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Transcript of A TOOLKIT FOR SENIOR CARE PHARMACISTS · · 2017-10-12a toolkit for senior care pharmacists ... ,...
MEDICATIONSAFETYDURINGTRANSITIONSOFCARE:ATOOLKITFORSENIORCAREPHARMACISTS
Thistoolkitisdesignedforseniorcarepharmacistsinanypracticesettingandservesasaresourceguideofavailablebest-practiceclinicalandmedicalinformationforuseduringtransitionsofcare.Itincludespracticalguidancetoassistpharmacistsastheynavigate
thecomplexbillinglandscape.
MedicationSafetyandTransitionsofCareWorkgroupAmericanSocietyofConsultantPharmacists,2016-2017
SPEAKERS
Marylee Grosso,BSPharm,PD,RPh,FASCP,2016-2017Co-ChairHealthCareConsults,LLCAlexandria,VA
AndrewTrella,PharmD,MBAFoulkeways atGwynedd RetirementCommunityGwynedd,PA
AddolorataM.Ciccone,PharmD,BCGP,2017Co-ChairJeffersonHouse,HartfordHealthcareNewington,CT
JosephGruber,RPh,BCGP,FASCP,2016Co-ChairActualMeds CorporationDublin,Ohio
DISCLOSURES
JosephGruberistheChiefClinicalOfficerofActualMedsCorporation.
Theotherspeakersdisclosenorelevantfinancialconflictsofinterestwithregardtothisactivity.
LEARNINGOBJECTIVES
Attheconclusionofthisknowledge-basedactivity,participantsshouldbeableto:
1. Describethetransitionsofcarelandscape.
2. Explaintheimportanceofmedicationsafetyprocessesduringtransitionsofcare.
3. ReviewthecomponentsofASCP'sMedicationSafetyduringTransitionsofCare(MSTOC)Toolkit.
MEDICATIONSAFETYDURINGTRANSITIONSOFCARE:ATOOLKITFORSENIORCAREPHARMACISTS
Thistoolkit,sponsoredbytheASCPBoardofDirectors,wasdevelopedbyavolunteerworkgroupofseniorcarepharmacistsrepresentingmultipleareasofconsultantpharmacistpractice.ASCPLeadershipwouldliketoacknowledge
thededicationandhardworkoftheseindividuals.
JosephGruber,RPh,BCGP,FASCP,2016Co-ChairActualMeds CorporationDublin,Ohio
MaryleeGrosso,BSPharm,PD,RPh,FASCP,2016-2017Co-ChairHealthCareConsults,LLCAlexandria,VA
AddolorataM.Ciccone,PharmD,BCGP,2017Co-ChairJeffersonHouse,HartfordHealthcareNewington,CT
JoanBaird,PharmD,BCGP,ASCPStaffLiaisonAmericanSocietyofConsultantPharmacistsAlexandria,VA
RobertAccetta,RPh,C-MTM,BCGPRivercare Consulting,LLCCortlandt Manor,NY
KatherineAnderson,PharmD,BCGP,FASCP,ASCPBoardLiaisonPharmacistsInternationalConsultingUniversityPlace,WA
DonnaBellamy,PharmD,BCGPDeptofGerontology,FortValleyStateUniversityFortValley,GA
KellyBraham,PharmD.BCGPUpstateCommunityHospitalSyracuse,NY
MarkE.Creasman,RPh,BCGP,FASCPTransylvaniaRegionalHospitalBrevard,NC
KimberlySasserCroley,PharmD,LDE,BCGP,FASCP,FAPhALaurelSeniorLivingCommunitiesLondon,KY
HelenHalchuk,BSPharm,RPhEliLillyIndianapolis,IN
SuzanneKelley,BSPharm,CPhCovenantCarePensacola,FL
EmilyKryger,PharmD,BCGPUniversityofPittsburghMedicalCenterPittsburgh,PA
AnnieLam,BSPharm,PharmD,BCGP,FASCP,ASCPBoardLiaisonUniversityofWashingtonSchoolofPharmacySeattle,WA
MacaylaLandi,PharmD,BCGPVACentralWesternMassachusettsNorthampton,MA
NicoleLopez,PharmDVASouthernNevadaHealthcareSystemLasVegas,NV
JeanneManzi,PharmD,BCGP,FASCP,ASCPBoardLiaisonCVS/CaremarkRockvilleCenter,NY
KimberleeJ.Otto,RPh,FASCPSeniorPharmacyConsulting,LLCOmaha,NE
Tarah Parsons,PharmDWestonCountyHealthServicesNewcastle,WY
ChristinaPolomoff,PharmD,BCACPHartfordHealthcare,IntegratedCarePartnersWethersfield,CT
JoshPostolski,PharmDMedicationManagers,LLCCincinnati,OH
NancySchiciano,BSPharm,FASCPDrugWorks,IncToledo,OH
ConnieSmith,RPh,MBA,CCP,CSSGBCompletePharmacyConsultingPhiladelphia,PA
AndrewTrella,PharmD,MBAFoulkeways atGwynedd RetirementCommunityGwynedd,PA
WhitneyZentgraf,PharmD,BCGPWesleyMedicalCenterWichita,KS
MEDICATIONSAFETYDURINGTRANSITIONSOFCARE:TOOLKITTABLEOFCONTENTS
IntroductionSection1 TheTransitionsofCareLandscape
Section2 MedicationSafetyDuringTransitionsofCare:ClinicalImplications
Section3 PayersandBilling:OpportunitieswithManagedCareandotherEntities
Section4 Technology:EmpoweringBestPracticeThroughAcquisition,HarmonizationandInteroperabilityofData
Section5 MSTOCOverviewWebinarSlideDeck
MSTOC=MedicationSafetyDuringTransitionsofCare
SECTION1:THETRANSITIONSOFCARELANDSCAPE
