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Pharmacy Leadership Forum

Pharmacy and the New Health Care Model: Roles and Responsibilities for Pharmacists

Presented as a Sunday Symposium at the

47th ASHP Midyear Clinical Meeting and Exhibition

Sunday, December 2, 2012 Las Vegas, Nevada

Planned and conducted by ASHP Advantage and the Center for Health-System Pharmacy Leadership. Supported by

an educational grant from Baxter Healthcare Corporation

Please be advised that this activity is being audio and/or video recorded for archival purposes and, in some cases, for repurposing of the content for enduring materials.

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A G E N D A

2:00 p.m. – 2:15 p.m. Welcome and Introductions James G. Stevenson, Pharm.D., FASHP

2:15 p.m. – 2:50 p.m. The ABCs of Accountable Care Organizations

James G. Stevenson, Pharm.D., FASHP

2:50 p.m. − 3:20 p.m. Value-based Purchasing Program: An Overview Darin L. Smith, Pharm.D., BCPS, FASHP

3:20 p.m. − 3:40 p.m. Refreshment Break

3:40 p.m. − 4:10 p.m. Clinical Quality Measures and Meaningful Use of EHRs: Are You Ready for Stage 2?

Shelly Spiro, B.S.Pharm., FASCP

4:10 p.m. − 4:40 p.m. The Pharmacist’s Role in the New Health Care Model: New Opportunities and Challenges

Kathleen S. Pawlicki, M.S., B.S.Pharm., FASHP 4:40 p.m. – 5:00 p.m. Faculty Discussion and Audience Questions All Faculty

F A C U L T Y

James G. Stevenson, Pharm.D., FASHP, Activity Chair Chief Pharmacy Officer University of Michigan Health System Professor and Associate Dean for Clinical Sciences University of Michigan College of Pharmacy Ann Arbor, Michigan Darin L. Smith, Pharm.D., BCPS, FASHP Director Pharmacy Services and Performance Improvement Norman Regional Health System Norman, Oklahoma Shelly Spiro, B.S.Pharm., FASCP Executive Director Pharmacy e-HIT Collaborative Alexandria, Virginia Kathleen S. Pawlicki, M.S., B.S.Pharm., FASHP Administrative Director of Professional Services and Director of Pharmaceutical Services William Beaumont Hospital Royal Oak, Michigan

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D I S C L O S U R E S T A T E M E N T

In accordance with the Accreditation Council for Continuing Medical Education’s Standards for Commercial Support and the Accreditation Council for Pharmacy Education’s Guidelines for Standards for Commercial Support, ASHP Advantage requires that all individuals involved in the development of activity content disclose their relevant financial relationships. A person has a relevant financial relationship if the individual or his or her spouse/partner has a financial relationship (e.g., employee, consultant, research grant recipient, speakers bureau, or stockholder) in any amount occurring in the last 12 months with a commercial interest whose products or services may be discussed in the educational activity content over which the individual has control. The existence of these relationships is provided for the information of participants and should not be assumed to have an adverse impact on presentations. All faculty and planners for ASHP Advantage education activities are qualified and selected by ASHP Advantage and required to disclose any relevant financial relationships with commercial interests. ASHP Advantage identifies and resolves conflicts of interest prior to an individual’s participation in development of content for an educational activity. The faculty and planners report the following relationships: James G. Stevenson, Pharm.D., FASHP

Dr. Stevenson declares that he has no relationships pertinent to this activity. Darin L. Smith, Pharm.D., BCPS, FASHP

Dr. Smith declares that he has no relationships pertinent to this activity. Shelly Spiro, B.S.Pharm., FASCP

Ms. Spiro declares that she has no relationships pertinent to this activity.

Kathleen S. Pawlicki, M.S., B.S.Pharm., FASHP

Ms. Pawlicki declares that she has no relationships pertinent to this activity. Erika L. Thomas, M.B.A., B.S.Pharm.

Ms. Thomas declares that she has no relationships pertinent to this activity. ASHP staff has no relevant financial relationships to disclose.

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A C T I V I T Y O V E R V I E W

Health care in the United States is in transition as technologies and treatments continue to emerge and the population continues to age. The active engagement of all health care practitioners will be required to embrace quality improvement and change management strategies to ensure that patients receive care that is effective and safe. Requirements of the Affordable Care Act are also driving change and accountability in all areas of the health care system. The accountable care organization (ACO) model is impacting medication management across the health system, and pharmacists can significantly impact medication-use management in this evolving health care model. Additionally, hospitals will be rewarded for high-level performance and penalized for poor performance on quality measures, patient perceptions, readmissions, mortality, and safety measures as they relate to Medicare beneficiaries through value-based purchasing. The goal of the Centers for Medicare & Medicaid Services (CMS) meaningful use incentive program is to promote the spread of electronic health records (EHR) to improve health care in the United States. Eligible providers and hospitals are allowed to earn incentive payments by meeting specific criteria. Important changes in health care policy and technologies impact medication management and the pharmacist’s role in patient care. This educational activity will explain how current practices will be impacted and changes that will be required as these additional roles and opportunities evolve.

