America Health System
Business Plan: Ambulatory Heart Failure Clinic
2010 Highway 78
Middleton, NC 55555
Phone (555-555-5555)
E-mail: Eplin@AHS.com
Proposed on March 1, XXXX
By
Kelly Epplen, FASHP
Director of Pharmacy Services
Ambulatory Heart Failure Clinic
Table of Contents
Page
Executive Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ….
3
Description of the Ambulatory Heart Failure Clinic …….……………………. 5
Consistency with American Health System Mission . . . . . . . . . . . . . . . . . . . . . 9
Market Analysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
Marketing Plan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
Facility and Equipment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
Management and Organization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
Financial Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
Evaluation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ……………………………. 29
Figure 1. Organizational Structure……………………………………………… 32
Figure 2. Floor Plan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ………….. 32
Appendix A. Equipment and Fixtures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .33
Appendix B. Staffing Plan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .33
Appendix C. Start Up Expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
Appendix D. Three Year Proforma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .34
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Ambulatory Heart Failure Clinic
Executive Summary
Purpose of the business plan
This business plan was created to secure commitment and funding to open a pharmacist run ambulatory
heart failure clinic as part of a multidisciplinary team care in the America Health Medical Center North
Building to serve our growing population of patients with heart failure.
Background
The clinic will be located on the first floor of the Medical Center North clinic located in Middleton. It will
be positioned within the Medical Center North multidisciplinary clinics for easy recognition and patient
accessibility. Clinical pharmacy staff with advance training, including the management of heart failure, will
provide medication management services to patients referred by their American Health primary care
physician or cardiologist. Internal and external referrals will be accepted. An ambulatory heart failure clinic
located in this Medical Center will augment the organization’s goal of providing optimal medical care,
increasing accessibility, providing medication expertise, and promoting enhanced patient outcomes.
Achieving these goals supports the organization’s Excellence pillar goals.
The Market
Market analysis has demonstrated a need to increase the capacity for heart failure management and services
in the north region served by America Health. There currently are no other clinics in the area providing
pharmacist-based ambulatory patient care services which we propose. The ambulatory heart failure clinic
will offer cutting edge and differentiated services that satisfy patient needs and improve patient outcomes.
Organization
The Medical Center North Ambulatory Heart Failure Clinic pharmacist will report to the manager of
ambulatory pharmacy services and the medical director for cardiology. The manager of ambulatory
pharmacy services is responsible for all of the organization’s ambulatory pharmacy operations, and the
medical director is integral in the clinical management of the heart failure patients.
Finances
The major expense to establish the clinic includes hiring an appropriately trained clinical pharmacist. A
conservative estimate of the return on this investment would be an annual profit of approximately $40,000.
Conclusion
The addition of an ambulatory heart failure clinic at the Medical Center North will augment current
provider cardiovascular services, improve access to medication management services, and promote optimal
drug therapy for America Health patients.
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Ambulatory Heart Failure Clinic
Business Plan
DESCRIPTION OF SERVICE
The demand for expanded ambulatory services and the provision of care through a primary provider is
prevalent in today’s health care environment. As the level of care provided on an outpatient basis increases,
so must efficient resources available to patients to ensure optimal outcomes. A multidisciplinary approach
to patient care in the ambulatory setting often proves to be beneficial to patients in obtaining therapeutic
goals. Integrated care, coordinated among physicians, pharmacists, nurses, and other health professionals,
is essential to achieving medication therapy outcomes that improve patient quality of life. The addition of
clinical pharmacy patient care services to health care teams greatly improves adherence to therapy,
improves transitions of care, decreases preventable adverse effects and interactions, and decreases
polypharmacy and related hospitalizations or re-hospitalizations.1,2,3
Benefits resulting from the addition of clinical pharmacy services in the ambulatory care setting in
therapeutic areas such as anticoagulation, heart failure, lipids, diabetes, asthma, and vaccination are evident
in the literature.3 However, the development and implementation of ambulatory clinical services is also met
with common barriers including the absence of clear-cut billing mechanisms and processes for
reimbursement, administration unfamiliarity with clinical pharmacy services, staff shortages, and other
providers’ resistance.
The problem of hospital readmissions is currently a focus for all health systems. Patients who return to the
hospital within 30 days after re-admission are at risk for poorer outcomes and are responsible for a
significant amount of preventable costs to the health system. American Health System is not immune to this
problem with hospital readmissions running at 22%. The top two conditions at American Health System for
hospital re-admissions are those related to heart failure and COPD. Poor use of medications has been
identified as a significant reason leading to four patients readmitted to the hospital.