• Healthcaresystemfailuresduringtransitionsofcare:– Rushedpatientcare– Fragmentedresponsibility– Unavailable,incompleteandinoperabledata– Littlerealcommunicationbetweenhealthcareteams
• Section1ofthetoolkit:– Outlineschallengesofimprovingmedicationsafetyduringcaretransitions– Definetransitionofcareandmedicationreconciliation– Identifystakeholdersdrivingchangeandimprovement– Speaktothepharmacist’sroleinprovidingmedicationmanagement
TRANSITIONSOFCARE
• “Transitionsofcare”canbedefinedasthemovementofpatientsbetween:–Healthcarelocations–Differentlevelsofcarewithinthesamelocation–Providers
TRANSITIONSOFCARE:THEPROBLEM
• Anestimated80% ofseriousmedicalerrorsinvolvemiscommunicationduringtransitionsbetweenhealthcaresettings.1
• 20% percentofpatientstransitioningfromthehospitalexperienceanadverse
event.Ofthese,66% arerelatedtomedications.2
• Approximately13% ofnursinghomeresidentstransitioninghomerequireERvisitorhospitalizationwithin 30days.3
• Ineffectivetransitionsofcareareresponsibleforasignificantburdenandexpenseonouroverallhealthcaresystem.HospitalreadmissionscostMedicareanestimated$15billionperyear.4
MEDICATIONRECONCILIATION
“Theprocessofidentifyingthemostaccuratelistofallmedicationsthatthepatientistaking,includingname,dosage,frequency,androute,bycomparingthemedicalrecordtoan
externallistofmedicationsobtainedfromapatient,hospital,orotherprovider.”5
“TheEPwhoreceivesapatientfromanothersettingofcareorproviderofcareorbelievesanencounterisrelevantshould
performmedicationreconciliation.”5
EP=EligibleProfessional
MEDICATIONRECONCILIATION:THEPROBLEM
• Resultsofalargehospital-basedmedicationreconciliationstudydemonstrated36% ofpatientshadmedicationerrorsatadmission,ofwhich85% originatedfromthepatient’smedicationhistory.6
• Additionofnewdrugs,discontinuationofdrugs,changesindoseandomissionofdrugsarethemostfrequentlyreportedmedicationrelatedproblems(MRPs)atdischarge.7
• Medicationerrorsoftenoccurwhenpatientsmovebetweenhealthcaresettings.8
–Half ofhospitalmedicationerrorsoccuronadmission,transferanddischarge.8
–30% ofthesehavethepotentialtocausepatientharm. 8
WHOISDRIVINGCHANGE?
• LegislationandRegulatoryBodies• InstituteforSafeMedicationPractices• QualityMeasureOrganizations• PharmacistsandProfessionalOrganizations
WHOISDRIVINGCHANGE?LEGISLATIONANDREGULATORYBODIES
• HITECHAct(2009)–MedicationreconciliationrequiredatTOCtomeetmeaningfuluse
• AffordableCareAct(2010)– ACOs,TOCprograms
• CMS– IMPACTAct(2014)– measuremedicationreconciliationacross4LTPACSettings
– Reimbursementmodelse.g.BPCI HITECHAct=TheHealthInformationTechnologyforEconomicandClinicalHealthActTOC=TransitionsofCare
ACO=AccountableCareOrganizationCMS=CentersforMedicareandMedicaidServices
IMPACT=ImprovingMedicarePost-AcuteCareTransformationLTPAC=Long-TermPost-AcuteCare
BPCI=BundledPaymentforCareImprovement
WHOISDRIVINGCHANGE?INSTITUTEFORSAFEMEDICATIONPRACTICES
• Reportsonmedicationadverseevents• Medicationsafetytoolkits• Patient-facingresources• Practiceguidelinesonimprovingmedicationsafetypractices• IOMwhitepaperonmedicationsafety• OverviewofSafetyRecommendationsforMedicationManagementTechnology
IOM=InstituteofMedicine
WHOISDRIVINGCHANGE?QUALITYMEASUREORGANIZATIONS
• NCQA/HEDISandAHRQ–MedicationReconciliationPost-Discharge
• PQA/CMS–MedicationReconciliation• HospitalStarMeasures- MRP• ACOPlanQualityMeasure• IMPACTAct– AcrossLTPACSettings
NCQA=NationalCommitteeforQualityAssuranceHEDIS=HealthcareEffectivenessDataandInformationSet
AHRQ=AgencyforHealthcareResearchandQualityPQA=PharmacyQualityAlliance
WHOISDRIVINGCHANGE?PHARMACISTSANDPROFESSIONALORGANIZATIONS
• TheNationalTransitionsofCareCoalition:9
– Considersmedicationmanagementthefirstessentialelementtosafelyexecutetransitionofcareservices
– Supportsempoweringpharmacistsasmanagersofmedicationreconciliation• Uponimplementationofpharmacist-ledmedicationreconciliationinalargenon-
profithealthcaresystem,prevalenceofMRPsandpost-dischargemedicationdiscrepancieswerefoundtobe80.7% and75.4% respectively.10
WHOISDRIVINGCHANGE?YOUARE!