A C T I V I T Y O B J E C T I V E S

After attending this application-based educational activity, participants should be able to

• Explain the fundamental principles behind the concept of ACOs.

• Predict potential opportunities for pharmacists to actively participate in ACOs.

• Explain the mechanisms by which performance will be measured under the CMS hospital value-based purchasing program.

• Define the role of clinical quality measures under the CMS EHR meaningful use incentive program.

• Describe possible roles for pharmacy in the new health care model.

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C O N T I N U I N G E D U C A T I O N A C C R E D I T A T I O N

The American Society of Health-System Pharmacists is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education. This activity provides 3 hours (0.3 CEUs) of continuing pharmacy education credit (ACPE activity #0204-0000-12-444-L04-P).

Attendees must complete a Continuing Pharmacy Education Request online and may immediately print their official statements of continuing pharmacy education credit at the ASHP CE Center at http://ce.ashp.org following the activity.

Complete instructions for receiving your statement of continuing pharmacy education online are on the next page. Be sure to record the session code beginning with “A” announced during the activity.

Available soon at www.ashpadvantage.com/pharmlead...

A Web-based version of this educational activity will be available at

www.ashpadvantage.com/pharmlead on March 1, 2013. Tell you pharmacy colleagues who were unable to attend the Midyear about this outstanding

on-demand educational activity! (Please note that individuals who claim CPE credit for the live symposium are ineligible to claim credit for the web-based activity.)

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P R O C E S S I N G C P E O N L I N E

The ASHP CE Center allows participants to obtain statements of continuing pharmacy education (CPE) conveniently and immediately using any computer with an internet connection. To obtain CPE statements for ASHP Advantage activities, please visit

http://ce.ashp.org

1. Log in to the ASHP CE Center using your e-mail address and password.

If you have not logged in to the ASHP CE Center and are not a member of ASHP, you will need to set up an account by clicking on “Become a user” and follow the instructions.

2. Once logged in to the site, click on Process Meeting CE.

3. If you are a registered attendee at the ASHP Midyear Clinical Meeting, click on the start button to the right of ASHP Midyear Clinical Meeting 2012.

If you are not registered to attend the ASHP Midyear Clinical Meeting, click on the start link to the right of the activity title. If this activity title does not appear in your meeting list, enter the 5-digit activity code in the box above the list and click submit. The activity code is noted below. Click submit when prompted and then click on the start link to the right of the activity title. Do not click on “remove" next to an activity title unless you did not attend that activity.

4. Click on the click here link to view sessions associated with the day of the activity.

5. Enter the session code announced during the activity (e.g., A12XXX and note that the letter is case sensitive) and select the number of hours equal to your participation in the activity.

6. Click submit to receive the attestation page.

7. Confirm your participation and click submit.

8. Complete the evaluation and click the finish button. You will then be able to view and print your transcript.

Date of Activity Activity Code Session Code

(announced during the live activity)

CPE credit hours

December 2, 2012

12444 A12_____ 3

NEED HELP? Contact ASHP Advantage at [email protected].

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James G. Stevenson, Pharm.D., FASHP Activity Chair Chief Pharmacy Officer University of Michigan Health System Professor and Associate Dean for Clinical Sciences University of Michigan College of Pharmacy Ann Arbor, Michigan James G. Stevenson, Pharm.D., FASHP, is Chief Pharmacy Officer at the University of Michigan Health System, as well as Professor and Associate Dean for the Department of Clinical Sciences at the University of Michigan College of Pharmacy. Dr. Stevenson received his Bachelor of Science and Doctor of Pharmacy degrees from Wayne State University in Detroit, Michigan. He then joined the faculty at the West Virginia University School of Pharmacy in Morgantown. Dr. Stevenson’s previous appointments include Assistant Director for Clinical Services, and subsequently Associate Director for Patient Care, Education and Research Services in the Department of Pharmaceutical Services at West Virginia University Hospitals, before being appointed Director of Pharmaceutical Services. He has also served as Director of Pharmacy Services at Detroit Receiving Hospital and University Health Center, Director of the Graduate Program in Health Systems Pharmacy Management in the Wayne State University College of Pharmacy, and Executive Director of Pharmacy Services for the Detroit Medical Center. He is a Fellow of the American Society of Health-System Pharmacists (ASHP) and has been recognized as Pharmacist of the Year by both the Michigan Society of Health-System Pharmacists and the Michigan Pharmacists Association. He has also been honored with the Distinguished Alumnus Award by the Wayne State University College of Pharmacy and the Joseph Oddis Leadership Award by the Michigan Society of Health-System Pharmacists. He recently completed a term of service on the ASHP Board of Directors and received the John W. Webb Lecture Award in 2010. In 2012, Dr. Stevenson was appointed to the Michigan Board of Pharmacy.