Medical Center North is a new facility located on Highway 78 just off I-72 that provides the community
convenient local access to America Health’s comprehensive medical expertise and vast health care
resources. The Medical Center North Ambulatory Heart Failure Clinic will be located on the first floor of
the Medical Center North facility. The clinic will provide clinical pharmacy services for ambulatory
patients seen by the cardiology practice and whose primary care physicians have admitting privileges to the
medical center. Anticipated start date for the Clinic will be January 20XX. Establishing a heart failure
clinic in the Medical Center North will provide America Health’s heart failure patients—a population
highly susceptible to poor medication adherence, medication-related problems, and re-hospitalization—
convenient access to clinical pharmacy services. The Ambulatory Heart Failure Clinic will provide services
consistent with accepted medication therapy management programs that have been shown to decrease
hospitalizations and improve care, including:
1.
2.
3.
4.
5.
A comprehensive medication therapy review and reconciliation post hospital discharge and with
each clinic visit;
Assistance with medication access issues;
Monitoring, detecting, and resolving medication-related problems such as adherence, adverse
medication effects, and improper utilization;
Creation and maintenance of an up-to-date personal medication record;
Patient education in self-management, including a medication-related action plan and (as needed
regarding their heart failure) other disease states and related life style issues;
4
6.
7.
Interventions as needed (dose titration, recommendations to prescriber, referral to other members
of a multidisciplinary team, consistency with heart failure evidence-based and institutional
guidelines); and
Documentation and follow up with all health providers (physicians, pharmacies, etc.) to ensure
continuity of care regarding medications and therapy plans.
The heart failure clinic will be staffed by 1.5 FTE ambulatory clinical pharmacists. The pharmacists will be
a midlevel provider and work under the supervision of the cardiologists in the clinic and alongside other
mid-level providers, including the heart failure nurse practitioner. The pharmacists will utilize incident-to
physician services as the billing mechanism to start the clinic. With the changing landscape of billing
towards pay for performance and attainment of quality measures, the financial value of this service is
expected to grow. Medical Center North currently services 1,930 patients with the diagnosis of heart
failure. The number of patients in the Heart Failure Clinic is expected to increase over the next 5 years
based on the aging population within the community served. It is possible that the demand for services may
require additional pharmacist time, at which time additional pharmacist FTEs to this facility will be
considered. Referral volumes will be assessed quarterly to determine if additional resources are required.
The Medical Center North Ambulatory Heart Failure Clinic not only will be the first in the area to utilize
clinical pharmacist services as a member of the care team, it will differentiate itself from other area clinics
with the establishment of a convenient location where America Health patients can easily utilize the
available services. It will also establish access to America Health’s electronic documentation systems,
which will improve continuity of care and efficiency by providing the pharmacists with complete patient
information from their medical record. Currently clinics in the area do not offer pharmacist patient care
services and reimbursement of medication therapy management services for Medicare patients. With the
anticipated success of the Ambulatory Heart Failure Clinic, ambulatory patient care pharmacy services can
be extended to more disease states or patient populations in collaboration with America Health physicians.
Finally pharmacy at American Health System is considered to be a leader in the profession with innovative,
progressive, and quality services that have proven to be a value to the organization. This program aligns
well with the Pharmacy Practice Model Initiative and national initiative for advancement of pharmacy
services and optimal use of pharmacist knowledge and skills. This will be the first program in the
ambulatory setting, and it will follow the same goal-oriented approach of other pharmacy-based initiatives.
We will benchmark our services based on other similar ambulatory clinics by comparing our clinic to
similar University Health System Consortium member outpatient services to ensure that we are optimizing
patient care while maximizing profits.
CONSISTENCY WITH THE ORGANIZATION’S MISSION
Ambulatory Heart Failure Clinic Mission Statement
It is the mission of the Ambulatory Heart Failure Clinic to promote seamless, quality care to heart failure
patients across the continuum of our health system and to ensure optimal drug therapy as recommended by
existing standards of care with the primary objective of improving patient outcomes and quality of life.
Consistency with America Health System Mission
The clinic’s mission aligns well with that of the Pharmacy department and that of the health system. The
Mission Statement of the Department of Pharmacy Services is to work collaboratively with other health
care professionals to provide optimal medication-related care to all patients, to advance medication
knowledge through educational and scholarly activities, and to promote positive patient outcomes.