“Thesolutiontocurtailingpreventablemedicationerrorsandtheconsequentoverutilizationofresourcesisstaringussquare
intheface.Pharmacistsareurgedtoactnowbytakingleadershiprolesinoversightofmedicationmanagementduringcaretransitionsorgettinginvolvedaspartofthecaretransitions
team!”11
SECTION1:THETRANSITIONSOFCARELANDSCAPE:KEYRESOURCES
• TRANSITIONSOFCARE– NationalTransitionsofCareCoalition– http://ntocc.org/Home/tabid/55/Default.aspx
• MEDICATIONRECONCILIATION– MarquisProject– http://tools.hospitalmedicine.org/resource_rooms/imp_guides/MARQUIS/marquis.html– https://www.scribd.com/document/117767285/AHRQ-Medication-Reconciliation
• MEDICATIONSAFETY– InstituteforSafeMedicationPractices– http://ismp.org/– https://www.ismp-canada.org/transitions/download-toolkit.php
• HEALTHCAREINFORMATIONTECHNOLOGY– PharmacyHITCollaborative– www.pharmacyhit.org
• PROFESSIONALORGANIZATIONS– AmericanSocietyofConsultantPharmacists– www.ascp.com/healthinfotech
SELF-ASSESSMENTQUESTION#1:
• Whichofthefollowingpromotesimprovementintransitionsofcareprocesses?
a) IMPACTActb) IOMwhitepaperonmedicationsafetyc) TheNationalTransitionsofCareCoalitiond) Alloftheabove
SECTION2:MEDICATIONSAFETYDURINGTRANSITIONSOFCARE:CLINICALIMPLICATIONS
Theclinicalimplicationsportionofthetoolkitisacollectionoftoolsforpharmacistsinanycaresettingtoutilizeinthe
identificationofkeymedicationclassesanddiseasestateswiththegoalofoptimizingmedicationsafetyduringcaretransitions.
SECTION2:MEDICATIONSAFETYDURINGTRANSITIONSOFCARE:CLINICALIMPLICATIONS
Section2.0 Introduction
Section2.1 Tools toIdentifyKeyDiseaseStates
Section2.2 ToolstoIdentifyHigh RiskMedications
Section2.3 ToolstoIdentifyPotentiallyInappropriateMedications
Section2.4 ToolstoClassifyMedication-RelatedProblems&MedicationErrors
Section2.5 ToolstoManage MedicationsSafely
Section2.6 ToolstoImproveTransitionsofCareProcesses
SECTION2:MEDICATIONSAFETYDURINGTRANSITIONSOFCARE:CLINICALIMPLICATIONS
2.1TOOLSTOIDENTIFYKEYDISEASESTATES• CMSdiagnosesforinappropriatere-admissions:– Pneumonia(includingaspirationpneumonia&sepsis)– Congestiveheartfailure(CHF)– Acutemyocardialinfarction(MI)– Chronicobstructivepulmonarydisease(COPD)– Electivetotalhiparthroplasty– Electivetotalkneearthroplasty– Coronaryarterybypassgraft(CABG)
CMS=CentersforMedicare&MedicaidServices
SECTION2:MEDICATIONSAFETYDURINGTRANSITIONSOFCARE:CLINICALIMPLICATIONS
2.2TOOLSTOIDENTIFYHIGHRISKMEDICATIONS• 2014OIGreport:adverseeventsinSNFsmostcommonlycausedby3HRMclasses:
– Hypoglycemics,anticoagulants,opioids• CMSQAPIresources:
– AHRQ/CMSPotentiallyPreventableAdverseEventsinNursingHomeslistsrelatedto:medications,residentcare,&infections
– AdverseDrugEventTriggerTool– FocusedSurveyonMedicationSafetySystems
• IHIHigh-AlertMedicationSafetyresources• ISMPlistsofHigh-AlertMedicationsincommunity/ambulatoryandacutecaresettings• HEDIS®MeasuresHRMlist
OIG=OfficeoftheInspectorGeneralHRM=HighRiskMedication
QAPI=QualityAssurance&PerformanceImprovementAHRQ=AgencyforHealthcareResearchandQuality
IHI=InstituteforHealthcareImprovementISMP=TheInstituteforSafeMedicationPractices
HEDIS®=HealthcareEffectivenessDataandInformationSet
SECTION2:MEDICATIONSAFETYDURINGTRANSITIONSOFCARE:CLINICALIMPLICATIONS
2.3TOOLSTOIDENTIFYPOTENTIALLYINAPPROPRIATEMEDICATIONS• AGSBeerscriteria• ZhancriteriaforPIMuseintheelderly• Screeningtoolofolderpeople'sprescriptions(STOPP)andscreeningtooltoalertto
righttreatment(START)criteriaforPotentiallyInappropriatePrescribinginOlderPeople:Version2