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Planned and conducted by ASHP Advantage and the Center for Health-System Pharmacy Leadership.

Supported by an educational grant from Baxter Healthcare Corporation.


Pharmacy and the New Health Care Model:Roles and Responsibilities for Pharmacists


Pharmacy and the New Health Care Model:

Roles and Responsibilities for Pharmacists

James G. Stevenson, Pharm.D., FASHP, ChairChief Pharmacy Officer

University of Michigan Health System

Professor and Associate Dean for Clinical Sciences

University of Michigan College of Pharmacy

Ann Arbor, Michigan

The ABCs of Accountable Care Organizations

• Desire to integrate hospital and physician

care

• Better align incentives around quality and

costs, with an opportunity to share in

savings

• Promote evidence-based and patient-

centered care with improved coordination

Why Accountable Care Organizations (ACO)?

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Accountable Care Organizations

• Networks of physicians and other providers that work together to improve the quality and costs of health care services for a defined population

• Need for new system that creates incentives for providers to work together to bend the cost curve and improve quality

• Goal– Improve care for individuals– Improve health of the population– Reduce growth in health care expenditures

• “ACOs were compared to the elusive

unicorn: everyone seemed to know what it looks like, but no one had actually seen

one.”

–Jenny Gold, Kaiser Staff Writer

ACO

Patient Centered Medical

Home

(Primary Care)

Specialty Areas

Challenge to take principles from PCMH and extend to specialty

care/areas; integrate with inpatient care and transitions

Inpatient Care and

Transitions of Care

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• Avoid unnecessary duplication of services

and medical errors

• Link provider reimbursements to quality

metrics and reduction in the total cost of care for the assigned population

– When an ACO succeeds in saving health care

dollars, it shares in the savings it achieved for the program

ACO Goals

Shared Savings Program

• Providers agree to be accountable for quality and cost of care of at least 5000 beneficiaries

• ACO is allowed to share in the savings it

achieves if it meets specified quality measures and cost controls targets

• Demonstration projects have shown that with

integrated approaches and coordination, significant reductions in cost of care can be

realized

Basic Features

• Enrollment of patients may be formal or through attribution to ACO that provides the preponderance of care

• Performance measurement including data on utilization, costs, and quality measures

• Costs in the ACO population are compared to other non-ACO populations and savings or costs may be shared with the ACO (risk)

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• Treat patients in best location

• Utilize practice guidelines

• Utilize the expertise of team-based care

• Avoid unnecessary admissions

• Enhance data integration between providers/hospitals in all sites of care

• Focus on chronic care of populations

• Focus on preventative care, screenings, and wellness

• Refer internally

• Improve transitions of care

Key Strategies Considered by ACOs

Which one of the following is a goal of ACOs?

a. Better care for populations.

b. Focus on inpatient care.

c. Increase hospital admissions and revenue.

d. Provide care for groups > 10,000 patients.

Audience Response

• Strong base of primary care collectively accountable for quality and total per capita costs across the full continuum of care for a population of patients

• Payments linked to quality improvements that also reduce overall costs

• Reliable and progressively more sophisticated performance measurement, to support improvement and provide confidence that savings are achieved through improvements in care

Organization – Core Principles for ACOs

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• By placing some of the financial responsibility on the provider, ACOs hope to limit unnecessary expenditures while continuing to provide patients with the freedom to select their medical services

• By increasing care coordination, ACOs can help reduce unnecessary medical care and improve health outcomes, leading to a decrease in utilization of acute care services

Organization – Core Principles

• One-sided risk

– ACO share any savings without any financial risk through a defined time period

• Two-sided risk

– ACOs share in the savings and losses for a defined time period

Organization – Payment Models

Importance of Medications

• At least 2/3 of physician visits result in prescription medication

• Chronic diseases managed primarily by drug

therapy

• Medicare beneficiaries have high utilization of medications and multiple chronic conditions

• Suboptimal use of medications can lead to

excess costs in care, hospital admissions, ED visits

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Key Medication-Related Measures in CMS* Demonstration Project (Pioneer)

• Risk standardized, all condition readmissions

• Medication reconciliation after discharge from inpatient facility

– Currently defined as being overseen by a physician or a clinical

pharmacist

• Influenza immunization

• Pneumococcal vaccination

• Tobacco use and tobacco cessation intervention

*CMS – Centers for Medicare & Medicaid Services

• Diabetes – hemoglobin A1c <8– LDL <100– BP < 140/90– Aspirin use– poor control hemoglobin A1c >9

• Controlling high blood pressure

• Ischemic vascular disease– LDL <100– Aspirin use

• Heart failure– Beta-blocker therapy for left ventricular systolic dysfunction

• Coronary artery disease– Drug therapy for lowering LDL– ACE inhibitor or ARB for CAD and diabetes and/or LVSD

Key Medication-Related Measures in CMS Demonstration Project (Pioneer)

To what degree is your pharmacy currently

engaged in initiatives to improve the measures in the Pioneer ACO?

a. Not at all.

b. To a small degree.

c. To a moderate degree.

d. We are currently engaged in improving all of these through the pharmacy.