American Health System has as its mission to serve the community by responding to their health care needs
with excellent and efficient care, with empathy, and with the patient always at the center of care.
5
As part of the clinical services provided by America Health System, the Medical Center North Ambulatory
Heart Failure Clinic will provide optimal medication therapy management by providing advanced
medication knowledge and care coordination to patient seen in the clinic. Pharmacists will provide patient
education and accurate, timely drug information to medical center physicians and staff to promote
enhanced patient outcomes.
In promoting America Health System Excellence, the Medical Center North Ambulatory Heart Failure
Clinic will enhance the pharmacy, clinic, and health system goals of service, quality, finance, people, and
growth. The Medical Center North Heart Failure Clinic will enhance service by increasing access to care by
seeing patients within 72 hours post discharge at a convenient location for patients to receive pharmacist
patient care. It will enhance quality by assuring evidence-based care and adherence to current heart failure
guidelines, using the existing EMR for continuity of care, and providing education and patient self
monitoring plans to ensure that patients properly use their medications It will enhance finance by increasing
pharmacy- generated revenue, reducing re-admissions and attainment of performance measures and goals.
It will enhance people by helping to develop a team-based approach to care of talented and intelligent
providers based on patient-centered principles. It will enhance growth by being the first to offer pharmacy
services in the area and expanding to a new location in the Middleton area.
The objectives of the Medical Center North Heart Failure Clinic are:
1.
2.
3.
4.
5.
6.
7.
8.
9.
To provide optimal drug therapy and related outcomes to American Health heart failure patients;
To increase patient understanding of heart failure and respective therapy;
To decrease the incidence of preventable adverse effects;
To improve patient adherence through individualized patient interactions;
To increase efficiency of physician’s office time (more time to devote to non-pharmaceutical
aspects of patient care);
To promote cost-effective utilization of heart failure and other medications;
To improve patient quality of life;
To decrease 30-day readmission rate and hospitalizations/ED visits related to CHF exacerbation;
and
To improve adherence to ACC/AHA treatment guidelines and JCAHO core measures.
A positive ROI is expected for the clinic. The costs of providing care will be offset by the reduction in
hospitalizations and improved outcomes for heart failure patients. This will position American Health
System well for the new reimbursement models associated with health care reform.
MARKET ANALYSIS
I.
Identification of the market for heart failure patients.
Heart failure is a complex clinical syndrome predominantly manifested by fatigue, dyspnea, and fluid
retention leading to pulmonary and peripheral edema. It is a progressive disorder with no cure. An
estimated 5 million people are affected in the United States (1.5−2% of the population), with 400,000 to
700,000 new cases diagnosed each year. Six to ten percent of the population greater than 65 years of age
has heart failure.
6
As the leading national cause of hospitalizations (6.5 million hospital days), the annual direct expenditures
total $40 billion, accounting for 5.4% of the health care budget. The risk of death is 5−10% annually in
patients with mild symptoms; this increases to 30−40% annually in patients with advanced disease.
Patients with heart failure are at risk for poor medication-related outcomes. Approximately 500 million
dollars are spent annually on heart failure medications alone. Patients often require multiple medications to
optimize treatment outcomes and require frequent dose adjustments to achieve therapeutic goals while
minimizing adverse side effects associated with therapy. In addition, diligent laboratory monitoring is
required with complicated medication regimens. Pharmacists are recognized as drug therapy experts who
can significantly impact patient outcomes by addressing these medication management needs
As stated, Medical Center North currently has 1,930 patients with the diagnosis of heart failure in the
population of patients seen over the past year. Middleton as a community is aging based on the most recent
U.S. census data. Trends seen in Medical Center North heart failure patients mimic the clinical, financial,
and health outcome trends as those described on a national level. American Health can expect growth in
patient visits for this condition and the associated costs both in the short and long term.
On external analysis the current population of the Middleton area, based on the 2010 census, is 145,000
with 50,000 patients over the age of 65 years.4 Estimates on the prevalence of heart failure would suggest
that over 5,000 patients in our service area may have heart failure. With the aging population, we can
expect approximately 250 patients yearly to have a new diagnosis of heart failure. Our target markets are
America Health System patients seen by the cardiology practice based at the medical center, or those whose
primary care physicians have admitting privileges at the medical center. With significant growth occurring
in Middleton in the North area, this area possesses the ability to have a large demand for services. As of
2010, the Middleton population accounted for about 39% of the total Middleton County population.