• AGS/ABIMFoundation’sChoosingWisely®Campaign• “TenThingsCliniciansandPatientsShouldQuestion”
• HanlonMedicationAppropriatenessIndex• Assess,Review,Minimize,Optimize,Reassess(ARMOR)Tool
AGS=AmericanGeriatricsSocietyPIM=potentiallyinappropriatemedication
ABIM=AmericanBoardofInternationalMedicine
SECTION2:MEDICATIONSAFETYDURINGTRANSITIONSOFCARE:CLINICALIMPLICATIONS
2.4TOOLSTOCLASSIFYMEDICATION-RELATEDPROBLEMS&MEDICATIONERRORS• FDAMedWatch• NationalCoordinatingCouncilforMedicationErrorReportingandPrevention(NCC
MERP)MedicationErrorIndex• AHRQMedicationErrorandAdverseDrugEventReportingSystem(MEADERS)• VAVeteransAdverseDrugEventReportingSystem(VADERS)• ChenUniversityofSouthernCalifornia(USC)MedicationTherapyIntervention&
SafetyDocumentationForm
FDA=FoodandDrugAdministrationVA=VeteransAffairs
SECTION2:MEDICATIONSAFETYDURINGTRANSITIONSOFCARE:CLINICALIMPLICATIONS
2.5TOOLSTOMANAGEMEDICATIONSSAFELY• Thissectionisdividedinto8Parts:
Part2.5.1 AnticoagulantsPart2.5.2 HypoglycemicsPart2.5.3 OpioidsPart2.5.4 PsychotropicsPart2.5.5 AntimicrobialsPart2.5.6 NarrowTherapeuticIndexMedicationsPart2.5.7 Anticholinergic/Sedation/FallRiskMedicationsPart2.5.8 Pharmacogenomics
SECTION2:MEDICATIONSAFETYDURINGTRANSITIONSOFCARE:CLINICALIMPLICATIONS
2.6TOOLSTOIMPROVETRANSITIONSOFCAREPROCESSES• Thissectionisdividedinto5Parts:
Part2.6.1 CareTransitionsToolsPart2.6.2 MedicationReconciliationToolsPart2.6.3 MedicationManagementToolsPart2.6.4 DeprescribingToolsPart2.6.5 RiskScreeningTools
SECTION2:MEDICATIONSAFETYDURINGTRANSITIONSOFCARE:CLINICALIMPLICATIONS:
KEYRESOURCES• 2.1TOOLSTOIDENTIFYKEYDISEASESTATES
– https://www.cms.gov/medicare/medicare-fee-for-service-payment/acuteinpatientpps/readmissions-reduction-program.html
• 2.2TOOLSTOIDENTIFYHIGHRISKMEDICATIONS– http://oig.hhs.gov/oei/reports/oei-06-11-00370.pdf– https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/QAPI/Adverse-Events-NHs.html– http://www.ihi.org/topics/highalertmedicationsafety/pages/default.aspx– http://www.ncqa.org/hedis-quality-measurement/hedis-measures/hedis-2017/hedis-2017-ndc-
license/hedis-2017-final-ndc-lists
• 2.3TOOLSTOIDENTIFYPOTENTIALLYINAPPROPRIATEMEDICATIONS– http://geriatricscareonline.org/toc/american-geriatrics-society-updated-beers-criteria-for-potentially-
inappropriate-medication-use-in-older-adults/CL001– http://www.choosingwisely.org/societies/american-geriatrics-society/
• 2.4TOOLSTOCLASSIFYMEDICATION-RELATEDPROBLEMS&MEDICATIONERRORS– http://www.nccmerp.org/types-medication-errors– http://www.ihconline.org/UserDocs/Pages/USC-Medication-Therapy-Intervention-and-Documentation-
Manual--Updated-4-6-2012.pdf
• 2.5TOOLSTOMANAGEMEDICATIONSSAFELY– Myriadofresourcesfor8keymedicationclasses/topics
• 2.6TOOLSTOIMPROVETRANSITIONSOFCAREPROCESSES– http://ntocc.org/WhoWeServe/HealthCareProfessionals.aspx– http://www.pathway-interact.com/interact-tools/– http://www.ncqualitycenter.org/wp-content/uploads/2013/01/MRToolkit.pdf– http://deprescribing.org/resources/
SECTION2:MEDICATIONSAFETYDURINGTRANSITIONSOFCARE:CLINICALIMPLICATIONS:
KEYRESOURCES
SELF-ASSESSMENTQUESTION#2:
• Whichofthefollowingmedicationsafetyprocessesmayimprovetransitionsofcare?
a) Medicationreconciliationflowsheetsb) Patient-friendlydischargemedicationlistc) Post-dischargefollow-upphonecallsd) Alloftheabove
Understandingtheroleofpayersandreimbursementintoday’senvironmentisa
challengeandonethatiscontinuallychanging.Offeringassistanceinnavigatingthroughthis
complexlandscapewillincreasethevalueyoubringtothetable.