Audience Response

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• Key role in assuring optimal outcomes

related to medications through:

– Ensuring appropriate medication use

– Reducing adverse drug events

– Improving transitions of care

– Preventing hospital readmissions

– More optimal management of chronic conditions

The Role of Pharmacists in ACOs

• Developed a systematic and standardized pharmacy practice model to provide comprehensive patient care

• Established collaborative practice agreements with physicians

• Obtained special clinical privileges endorsed by credentialing committee

• Developed new billing structure and process for service reimbursement

Preparation for Pharmacist Integration

• Embedded pharmacists in primary care clinics

• Patient recruitment• Physician referral

• Site-specific disease registries

• Targeted interventions without referral

• Collaborative practice agreements with delegated prescriptive authority• Diabetes, hypertension, hyperlipidemia

• Scheduled patient visits/consults• Clinic visits (30 minutes)

• Phone consults (15 – 30 minutes)

Pharmacist Practice Model

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increased dose

added medication

decreased dose

deleted medication

optimized regimen

Year 3: 2,674 interventions

Therapeutic Interventions by Pharmacists

245

357

523

211

1338

Example of Impact on Clinical Measures

• Diabetes Management by pharmacists

– Results during Year 1 (ramp up)

• Patients with baseline A1c > 7% (n=270) had a mean decrease of 0.8% (95% CI 0.6 to 1.0, p<0.001)

• Patients with baseline A1c > 9% (n=118) had a mean decrease in A1c of 1.4% (95% CI 1.1 to 1.8, p<0.001)

0.0

1.1

4.1

0.0

0.5

1.0

1.5

2.0

2.5

3.0

3.5

4.0

4.5

<$10,000 (n=1210) $10-50,000 (n=197) $>50,000 (n=40)

Annual Health Care Cost

Average Number of Admissions

Focus on High Risk Patients

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11

13

17

16

0

2

4

6

8

10

12

14

16

18

$20,000-50,000 (n=147) $50,000-80,000 (n=76) $80,000-110,000 (n=55) $110,000-140,000 (n=34)

Average number of medications

Annual Health Care Cost

Large Number of Medications in High Cost Patient Population

• Pharmacists should be actively engaged within their health-system’s ACO initiatives

• Pharmacists should be an integral part of

providing team-based care

– Selection of most appropriate regimen

– Modifying regimens as needed to achieve goals

– Patient education/patient empowerment

– Enhancing medication adherence

– Targeted interventions for high risk populations

Opportunity/Call to Action

• Identify opportunities for starting new

services or expanding existing programs

– Chronic disease management

– Polypharmacy

– Adherence

– Transitions of care

• Educational needs of patients

• Medication access issues

– Case management of high risk populations

Opportunity/Call to Action

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• Accountable for quality, cost and overall care for patients

• Payment reform that promotes value

• Shared savings program that rewards providers with

incentive payments for improving quality of care and reducing cost

• Performance measurement that allows organizations to be

accountable for quality and cost for a defined population

• Delivery system changes that promote integrated,

organized processes of care � must embrace a team-based approach

• Significant opportunities for pharmacists

ACO Summary

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Darin Smith, Pharm.D., BCPS, FASHP Director Pharmacy Services and Performance Improvement Norman Regional Health System Norman, Oklahoma Darin Smith, Pharm.D., BCPS, FASHP, is Director of Pharmacy Services and Performance Improvement for Norman Regional Health System in Norman, Oklahoma. He is responsible for oversight of pharmacy services as well as leading performance improvement initiatives for Norman Regional Hospital, Norman Regional Healthplex, and Moore Medical Center. Dr. Smith received his Bachelor of Pharmacy and Doctor of Pharmacy degrees from the University of Oklahoma College of Pharmacy (OUCOP). He completed a specialty residency in pharmacokinetics at OUCOP and is board-certified in pharmacotherapy. Dr. Smith was recognized as a Fellow of the American Society of Health-System Pharmacists (ASHP) in March 2011. Dr. Smith is active with the Oklahoma Society of Health-System Pharmacists (OSHP), serving as president in 1988-89, and state delegate to the ASHP House of Delegates for multiple terms. He was awarded the Oklahoma Health-System Pharmacist of the Year in 2001 and the Quality Professional Award by the Oklahoma Hospital Association in 2004 for his accomplishments and contributions in the area of quality improvement. Dr. Smith currently serves as Vice Chair for the Board of Directors of the Oklahoma Foundation for Medical Quality (Oklahoma’s QIO) and chairs the Oklahoma Hospital Association Council on Quality and Patient Safety. He also serves on the Joint Commission’s Hospital Advisory Council.