Middleton experienced the second largest growth in the county with a rate of 12% between 2009 and 2010,
second only behind the city of Grayville. In addition to the Middleton population, the Medical Center North
Ambulatory Heart Failure Clinic will also serve patients traveling from outside areas including Smithville,
Summerton, and Dexter. A heart failure clinic serving current and anticipated heart failure patients visiting
the Medical Center North will be beneficial because they will not have to travel to the main America
Health campus to obtain needed services. American Health will need to be prepared to manage this growth
in patients in order to assure positive health and financial outcomes utilizing efficient models. This plan
offers one such model.
For internal analysis a retrospective, single-center, non-randomized study was performed to assess
adherence to ACC/AHA guidelines and JCAHO core measures within our health system. This study
revealed suboptimal adherence to recommended treatment guidelines and identified the need for expanded
services for CHF patients. It highlighted the need for enhanced discharge counseling and transitional care
for our heart failure patients to decrease readmission for heart failure exacerbation (see Table 1). The
results of the study reinforced the need for optimal dose titration of medications recommended by the
guidelines and indicated specific points across the care continuum that would benefit from pharmacy
services. No other area hospitals offer ambulatory clinical pharmacy services for patients with heart failure.
II.
Identification of Customers and Customer Needs:
7
a.
Heart Failure Patients: Heart failure patients are a vulnerable population to
misunderstanding of their medications, confusion over self-management, and frequent
Table 1: Heart Failure Core Process Performance
Quarterly Percent Compliance Snapshot for Q2 2009
100%
80%
60%
40%
20%
0%
HF1 - All
Discharge
Instructions
b.
c.
d.
e.
HF2 - LVF
Assessment
HF3 - ACEI for
LVSD
HF4 - Adult
smoking cessation
advice/counseling
health deterioration resulting in frequent hospitalizations. This patient population benefits
from comprehensive, frequent team-based care. An Ambulatory Heart Failure Clinic with
a pharmacist as a crucial member of the team is not offered by any other community
hospital setting in the area.
Physicians: Medical North has a group of excellent cardiologists all trained at centers
known for excellence in cardiology. Based on our internal analysis, the physicians are
struggling to meet certain quality measures. Analysis of the data points to process issues
of time, patient load, overworked staff, poor coordination, and communication. An
Ambulatory Heart Failure Clinic and addition of a pharmacist to the team to focus on the
heart failure patient care described would allow physicians to make more efficient use of
their office time and facilitate adherence to evidence-based guidelines.
Pharmacy Department: An Ambulatory CHF Clinic would promote clinical pharmacy
services in the ambulatory setting and expand the pharmacist’s role and presence across
the health system.
Nursing: An Ambulatory CHF Clinic would utilize and promote a multidisciplinary
approach to patient care. In addition, pharmacists would facilitate coordination of care in
efforts to improve adherence to core measures. Pharmacists would effectively help to
maximize efficient use of nursing personnel time during the discharge process and ensure
patients receive optimal drug therapy and education.
Administrators: An Ambulatory CHF Clinic could decrease inappropriate resource
utilization across the health system, ensure an acceptable 30-day readmission rate for
CHF exacerbation, and increase adherence to JCAHO core measures.
The following SWOT (strength, weakness, opportunities, and threats) analysis expands upon our rationale
for proposing this service.
Identified Strengths:
 Qualified pharmacists on staff, residency and certificate trained with a nationally recognized
program;
 Existence of well accepted evidence-based care and clinical practice guidelines for heart
failure;
 Support of initiative from physicians and other health care providers on staff;
 Improved outcomes established with multidisciplinary approach;
8



Support of pharmacy administration;
Established need in the community; and
Medicare priority to reduce heart failure re-admissions.
Identified Weaknesses:




Reimbursement barriers;
No established referral process;
Inadequate access to pharmacy records; and
Limited space availability.
Identified Opportunities:









Revenue generation;
Cost avoidance;
Potential decrease in inappropriate resource utilization;
Increased efficiency of physician time;
Multidisciplinary model of care;
Maximized cost-effectiveness of medication use;
Increased adherence to core measures;
Increased quality of life for heart failure patients; and
American Health and Medical Center North recognized as leaders in innovative health care.