SECTION3:PAYERSANDBILLING:OPPORTUNITIESWITHMANAGEDCAREANDOTHERENTITIES
Section3.1 MedicareAthroughDandCMSStarRatingsforPlans
Section3.2 UnderstandingLTPAC5StarRatingsandHowthePharmacistCanHelp
Section3.3 Payer-DrivenOpportunities
SECTION3:PAYERSANDBILLING:OPPORTUNITIESWITHMANAGEDCAREANDOTHERENTITIES
LTPAC=Long-TermPost-AcuteCare
SECTION3:PAYERSANDBILLING:OPPORTUNITIESWITHMANAGEDCAREANDOTHERENTITIES
3.1MEDICAREPARTSATHROUGHD&CMSSTARRATINGSFORPLANS• CMSStarRatings– MeasureQualityMetrics– Provideopportunityforpharmaciststoprovethevaluetheyaddtothecontinuumofcareforpayersandtheirenrolledmembers/patients
SECTION3:PAYERSANDBILLING:OPPORTUNITIESWITHMANAGEDCAREANDOTHERENTITIES
3.1MEDICAREPARTSATHROUGHD&CMSSTARRATINGSFORPLANS• Pharmacistparticipation:– Participatesasanemployeeofamanagedcareplan,pharmacybenefitmanager,longtermcarefacility,oremployerself-operatedhealthplan
–Mayalsoengageasanindependentcontractortotheseentitiesandprovideservices
• Interventionscapturedwithmeasurableoutcomesincludedinreimbursementformulatotheproviderentity
SECTION3:PAYERSANDBILLING:OPPORTUNITIESWITHMANAGEDCAREANDOTHERENTITIES
3.1MEDICAREPARTSATHROUGHD&CMSSTARRATINGSFORPLANS• Programstomeasurepharmacies’impactoncare:– ElectronicQualityImprovementPlatformforPlansandPharmacies(EQuIPP)– PharmacyQualitySolutions(PQS)EQuIPP program
• RatingsystemsforpharmaciestotracktheirperformanceandhowtheyareaffectingStarRatingsforplans– Neutralintermediary– Ensuresconsistencyacrossplans/PBMs– Providestransparency
PBMs=PharmacyBenefitsManagers
SECTION3:PAYERSANDBILLING:OPPORTUNITIESWITHMANAGEDCAREANDOTHERENTITIES
3.2UNDERSTANDINGLTPAC5STARRATINGSANDHOWTHEPHARMACISTCANHELP• OverallCMSStarRatingforLTCfacilities– Formula=StateSurveyResults+StaffingRating+QualityMeasureRatings
• ImportanceofFiveStarRatinginLTPACWorld– CMSBPCImodels– Healthcarepartnerships
LTC=LongTermCareBPCI=BundledPaymentforCareImprovement
SECTION3:PAYERSANDBILLING:OPPORTUNITIESWITHMANAGEDCAREANDOTHERENTITIES
3.2UNDERSTANDINGLTPAC5STARRATINGSANDHOWTHEPHARMACISTCANHELP:LongStayPatientsintheLTCFacility• AppropriateClinicalandMedicationManagementcanimprovequalitymeasuresintheseareas:– UTIs– Pain– Fallwithmajorinjury– Antipsychoticusewithoutdiagnosis– Newlyprescribedantipsychoticswithoutdiagnosis– Useofhypnotics/anxiolytics
UTIs=UrinaryTractInfections
SECTION3:PAYERSANDBILLING:OPPORTUNITIESWITHMANAGEDCAREANDOTHERENTITIES
3.2UNDERSTANDINGLTPAC5STARRATINGSANDHOWTHEPHARMACISTCANHELP:PostAcute- ShortStayPatientsintheLTCFacilities• Pharmacistinterventioncanimpactqualitymeasuresintheseareas:
NH=NursingHomeER=EmergencyRoom
Re-hospitalization %ofresidentswhowerere-hospitalizedafterNHadmission
ERUse %ofresidentswhohavehadanoutpatientemergencydepartmentvisit
DischargetoCommunity %ofresidentswhoweresuccessfullydischargedtocommunity
SECTION3:PAYERSANDBILLING:OPPORTUNITIESWITHMANAGEDCAREANDOTHERENTITIES
3.3PAYER-DRIVENOPPORTUNITIES• MedicationTherapyManagement(MTM)• “Incident-To”Billing– TransitionalCareManagement(TCM)–AnnualWellnessVisits(AWV)–ChronicCareManagement(CCM)
SECTION3:PAYERSANDBILLING:OPPORTUNITIESWITHMANAGEDCAREANDOTHERENTITIES
3.3PAYER-DRIVENOPPORTUNITIES• MedicationTherapyManagement(MTM)&PartD– AllPartDPlansponsorsmustincorporateanMTMProgramintothebenefitstructuretoensureoptimalmedicationoutcomes
– Pharmacistsperformmedicationreviewsforinsuredhigh-riskpatientswithchronicillnesstopromotetherapycomplianceandahealthylifestyletoremainhospital-free
• ExamplesofcompaniesadministeringMTMprograms:• http://mirixa.com/• http://www.outcomesmtm.com/
SECTION3:PAYERSANDBILLING:OPPORTUNITIESWITHMANAGEDCAREANDOTHERENTITIES
3.3PAYER-DRIVENOPPORTUNITIES• “Incident-To”Billing– Servicesmustbeanintegralpartofthepatient’snormalcourseoftreatment– Practitionermustperforminitialserviceandremainactivelyinvolvedinthecourseoftreatment
– Practitionermustprovidedirectorgeneralsupervision– Paymentforpharmacist’sservicesarenegotiatedwithprovider/facilityinadvance
SECTION3:PAYERSANDBILLING:OPPORTUNITIESWITHMANAGEDCAREANDOTHERENTITIES
3.3PAYER-DRIVENOPPORTUNITIES• TransitionalCareManagement(TCM)– Pharmacistasamemberofthemedicalteamprovidessafetransitionsinthehealthcarecontinuum
– Requirements:• Interactivecontactwithin2daysofdischarge• Nonface-to-faceservicesundergeneralsupervision• Face-to-facevisitbyprovider
– Anall-inclusiveservicebilledtoMedicarebythemedicalprovider.Thepharmacistisprovidingan“incident-to”serviceandcannotbilldirectly.