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Pharmacy and the New Health Care Model:Roles and Responsibilities for Pharmacists

Darin L. Smith, Pharm.D., BCPS, FASHPDirector

Pharmacy Services and Performance Improvement

Norman Regional Health System

Norman, Oklahoma

Value-based Purchasing Program: An Overview

Value-Based Purchasing

• The Patient Protection and Affordable Care Act (H.R. 3590)

– Established Value-Based Purchasing

• “Hospital Performance Score”

– Reimbursement dollars withheld then awarded based

on positive performance

• Percentage of Medicare reimbursement at risk

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Value-Based Purchasing FFY 2013

• Proposed Rules– Published in Federal Register – Jan 13, 2011

• Vol. 76, No. 9, 42 CFR Parts 422 and 480

• Comments were due no later than 5 pm, March 8th, 2011

– Applies to payments for discharges occurring on or after Oct 1st,

2012.

• Medicare FFY = October 1st through September 30th

• Baseline period: July 1st , 2009 – March 31st, 2010

• Measurement period: July 1st, 2011 – March 31st, 2012

– Incentive payments funded for FFY 2013 through a reduction in

FFY 2013 base operating DRG payments for each discharge of 1%

We are here

Proposed Rules – Federal Register

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Rules and Regulation – Federal Register

Rules and Regulation – Federal Register

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“The overarching goal of these

initiatives is to transform Medicare from a passive payer of claims to an active purchaser of qualityhealthcare for its beneficiaries.”

“This new program will necessarily be a fluid model, subject to change as knowledge, measures and tools evolve.”

“Measures or measurement domains need not be given equal weight, but over time, scoring methodologies should be more

weighted towards outcome, patient experience and functional status measures.”

“Across all programs, CMS seeks to move as quickly as possible to the use of primarily outcome and patient

experience measures.”

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Medicare Reimbursement

CLABSI

SSI

At Risk: FFY2014

Hospital Consumer

Assessment of Healthcare

Providers and Systems (HCAHPS)

(Section 3001)

At Risk: 1% FFY2013, 1.25% FFY2014, 1.5% FFY2015, 1.75% FFY2016, 2% FFY2017 and beyond

AMI, PNE, HF

SCIP/HOP

Core Measures

(Section 3001)Healthcare-Associated

Infections (HAI)(Section 3001)

At Risk: 1% reduction in FFY2013, may increase to 3 to 5%

COPD, CABG,

PTCA, etc.

AMI, PNE, HF

Readmission Rates(Section 3025)

30-day Mortality:

AMI,HF,PNE

FFY2014

Winners/Losers – Budget Neutral

Losers Only - $1.4 billion cut/10 yrs nationwide Losers Only - $10 billion cut/10 yrs nationwide

HR 3590 The Patient Protection and Affordable Care Value-Based Purchasing (VBP)

Medicare spending

per beneficiary

Efficiency Measures(Section 3001)

Foreign Object Postop,

Air Embolism, Blood

Incompatibility, Pressure

Ulcer, Falls/Trauma

At Risk: 1% reduction beginning FFY2015

Hospital Acquired

Conditions (HAC)(Section 3008)

CAUTI, Vascular Catheter

Associated Infections, Poor

Glycemic Control

AHRQ Patient Safety

Indicators


CLABSI

SSI

At Risk: FFY2014

Hospital Consumer



(Section 3001)


AMI, PNE, HF

SCIP/HOP

Core Measures



COPD, CABG,

PTCA, etc.

AMI, PNE, HF



Air Embolism, Blood


Ulcer, Falls/Trauma


Hospital Acquired


30-day Mortality:

