PSHP Annual Assembly 2015PSHP Annual Assembly 2015
Importance of Measuring Pharmacy Department Data: How to
Enhance Productivity Through a Scorecard
Jill Rebuck, Pharm.D., MBA, BCPS, FCCM, FCCP
Director of Clinical Pharmacy Services
Penn State Milton S. Hershey Medical Center
Objectives
Discuss at least 3 examples of meaningful clinical & operational metrics for a health-system pharmacy department
Driving Forces for Change
Pharmacy
Practice change
Quality payments
Complex drug therapies
Technology advances
Care Transitions
Greater pharmacist
accountability
Provider movement
AJHP 2009;66:713
Why Measure Performance? Shift from volume to value-based care
Accountable Care Act Value based purchasing Meaningful use
PPMI leaders believe: Lack of pharmacy resources is barrier to
optimal practice models (83%) Stakeholders have “insufficient recognition”
of pharmacy’s value (73%)
PPMI Summit 2010; Accessed via ashp.org
Pharmacy Department Realities
Limited pharmacy staff
Tighter budgets
Rising drug expenses
Expectation to provide highest quality pharmacy services while decreasing total cost of care
Greater accountability to defined patient outcomes
“If you can’t measure it, you can’t improve it”
- Peter Drucker
Advantages of Pharmacy Scorecard
If adequately constructed & updated frequently: Represent broad view of performance Guide for strategic decision making Improve quality of pharmacy services
Demonstrate impact of pharmacy on organizational alignment
Enwere EN, et al. Hosp Pharm 2014;49:579-84
Department Alignment
Mission
Vision
Values
Strategic Goals
Initiatives
Department Performance Metrics
Adapted by Enwere EN, et al. Hosp Pharm 2014;49:579-84
Scorecard Considerations
Tactical indicators of performance metrics based on specific goals
Trend data over time (vs. dashboards) Monthly or quarterly & YTD
Push vs. pull data considerations Need to be easily monitored
Resource allocation for data collection
Establishing Performance Targets
Obtain institution-specific baseline data Incorporate external benchmarks
Enhance validity & credibility Determine frequency of updating info
Monthly, quarterly, annually Visualization of progress
Evaluate metrics annually
Controversy: Scorecard Content
Pharmacy-centric metricsvs.
Organizational wide metrics
Examples: % Med Rec Completed or 30-day Readmission % Patients receiving anticoagulation or % DVT/PE % Patients with pain scores < 5 or % Top Box
HCAHPS pain control
Examples of Med-Related Outcomes
Metric ( ↑ = Higher numbers are better ↓ = Lower numbers are better) FY15 Baseline
Goal July Aug Sept
MEDICATION-RELATED PATIENT OUTCOMES
Number of Rx Interventions per 100 Discharges ↑ 800 900 815 830 910
Weighted Rx Inteventions per 100 Discharges ↑ 2,000 2,700 2,100 2,800 2,900
Percentage of High Risk Patients Receiving Medication Counseling ↑ 20.0% 70% 35.0% 50.0% 60.0%
Number of Reported Serious Medication Events per Month ↓ 0.9 0 0 0 0
H-CAHPS Communication About Medicines (% Always) ↑ 65.0% 68.0% 64.0% 66.0% 69.0%
% Rx Referred Ambulatory Patients with HTN Controlled ↑ 50% 60% 55% 58% 62%
Numbers above represent fictitious data for illustrative purposes only
Examples: Pharmacy Operations
Further consideration on order verification turn-around-time
Pharmacy Operations
Weighted Drug Orders Processed per Pharmacist FTE ↑
Weighted Orders Dispensed per Technician FTE ↑
Retail Pharmacy: Prescriptions Dispensed per Pharmacist FTE ↑
Code S TPA Preparation Time in Minutes (Prep and Delivery) ↓
% Medications Dispensed as Overrides ↓
% Medications Redispensed ↓
IV Admixture Service Environmental Index (% WNL) ↑
Further consideration of order verification turn-around-time
Examples: Pharmacy Operations
Further consideration on order verification turn-around-time
Pharmacy Operations
Weighted Drug Orders Processed per Pharmacist FTE ↑
Weighted Orders Dispensed per Technician FTE ↑
Retail Pharmacy: Prescriptions Dispensed per Pharmacist FTE ↑
Code S TPA Preparation Time in Minutes (Prep and Delivery) ↓
% Medications Dispensed as Overrides ↓
% Medications Redispensed ↓
IV Admixture Service Environmental Index (% WNL) ↑
Further consideration of order verification turn-around-time
Examples: Financial & Growth
Further consideration on order verification turn-around-time
Pharmacy Financial Optimization
Inpatient Drug Expense per Discharge ↓
Inventory Turns ↑
% Overtime ↓Pharmacy Growth
% Increase in Employee Prescriptions at Retail Pharmacy ↑% Increase in Discharge Prescriptions at Retail Pharmacy ↑
Number of Rx-Generated Patient Ambulatory Encounters per Month ↑
Number of Rx Collaborative Drug Therapy Management Protocols ↑
Examples: Employee Talent
Employee Talent
% Pharmacists with Certification/Advanced Training ↑% Pharmacy Technicians with Certification ↑
Number of Pharmacy Educational Offerings ↑% of Pharmacists Serving as Preceptors ↑
Productivity Monitoring Indicators
Worked hours per unit of service Drug (or labor) cost per admission Labor expense per 1,000 doses billed RPh worked hours per order Tech worked hours per dose Clinical interventions per RPh shift RPh:Technician skill mix ratio Rx cost as % of total hospital cost
Adapted from Rough SS, et al. AJHP 2010;67:380-8.
Pharmacy Intensity Score
Resource-based relative value intensity grouping system
Uses pharmaceutical resource consumption data Produce DRG-specific drug use weights
Generally preferred over CMI Example: hip replacement vs. kidney
transplant
Rough SS, et al. AJHP 2010;67:300-11.
Scorecards: Summary
Important to promote and justify patient-centered pharmacy services
Update & share regularly with pharmacy employees and stakeholders
Influence ‘right size’ of department
Questions
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