SECTION3:PAYERSANDBILLING:OPPORTUNITIESWITHMANAGEDCAREANDOTHERENTITIES
3.3PAYER-DRIVENOPPORTUNITIES• AnnualWellnessVisits(AWV)– IncludesaHealthRiskAssessmentofthepatient– BillPartBincident-tosupervisingpractitionerusingcodeG0438(initialvisit)orG0439(subsequentvisit)
– Requiresdirectsupervisionbypractitioner
SECTION3:PAYERSANDBILLING:OPPORTUNITIESWITHMANAGEDCAREANDOTHERENTITIES
3.3PAYER-DRIVENOPPORTUNITIES• ChronicCareManagement(CCM)– Primarycareserviceforbeneficiarieswithmultiplechronicconditionsexpectedtolastgreaterthan12monthsthatplacethepatientatriskofdeathorsignificantdecline
– EstablishmentofacomprehensivecareplanusingcertifiedEHR– Incident-tobilling(CPTcodes99490,99487,99489)
EHR=ElectronicHealthRecordCPT=CurrentProceduralTerminology
SECTION3:PAYERSANDBILLING:KEYRESOURCES
• 3.1MEDICAREPARTSAthroughD&CMSSTARRATINGSFORPLANS– http://www.medicareinteractive.org/get-answers/overview-of-medicare-health-coverage-options/changing-
medicare-health-coverage/the-five-star-rating-system-and-medicare-plan-enrollment– https://www.equipp.org/
• 3.2UNDERSTANDINGLTPAC5STARRATINGSANDHOWTHEPHARMACISTCANHELP– http://www.cms.gov/Medicare/Provider-Enrollment-and-
Certification/CertificationandComplianc/FSQRS.html– https://innovation.cms.gov/initiatives/bundled-payments/
SECTION3:PAYERSANDBILLING:KEYRESOURCES
• 3.3PAYER-DRIVENOPPORTUNITIESMEDICATIONTHERAPYMANAGEMENT– https://www.cms.gov/medicare/prescription-drug-coverage/prescriptiondrugcovcontra/mtm.htmlTRANSITIONALCAREMANAGEMENT– https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/MLN-
Publications-Items/ICN908628.htmlINCIDENT-TOBILLING– https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-
MLN/MLNMattersArticles/downloads/se0441.pdfCHRONICCAREMANAGEMENT– https://www.cms.gov/Outreach-and-Education/Outreach/NPC/National-Provider-Calls-and-Events-
Items/2015-02-18-Chronic-Care-Management-new.htmlANNUALWELLNESSVISITS– https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-
MLN/MLNProducts/downloads/AWV_chart_ICN905706.pdf
SECTION4:TECHNOLOGY:EMPOWERINGBESTPRACTICETHROUGHACQUISITION,HARMONIZATIONANDINTEROPERABILITYOFDATA
4.1ELECTRONICHEALTHRECORDS12
“Anelectronichealthrecord(EHR)isadigitalversionofapatient’spaperchart.EHRsarereal-time,patientcentered
recordsthatmakeinformationavailableinstantlyandsecurelytoauthorizedusers.”