AMI,HF,PNE

FFY2014




Medicare spending

per beneficiary




Glycemic Control

AHRQ Patient Safety

Indicators


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VBP FFY 2013-2015

We are here

VBP Patient Experience

VBP FFY 2013 HCAHPS

30%

Communication with Nurses

Communication with Doctors

Responsiveness of Hospital Staff

Pain Management

Communication about Medications

Cleanliness and Quietness

Discharge Information

Overall Rating of Hospital

VBP FFY 2014 HCAHPS

30%




Pain Management





VBP FFY 2015 HCAHPS

30%




Pain Management





We are here

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VBP Process of Care

Measures FFY 2013 FFY 2014 FFY 2015

70% 45% 20%

AMI-7A Fibrinolytic received within 30 min of arrival X X X

AMI-8A PCI received within 90 min of arrival X X X

HF-1 Discharge instructions X X Retired

PN-3b Blood culture before 1st antibiotic X X X

PN-6 Initial antibiotic selection X X X

SCIP-1 Antibiotic within 1 hour before incision (2 hours if

Vancomycin/Quinolone)X X X

SCIP-2 Appropriate prophylactic antibiotic selection X X X

SCIP-3 Prophylactic antibiotic discontinued within 24 hours X X X

SCIP-4 Controlled 6 AM post-op glucose – cardiac surgery X X X

SCIP-9 Post-op urinary catheter removal on day 1 or 2 New X

SCIP VTE-1 VTE prophylaxis ordered X X Retired

SCIP VTE-2 VTE prophylaxis received within 24 hours prior to or after surgery X X X

SCIP Card-2 Pre-admission/peri-operative beta-blocker X X X

New

Achievement Points

• Applies to Process of Care and HCAHPS* Scoring

• Points awarded based on individual hospital

performance compared to all hospitals (achievement)

– (threshold) 50th percentile of all hospitals

– (benchmark) mean of the top decile (~95th %ile)

• Scoring

– 10 points (hospital rate at or above benchmark)

– 1 to 9 points (hospital rate equal to or greater than the

achievement threshold and less than the benchmark)

– 0 points (hospital rate below achievement threshold)

HCAHPS - Hospital Consumer Assessment of Healthcare Providers and System

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Improvement Points

• Applies to Process of Care and HCAHPS Scoring

• Points awarded by comparing hospital’s current

performance rate to baseline period (self comparison)

• Scoring:

– 9 points (hospital rate at or above benchmark)

– 0 to 9 points (hospital rate between the baseline rate and the

benchmark)

– 0 points (hospital rate at or below baseline rate)

Consistency Points

• Applies to HCAHPS Scoring Only

• Purpose: to reward hospitals that have scores above the

national 50th percentile for all 8 HCAHPS dimensions

• Scoring (possible 20 points):

– 20 points (hospital rate 50th %ile for all 8 HCAHPS dimensions)

– 0-20 points (lowest dimension is compared to the range between

the national 0 percentile (floor) and the 50th percentile (threshold)

and awarded points proportionately

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Norman Regional Health System Payment Summary FFY 2013


Top

Decile 50th %ile

30


Top

Decile50th %ile


NRHS at Risk ~$500,000 (1%) x 0.9535882398 = Return of $476,794

Estimated Loss = $23,206

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VBP Outcomes (Mortality)

VBP FFY 2014

25%

MORTALITY

30 Day Mortality – Acute Myocardial Infarction

30 Day Mortality – Heart Failure

30 Day Mortality – Pneumonia

VBP FFY 2015

25%

MORTALITY

30 Day Mortality – Acute Myocardial Infarction

30 Day Mortality – Heart Failure

30 Day Mortality – Pneumonia

COMPLICATIONS/PATIENT SAFETY

AHRQ Patient Safety Indicator Composite

CLABSI

Central Line-Associated Blood Stream Infection

VBP Efficiency

VBP FFY 2015

20%

Medicare Spending Per Beneficiary (MSBP)

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VBP Efficiency

VBP Baseline vs Performance

FFY 2013 (Oct 2012-Sep 2013)

Baseline Performance Period

Core Measures/SCIP Jul 1, 2009-Mar 31, 2010 Jul 1, 2011-Mar 31, 2012

HCAHPS Jul 1, 2009-Mar 31, 2010 Jul 1, 2011-Mar 31, 2012

FFY 2014 (Oct 2013-Sep 2014)


Core Measures/SCIP Apr 1, 2010-Dec 31, 2010 Apr 1, 2012-Dec 31, 2012

HCAHPS Apr 1, 2010-Dec 31, 2010 Apr 1, 2012-Dec 31, 2012

Outcomes (Mortality) Jul 1, 2009-Jun 30, 2010 Jul 1, 2011-Jun 30, 2012

FFY 2015 (Oct 2014-Sep 2015)


Core Measures/SCIP Jan 1, 2011-Dec 31, 2011 Jan 1, 2013-Dec 31, 2013

HCAHPS Jan 1, 2011-Dec 31, 2011 Jan 1, 2013-Dec 31, 2013

Outcomes

Mortality Oct 1, 2010-Jun 30, 2011 Oct 1, 2012-Jun 30, 2013

PSI Composite Oct 15, 2010-Jun30, 2011 Oct 15, 2012-Jun 30, 2013

CLABSI Jan 1, 2011-Dec 31, 2011 Feb 1, 2013-Dec 31, 2013

Efficiency May 1, 2011-Dec 31, 2011 May, 1 2013-Dec 31, 2013

We are

here

33


CLABSI

SSI

At Risk: FFY2014

Hospital Consumer



(Section 3001)


AMI, PNE, HF

SCIP/HOP

Core Measures



COPD, CABG,

PTCA, etc.

