Alignment • B11 and B12 – Prioritize pharmacist interventions (high risk patients) • B20 – Medication continuity of care • Advancing role of the pharmacy technician • Expanded ownership and accountability for quality and access Am J Health Syst Pharm. 2011; 68: 1148-52. Ongoing Efforts at Cleveland Clinic • Initiatives align with goals and metrics from Affordable Care Act – Patient experience / HCAHPS – Access to care – Readmissions • What’s next? Targeted Counseling Targeted Counseling Med Rec Target: Discrepancies Discharge Counseling Target: HCAHPS First Dose Teaching Target: HCAHPS • For home-going patients: • Review discharge prescriptions • Ensure clear medication list and instructions for discharge • Use electronic health record to prioritize work • For home-going patients: • Education on medication purpose and side effects • Reinforce after-hospital medication-related follow up plans • Use electronic health record to prioritize work • For all neurology patients, educate on: • Anticonvulsants • Antidepressants • Antipsychotics • Use electronic health record to identify inpatient orders Impact - HCAHPS • Counseling 4-6 patients per day - ~66% capture rate of home discharges Highest-ever 98th percentile Bedside Delivery of Medications • Bedside delivery option for discharge prescriptions – Program targets discharging patients to improve access to medications and increase compliance – Assures patient has tools necessary to continue medication therapy plan after discharge Bedside Delivery Win-Win • Large increases in revenue for pharmacy department – 13% return on investment • Large patient satisfier – 98% would recommend Pharmacy Heart Failure Education • Patients with actively managed heart failure (HF) – Multi-disciplinary discharge checklist – Pharmacy education as required element • Hard stop in electronic health record if pharmacist education not documented What’s Next? • HCAHPS remains a high focus of the enterprise – COPD education – Targeted expansion to high-risk patients using complexity score • Medication reconciliation • Patient counseling • Messaging: No quick fix – follow the data, adjust the focus What’s Next? • Patient safety indicators • Readmissions • Increasing emphasis on hospital acquired infections – Pharmacist role? Questions???