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???