AMI, PNE, HF



Air Embolism, Blood


Ulcer, Falls/Trauma


Hospital Acquired


30-day Mortality:

AMI,HF,PNE

FFY2014




Medicare spending

per beneficiary




Glycemic Control

AHRQ Patient Safety

Indicators


Condition

Foreign Object Retained After Surgery

Air Embolism

Blood Incompatibility

Pressure Ulcers Stages III & IV

Falls and Trauma

Vascular Catheter-Associated Infection

Catheter-Associated UTI

Manifestations of Poor Glycemic Control

VBP Hospital-Acquired Conditions

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VBP Hospital-Acquired Conditions

NRHS at Risk ~$500,000 (1%) x ? = Return of $?


CLABSI

SSI

At Risk: FFY2014

Hospital Consumer



(Section 3001)


AMI, PNE, HF

SCIP/HOP

Core Measures



COPD, CABG,

PTCA, etc.

AMI, PNE, HF



Air Embolism, Blood


Ulcer, Falls/Trauma


Hospital Acquired


30-day Mortality:

AMI,HF,PNE

FFY2014




Medicare spending

per beneficiary




Glycemic Control

AHRQ Patient Safety

Indicators


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Readmissions (30 Day All Cause) – FFY 2013, FFY 2014

Acute Myocardial Infarction (AMI)

Pneumonia (PNE)

Heart Failure (HF)

Readmissions

Readmissions (30 Day All Cause) – FFY 2015

Chronic Obstructive Pulmonary Disease (COPD)

Coronary Artery Bypass Graft (CABG)

Percutaneous Transluminal Coronary Angioplasty (PTCA)

Other Vascular Conditions

Readmissions

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Readmissions

FFY 17FFY 16FFY 15FFY 14FFY 13FFY 12FFY 11

VBP 1%

Medicare Federal Fiscal Year (FFY) = Oct 1st –Sep 30th

(ie. FFY 13 = Oct 1st, 2012 – Sep 30th, 2013)

VBP 1.25% VBP 1.5% VBP 1.75% VBP 2% 2% ?

Readmissions

1%

Readmissions

2%

Readmissions

3%

Readmissions

3%

Readmissions

3%3% ?

HAC 1% HAC 1% HAC 1% 1% ?

VBP – Medicare Dollars at Risk

2% Total 3.25% Total 5.5% Total 5.75% Total 6% Total 6% ?

37

www.hospitalcompare.hhs.gov

38

http://www.hospitalcompare.hhs.gov/data/VBP/value-based-purchasing.aspx


39



40

Remember

• Data must be publicly reported for 1 year

on www.hospitalcompare.hhs.gov to be

eligible for VBP inclusion

Opportunities for the Pharmacist

• Process of Care/HCAHPS

• Readmissions and 30-Day Mortality– Impact of evidence-based medication use (AMI, HF, PNE)

• Hospital Acquired Conditions– Falls and Trauma (inappropriate medication use)

– Manifestations of Poor Glycemic Control (hyperglycemia management)

– CAUTI, CLABSI (antimicrobial stewardship)

• Future measures proposed for potential VBP inclusion– Immunization (Pneumococcal and Influenza)

– Healthcare Provider (HCP) Influenza Immunization Rates

– Venous Thromboembolism (VTE) Measures (medication use)

– Stroke Measures (STK) (medication use)

– Clostridium difficile rates (antimicrobial stewardship)

Medication Related Process of Care Measures Medication Related HCAHPS Measures

FFY 2013 (11 of 12) (2 of 8)*

FFY 2014 (11 of 13) (2 of 8)*

FFY 2015 (9 of 11) (2 of 8)*

*Pain Management, Communication about Medications

41


42


Shelly Spiro, B.S.Pharm., FASCP Executive Director Pharmacy e-HIT Collaborative Alexandria, Virginia Shelly Spiro, B.S.Pharm., FASCP, is Executive Director of the Pharmacy e-Health Information Technology Collaborative (e-HIT Collaborative). The e-HIT Collaborative is an organization of major national pharmacy associations and associate members focused on assuring the meaningful use of standardized electronic health records that support safe, efficient, and effective medication use and continuity of care. An additional goal of the e-HIT Collaborative is to assure that pharmacists are part of the health care team providing quality patient-care services that are integrated into the national health information technology (HIT) interoperability framework. Ms. Spiro received her Bachelor of Pharmacy degree from the University of Illinois at Chicago. Ms. Spiro is active in national pharmacy associations and standards development organizations including the National Council for Prescription Drug Programs, Health Level Seven International, and The Accredited Standards Committee X12. She is a past president and fellow of the American Society of Consultant Pharmacists.

