Ohio House of Representatives Health and Aging Committee
Proponent Testimony, House Bill 188
Stuart J. Beatty, Pharm.D., R.Ph.
Associate Professor of Clinical Pharmacy; The Ohio State University College of Pharmacy
Clinical Pharmacist; The Ohio State University Division of General Internal Medicine
May 27, 2015
Chairwoman Gonzales, Vice Chair Huffman, Ranking Member Antonio, and members of the
House Health & Aging Committee, thank you for this opportunity to support House Bill 188 to
improve efficiency of physician-pharmacist partnerships for quality care of patients.
My name is Stuart Beatty and I am a faculty member at The Ohio State University College of
Pharmacy. For the past 9 years, I have also been a practicing pharmacist for The Ohio State
University Division of General Internal Medicine. General Internal Medicine includes six National
Committee for Quality Assurance Tier 3 Patient-Centered Medical Homes in the Columbus
area. A Patient Centered Medical Home (PCMH) is a model of care that prioritizes team-based
care coordination and communication, accessibility for the patient, and a focus on quality and
safety. The healthcare team at General Internal Medicine includes 38 attending physicians,
more than 90 medical residents, multiple nurses and medical assistants, 4 pharmacists, and 3
pharmacy residents.
I’d like to talk to you about the services that our pharmacists provide for the patients at General
Internal Medicine and how this legislation will allow us to improve the quality of that care, but
first I want to describe the need for comprehensive medication management for patients in
Ohio. The quantity of medications used to treat acute and chronic medical conditions is growing
rapidly, increasing the risk for adverse reactions and drug interactions. Certain medications,
such as warfarin and insulin, require close monitoring and management to maintain a safe and
effective dose. As pharmacists, trained extensively in appropriate use of medications, we are
uniquely qualified to evaluate and recommend methods for optimizing medication therapy.
As a pharmacist at General Internal Medicine, I serve as a drug information resource to both
attending and resident physicians. In addition, pharmacists at General Internal Medicine
commonly see patients for visits on the referral of a physician. These visits are requested for a
variety of reasons including comprehensive medication reviews, adherence counseling, and
device teaching. We provide care for patients as a team with the physicians in interprofessional
clinics for diabetes and polypharmacy; we also help provide transitional care management
services to our patients recently discharged from the hospital or nursing home.
In our diabetes clinic, the pharmacist identifies the best possible choice of medications to treat
diabetes and its complications as well as opportunities to help the patient adhere to their
medication therapy. Education is provided to assist the patient in self-management of the
disease and goals are set and monitored for the patient as they make these lifestyle changes.
The focus of our polypharmacy clinic is to ensure the appropriateness of therapy for patients on
a high number of medications. Interventions made by pharmacists in this clinic have addressed
the pill burden for patients and reduced the potential for adverse effects from their medications.
In an effort to improve medication use and reduce hospital readmission rates, our pharmacy
team also provide a transitional care management program. Through this program, patients who
are discharged from the hospital or emergency room are contacted by a pharmacist for
medication management and education before being connected back with their primary care
physician for follow up. Studies have demonstrated that pharmacists are able to decrease
adverse events during transitions of care, improve quality of care, and reduce costs to patients
and taxpayers.
The pharmacy services at General Internal Medicine are demonstrating positive outcomes in
financial savings and cost avoidance, clinical impact, and patient and physician satisfaction,
consistent with pharmacists’ contribution to patient care teams documented in the literature.
Unfortunately, the benefits of these services are impacted by the burden of inefficiency and the
limitation in scope involved in the current consult process. As a faculty member, practitioner,
and program director of a pharmacy residency training program, I am always striving to teach
students and residents to practice at the top of their license in order to provide the best possible
care to our patients.
Under the current version of the law, a separate consult agreement must be entered into for
each individual whose drug therapy is to be managed by a pharmacist. It further states that a
consult agreement applies only to the particular diagnosis for which a physician prescribed an
individual's drug therapy. With 38 attending physicians and more than 90 medical residents,
having a separate consult agreement for each patient is not feasible. The patients we serve at
General Internal Medicine have multiple comorbidities and many experience barriers to
medication access and adherence. The idea of addressing only one disease state or only one
medication is counter to the whole-person approach of the patient-centered medical home. For
these reasons, we are currently unable to utilize consult agreements at General Internal
Medicine.
Without consult agreements, every medication adjustment and lab order made by the pharmacy
team during the various services that I described must be approved by the referring physician.
This leads to a great inefficiency in our patient care process. When seeing a patient on referral
from one of our physicians, after assessing the patient’s current therapy, lab values, and
treatment goals and determining an optimal medication adjustment and monitoring plan, we
then have to track down the referring physician to have the plan approved before it can be
implemented.
Our physicians refer patients to our services because they trust and depend on our clinical
judgement and because allowing us to manage their patients with medication-related needs
allows them more time to see patients with more complex medical needs. Their referral is a
partnership in which they trust us to make clinical decisions in the best interest of the patient.
Based on years of experience working together as a healthcare team, our recommended plans
are rarely met with disagreement from the physicians, making the process of gaining approval
more of a logistical burden than a necessity. The proposed changes in HB 188 will improve the
efficiency of this process and provide further opportunities for physician-pharmacist
partnerships, allowing more patients to benefit from the healthcare services provided by the
pharmacist. It will allow collaborative medication management utilizing medication experts to
effectively manage patients while allowing physicians to spend more time using their medical
license.
I would like to thank Vice Chair Huffman and Representative Manning for their support of this
legislation, which will improve efficiency of physician-pharmacist partnerships for quality patient
care in the state of Ohio. I appreciate you allowing me to provide testimony in support of HB 188
this morning, and I would be happy to answer any questions you may have.