SECTION4:TECHNOLOGY:EMPOWERINGBESTPRACTICETHROUGHACQUISITION,HARMONIZATIONANDINTEROPERABILITYOFDATA
4.1ELECTRONICHEALTHRECORDS12
• WhatarethebenefitsofEHRs?– Improvedpatientcare– Improvedcarecoordination– Practiceefficienciesandcostsavings– Increasepatientparticipation– Improveddiagnosticsandpatientoutcomes
SECTION4:TECHNOLOGY:EMPOWERINGBESTPRACTICETHROUGHACQUISITION,HARMONIZATIONANDINTEROPERABILITYOFDATA
4.1ELECTRONICHEALTHRECORDS- SNOMEDCTCODES13
• SystematizedNomenclatureofMedicine– ClinicalTerminology• LanguagethatallEHRswillusetocommunicate• MorespecificandcomplexthanICD-10codes,butcanbemappedtosuchcodingschemes
• Awaytojustifythevalueofourservicesbyassociatingstandardlycodeddocumentationforpharmacistcontributionswithpatientoutcomes
ICD=InternationalClassesofDiseases
SECTION4:TECHNOLOGY:EMPOWERINGBESTPRACTICETHROUGHACQUISITION,HARMONIZATIONANDINTEROPERABILITYOFDATA
4.1ELECTRONICHEALTHRECORDS- SNOMEDCTCODES13• Individualpatientutility:accessibilityofclinicalinformationacrossEHRsystems– Enablecommunicationofpatients’medication-relatedproblemsandmedicationhistorywithothercareteammembersacrosspracticesettings
• Populationhealthutility:allowsforlargescaleoutcomesresearch,evaluationofquality&costofcare,anddevelopmentoftreatmentguidelinesthroughretrievability ofdata
• CMSrequiringplansofferingEnhancedMTMmodeltoreportinSNOMEDcode• PQAadoptingSNOMEDcodingforreportingofnewqualitymeasures
SECTION4:TECHNOLOGY:EMPOWERINGBESTPRACTICETHROUGHACQUISITION,HARMONIZATIONANDINTEROPERABILITYOFDATA
4.1ELECTRONICHEALTHRECORDS12
• WHERECANIGOFORMOREINFORMATION?– BenefitsofEHRs– HowtoImplementEHRs–Whataretheadvantagesofelectronichealthrecords(EHR)?–WhatinformationdoesanEHRcontain?– EMRvsEHR– WhatistheDifference?
SECTION4:TECHNOLOGY:EMPOWERINGBESTPRACTICETHROUGHACQUISITION,HARMONIZATIONANDINTEROPERABILITYOFDATA
4.2HEALTHINFORMATIONEXCHANGES(HIEs)14
“Electronichealthinformationexchange(HIE)allowsdoctors,nurses,pharmacists,otherhealthcareprovidersandpatientstoappropriately
accessandsecurelyshareapatient’svitalmedicalinformationelectronically—improvingthespeed,quality,safetyandcostofpatient
care.Thevalueofelectronicallyexchanginginformationisthestandardizationofdata.Oncestandardized,thedatatransferredcan
seamlesslyintegrateintotherecipients'ElectronicHealthRecord(EHR),furtherimprovingpatientcare.”
SECTION4:TECHNOLOGY:EMPOWERINGBESTPRACTICETHROUGHACQUISITION,HARMONIZATIONANDINTEROPERABILITYOFDATA
4.2HEALTHINFORMATIONEXCHANGES(HIEs)14
• Therearecurrentlythreekeyforms:
DirectedExchange Abilitytosendandreceivesecureinformationelectronicallybetweencareproviderstosupportcoordinatedcare
Query-basedExchange
Abilityforproviderstofindand/orrequestinformationonapatientfromotherproviders,oftenusedforunplannedcare
ConsumerMediatedExchange
Abilityforpatientstoaggregateandcontroltheuseoftheirhealthinformationamongproviders
SECTION4:TECHNOLOGY:EMPOWERINGBESTPRACTICETHROUGHACQUISITION,HARMONIZATIONANDINTEROPERABILITYOFDATA
4.2HEALTHINFORMATIONEXCHANGES(HIEs)14WHATARETHEBENEFITSOFHIEs?• Improvequality&safetyofpatientcarebyreducingmedication/medicalerrors• Stimulatepatients'involvementintheirownhealthcare• Increaseefficiencybyeliminatingunnecessarypaperwork• Providecaregiverswithclinicaldecisionsupporttools• Efficientdeploymentofemergingtechnologyandhealthcareservices• TechnicalinfrastructureforleveragebynationalandState-levelinitiatives• ProvideabasiclevelofinteroperabilityamongEHRs• Reducehealthrelatedcosts
SECTION4:TECHNOLOGY:EMPOWERINGBESTPRACTICETHROUGHACQUISITION,HARMONIZATIONANDINTEROPERABILITYOFDATA
4.3MEDICATIONMANAGEMENTDOCUMENTATIONSYSTEMCOMPANIES
ActualMedsCorporation
Agadia Systems,Inc. Aprexis HealthSolutions,Inc
CeutiCare ClinicalSupportServices,Inc
MedicationManagementSystems
PerformRx PharmMD Mirixa Corporation
OutcomesMTM RamsellCorporation SinfoniaRx
SECTION4:TECHNOLOGY:EMPOWERINGBESTPRACTICETHROUGHACQUISITION,HARMONIZATIONANDINTEROPERABILITYOFDATA:
KEYRESOURCES
4.4HEALTHCAREINFORMATIONTECHNOLOGY– TheAmericanHealthInformationManagementAssociation(AHIMA):www.ahima.org
– TheAmericanSocietyOfConsultantPharmacistse-HIT:www.ascp.com/healthinfotech
– HEATHIT.GOV:www.healthit.gov
– TheHealthInformationAndManagementSystemsSociety(HIMSS):www.himss.org
– ThePharmacyHITCollaborative:www.pharmacyhit.org
SELF-ASSESSMENTQUESTION#3:
• Youarecuriousaboutthedifferenttypesofhealthinformationexchanges.WhatsectionoftheMSTOCtoolkitholdsthisinformation?