Identified Threats:





Patient acceptance of pharmacist role;
Use of non-pharmacist practitioners to provide service;
Inadequate resources/FTE allocation;
Other health care provider resistance; and
Management of growth for the clinic.
In a critical review of the SWOT analysis, a number of strengths and opportunities suggest a solid benefit
to moving forward with the American Heart Failure Clinic. However, significant weaknesses and threats
still remain. Reimbursement currently is the greatest barrier for such a clinic. Pharmacists are not
recognized as Medicare Part B providers and, therefore, the clinic may only use incident-to a physician
billing option in the current fee-for-service model. However, with American Health strategically planning
participation in local Accountable Care Organization initiatives, the reliance on fee-for-service
reimbursement will be replaced in achieving desired patient outcomes in the most cost-effective manner.
Early results from multi-disciplinary models suggest the multi-disciplinary approach indeed reduces costs
and improves outcomes.5 The clinic currently also assists in attaining and improving current quality
measure under Medicare.
Patients with heart failure have many visits with health care providers and may be unwilling to have an
additional visit with a pharmacist. Because this is a new role for a pharmacist, patients may not be able to
understand the role and therefore may not see the need to make such a visit. This may result in a number of
no-show visits and a cost initially.
To manage these two major barriers as well as others, which have been identified, the clinic will start with
a robust and balanced quality and performance improvement measurement program. The program will be
described later in the document.
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MARKETING PLAN
Product
We will specifically define the services provided by the clinic as outlined under the Description section of
this business plan. Two flyers will be created for health care providers and for patients that will clearly
describe what kind of patient would need the Ambulatory Heart Failure Clinic services and what to expect
as a result of the services. The flyers would be specifically geared toward each customer.
Price
Promotional material and talking points will be developed that outlines the value of such services to quality
of care and the overall cost/benefit to each customer.
Place
The clinic will utilize existing clinic space at Medical Center North strategically positioned to have optimal
access with the multi-disciplinary team. The space will mimic the professional look of a physician or nurse
practitioner space. This will provide the patient with confidence in the professional level of care that the
pharmacist will provide.
Promotion
To introduce our new services to employees, pharmacy services will inform staff by electronic mail, the
America Health and pharmacy services web page, and publicize the opening in the America Health
newspaper, the Catalyst. Pharmacists will attend manager meetings, nurse practice council meetings, and
medication management meetings to make all staff aware of available services offered by the Ambulatory
Heart Failure Clinic. To introduce our clinic physicians to the pharmacy services provided, pharmacists
will personally contact every practice in the Medical Center North facility describing our services. Contact
will be extended through the use of electronic mail, flyers, and personal meetings. In addition, pharmacists
will attend regional physician group meetings to promote the Ambulatory Heart Failure Clinic. To
introduce our patients to our services, a banner will be hung at the entrance to the building, flyers will be
placed in every physician’s office waiting room, flyers will be available at the downtown facilities, and
information will be on the America Health web site and media services.
People
Only qualified pharmacists as previously described will be recruited for this position. The pharmacists, to
ensure current and ongoing competence, will participate in American Health credentialing and privileging
process. The pharmacist’s credentials will be used in promotional material.
Packaging
This program will be aligned with the patient-centered initiatives of American Health so that all customers
will understand the experience they can expect to receive from the clinic.
Process
Policy and procedures will be developed such that each customer (patients, other health care providers,
pharmacy department, nursing and administration) will understand how to access the service, what to
expect from the service, what tangible output they will receive, and how often they will receive the
information.
Our performance improvement plan will track referral volume as well as patient and provider satisfaction,
which will aid evaluation of our marketing plan. Should we not generate the desired volume anticipated, we
10
will increase our pamphlets and flyers available to patients and utilize our current pharmacy staff, social
workers, and administrators to increase our verbal communication concerning this service with patients.
FACILITY AND EQUIPMENT
This new clinic will be located within the existing multidisciplinary clinics of Medical Center North. There
will be an office for the clinical pharmacists and one pharmacotherapy exam room situated in a manner that
facilitates communication between the team. See Figure 1 for the schematic layout of the clinic floor plan
and proposed location of the pharmacotherapy exam room (Exam 1) that the pharmacists will be assigned.
See Appendix A for a list of fixtures and equipment needed.
MANAGEMENT AND ORGANIZATION
The Medical Center North Ambulatory Heart Failure Clinic pharmacists will report to the manager of
ambulatory pharmacy services who is responsible for all of the organization’s ambulatory pharmacy
operations. This will facilitate the continuity of pharmacy services within American Health. The
organizational structure is illustrated in Figure 2. For specific heart failure patient care issues, the
pharmacists will report to the Medical Director for Cardiology. The pharmacy will be supported by the
department’s administrative and clinical staff and an extensive support services staff of billing and
reimbursement, drug information, medication safety, and informatics specialists.
The proposed initial staffing plan specifies 1.13 full time equivalent employees and is illustrated in
Appendix B. Initially, the clinic will require 1.5 FTE clinical pharmacists. The pharmacists will have
obtained a Doctor of Pharmacy degree with a minimum of one year post-graduate training. PGY2 training
in ambulatory care or cardiology pharmacy practice or equivalent experience is preferred. Coverage for
leave will be provided by other clinical pharmacists in the department’s ambulatory pharmacy services
division. The clinic hours will be weekdays with a half day on Friday.
After receiving approval to proceed, a detailed floor plan and construction schedule will be developed.
Assuming funding for the project in July 20XX, set-up of the clinic will take approximately one month.
The planned opening date pharmacy would be August 1st.
FINANCIAL SUMMARY
The initial expenses to outfit the clinic are estimates based on experience gained in establishing the
organization’s other ambulatory clinics. As illustrated in Appendix C, the major start-up expenses include
office and exam room equipment.
A three-year proforma income and expense statement is illustrated in Appendix D. Clinic volumes have
been conservatively estimated at an average of 16 patients per day Monday through Thursday and 8
patients on Fridays (½ day) for the first year (allowing for ½ hour initial appointments). The payer mix is
expected to be greater than 90% Medicare Part B as the majority of the patients will be Medicare age.
The focus of the Ambulatory Heart Failure Clinic services will initially be patients referred for
management of heart failure for which there is a significant demand. Patient visits and reimbursement have
been estimated based on experience at the department’s other clinics.
A conservative estimate of the return on this investment would be an annual profit of $35,910 in year 1.
EVALUATION
The progress and success of this new clinic will be monitored on a quarterly basis utilizing a balanced
performance improvement measurement plan. It is described as follows:
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Financial



Direct costs and reimbursement
Cost avoidance through health care utilization (re-hospitalizations)
Quality performance measure reimbursement






Referral volume and source
Visit volume
No-show visits
Visit length
Communication issues and time deviation
Acceptance of pharmacist recommendations
Process
Clinical Outcome


NQF endorsed and P4P heart failure measures
Patient experience and satisfaction (Press-Ganey satisfaction survey)
Team-based work


Communication issues
Team satisfaction
A consolidated quarterly evaluation report will be prepared by the manager of ambulatory pharmacy
services for incorporation into the department’s balanced score card and reviewed by the Pharmacy
Director and the Medical Director for Cardiology.
References
1. Lee JK, Grace KA, Taylor AJ. Effect of a pharmacy care program on medication adherence and
persistence, blood pressure, and low-density lipoprotein cholesterol: A randomized controlled trial. JAMA.
2006; 296(21):2563-2571.
2. Chisholm-Burns MA, Lee JK, Spivey CK, et.al. US pharmacists’ effect as team members on patient
care: Systematic review and meta-analysis. Med Care. 2010; 48:923-933.
3. Schnipper JL, Kirwin JL, Cotugno MC, et.al. Role of pharmacist counseling in preventing adverse drug
events after hospitalization. Arch Intern Med. 2006; 166(5):565-571.
4. U.S. Census Bureau. Census 2010. http://2010.census.gov/news/releases/operations/cb10-cn93.html.
accessed 11 20XX.
5. Reid RJ, Coleman K, Johnson EA, et.al. The Group Health medical home at year two: Cost savings,
higher patient satisfaction and less burnout for providers. Health Affiars. 2010; 5(29):835-843.
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Figure 1. Floor Plan
Figure 2. Organizational Structure
<separate document>
13
Appendix A. Equipment and Fixtures
Pharmacotherapy Counseling/Exam Room/Office
Computer workstation
Office equipment
Sphygmomanometer
Dedicated phone line
Scale
Appendix B. Staffing Plan
Appendix C. Start Up Expenses
14
Appendix D. Three Year Proforma Income and Expense
Statement
15