a) Section1:TheTransitionsofCareLandscapeb) Section2: MedicationSafetyduringTransitionsofCare:Clinical
Implicationsc) Section3: PayersandBilling:OpportunitieswithManagedCare
andOtherEntitiesd) Section4: Technology:EmpoweringBestPracticeThrough
Acquisition,HarmonizationandInteroperabilityofData
SELF-ASSESSMENTQUESTION#4:
• Youareconsideringanopportunitywithaphysician’spracticeasa“medicationspecialist”.Whatsectionwouldyouaccesstofindinformationabout“incident-to”billing?
a) Section1:TheTransitionsofCareLandscapeb) Section2: MedicationSafetyduringTransitionsofCare:Clinical
Implicationsc) Section3: PayersandBilling:OpportunitieswithManagedCare
andOtherEntitiesd) Section4: Technology:EmpoweringBestPracticeThrough
Acquisition,HarmonizationandInteroperabilityofData
ASCP.com/MSTOC
ASCP.com/MSTOC
“RealWorldApplicationoftheMedicationSafetyDuringTransitionsofCareToolkit– Parts1and2” willbepresentedatASCP’s2017AnnualMeetingandExhibition.ThesessionswillprovideabriefoverviewofthepurposeandcomponentsoftheMSTOCToolkitandutilizeaseriesofcasestudiesfollowingasinglepatienttransitioningthroughmultiplecaresettingstodemonstratetheclinicalandpracticalvalueofthetoolkit.
Registernowatwww.ascp.com/annual2017
REFERENCES1. JointCommissionCenterforTransformingHealthcareReleasesTargetSolutionsToolforHand-OffCommunications.Joint
CommissionPerspectives.Availableat https://www.jointcommission.org/assets/1/6/tst_hoc_persp_08_12.pdf .AccessedAugust31,2017.
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3. ImprovingCareTransitionsinNursingHomes.JournalofAmericanSocietyonAging.Availableathttp://www.asaging.org/blog/improving-care-transitions-nursing-homes.AccessedApril23,2017.
4. HostetterM,KleinS.AvoidingPreventableHospitalReadmissionsbyFillinginGapsinCare:TheCommunity-BasedCareTransitionsProgram.QualityMatters.August/September2012Issue.Availableat:http://www.commonwealthfund.org/publications/newsletters/quality-matters/2012/august-sept/in-focus.AccessedJuly21,2017.
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6. GleasonKM,McDanielMR,Feinglass J,etal.ResultsoftheMedicationsatTransitionsandClinicalHandoffs(MATCH)study:ananalysisofmedicationreconciliationerrorsandriskfactorsathospitaladmission.JGenInternMed.2010;25:441-7.
7. Garcia-Caballos M,Ramos-DiazF,Jimenez-Moleon JJ,etal.Drug-relatedproblemsinolderpeopleafterhospitaldischargeandinterventionstoreducethem.AgeandAgeing 2010;39:430-8.
8. Theimportanceofmedicationreconciliationforpatientsandpractitioners.AustralianPrescriber.Availableathttps://www.nps.org.au/australian-prescriber/articles/the-importance-of-medication-reconciliation-for-patients-and-practitioners.AccessedAugust20,2017.
REFERENCESCONTINUED…
9.NationalTransitionsofCareCoalition(NTOCC)RecommendationsforImprovingTransitionsofCare.http://www.usahealthsystem.com/workfiles/com_docs/gme/2011%20Links/GME-Today-Transitions-of-Care.pdf.AccessedApril23,2017.
10.Surbhi S,Munshi KD,BellPC,etal.Drugtherapyproblemsandmedicationdiscrepanciesduringcaretransitionsinsuper-utilizers.JAmPharmAssoc.2003;56:633-42
11.ASHP-APHAMedicationManagementinCaretransitionsBestPractices.AmericanSocietyofHealthSystemsPharmacistsandAmericanPharmacistAssociation.Availableat:http://media.pharmacist.com/practice/ASHP_APhA_MedicationManagementinCareTransitionsBestPracticesReport2_2013.pdfAccessedSeptember29,2017
12.Whatisinanelectronichealthrecord?.Availableathttps://www.healthit.gov/providers-professionals/faqs/what-electronic-health-record-ehr.AccessedAugust202017.
13.PharmacyHITCollaborative.MedicationTherapyManagementClinicalDocumentation:UsingaStructuredCodingSystem-SNOMEDCT.Availableathttp://www.pharmacyhit.org/pdfs/workshop-documents/WG2-Post-2014-02.pdf.AccessedAugust20,2017.
14.HealthcareInformationandManagementSystemsSociety(HIMSS).“EvaluatingaPotentialHIEOpportunity WebSiteDisclaimers”,HIMSSGuidetoParticipatinginHIE.2009November.