43




Shelly Spiro, B.S.Pharm., FASCP

Executive Director

Pharmacy e-HIT Collaborative

Alexandria, Virginia

Clinical Quality Measures and Meaningful Use of EHRs: Are You Ready

for Stage 2?

Background

• Reporting of clinical quality measures (CQMs) will change for all providers beginning 2014– Eligible Professionals (EPs)– Eligible Hospitals (EHs)– Critical Access Hospitals (CAHs)

• CQMs are now incorporated into the definition of a meaningful user rather than part of Core Set Measures– 16 CQMs required for EH/CAH– 9 Measures for EP

Source: 2014 Clinical Quality Measures. http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/2014_ClinicalQualityMeasures.html (2012 October 29).

advisory.com

Publicly Available Tools hosted by the Advisory Board Company

Meaningful Use – The Whiteboard Story

www.advisory.com/MUwhiteboard

Quick Guide Comparison―Stage 1

to Stage 2 Objectives and Measures

www.advisory.com/MUpocketguide

Bookmark versions of the Final Rules

www.advisory.com/MUbookmarkCMSwww.advisory.com/MUbookmarkONC

Download Useful Tools and Educate

Yourself

44

Stage 1 Stage 2 Certification Standards

Meaningful Use the Whiteboard Storywww.advisory.com/MUwhiteboard

Data

Elements

A Red band

on a cell =

change

from the

proposed

rule

Legend

Zoom to 100% and Scroll Around to See the Text

Objectives, Numerators, Denominators, Thresholds, Exclusions, and more

Meaningful Use Pocket Guidewww.advisory.com/MUpocketguide

45

Pocket Guide

Source: Pocket Quick Guide Comparison Stage 1 to Stage 2 Meaningful Use Final Rule Objectives and Measures. www.advisory.com/MUpocketguide. (2012 October 29).

EH View – Download - Transmit

46

lmorales

Typewritten Text

Enlarged on page 55

Reporting of clinical quality measures

(CQMs) will change for all providers beginning:

a. 2013.

b. 2014.

c. 2015.

d. 2016.

Audience Response

For reporting on Clinical Quality Measures (CQMs):

a. EPs, EHs, and CAHs all report on the same number of CQMs.

b. EPs and EHs report on 16 CQMs and CAHs report on 9 CQMs.

c. EPs report on16 CQMs and EHs/CAHs report on 9 CQMs.

d. EPs report on 9 CQMs and EHs/CAHs report on 16 CQMs.

Audience Response

Eligible Professionals (EP), Eligible Hospitals (EHs),Critical Access Hospitals (CAHs),

Clinical Quality Measures (CQMs)

CQMs Relate to Certified EHR

• CQMs eliminated from the core objective

– EPs and EHs are still required to report CQMs to

CMS or the States

– To demonstrate MU of certified EHR technology

• EHs and CAHs must report on 16 of the 29 CQMs

• EHs and CAHs must select CQMs from at

least 3 of the 6 key healthcare quality domains

47

National Quality Strategy (NQS) Domains

• Patient and Family Engagement

• Patient Safety

• Care Coordination

• Population and Public Health

• Effective Use of Healthcare Resources

• Clinical Process/Effectiveness

USHIK

• United States Health Information Knowledgebase (USHIK)

• USHIK website provides– Publicly accessible registry and repository

– Human-readable and some computable formats for • viewing, downloading, and comparing electronic CQM versions • and their value sets

• AHRQ USHIK is a metadata registry of healthcare-related standards– Data elements, and metadata

– funded and directed by AHRQ, in partnership with the Centers for Medicare and Medicaid Services (CMS) and the Veterans Administration

Agency for Healthcare Research and Quality 2014 Meaningful Use Clinical Quality Measures Posted to United States Health Information Knowledgebase (USHIK). http://ushik.ahrq.gov/index.jsp?enableAsynchronousLoading=true . (2012 November 1).

AHRQ - USHIK

Agency for Healthcare Research and Quality 2014 Meaningful Use Clinical Quality Measures Posted to United States Health Information Knowledgebase (USHIK). http://ushik.ahrq.gov/whats_new.jsp?enableAsynchronousLoading=true. (2012 November 1).

48

MU Measures and Meta Data

Agency for Healthcare Research and Quality 2014 Meaningful Use Clinical Quality Measures Posted to United States Health Information Knowledgebase (USHIK). http://ushik.ahrq.gov/MeaningfulUseMeasures?system=mu&enableAsynchronousLoading=true . (2012 November 1).

AHRQ – MU CQMs

Agency for Healthcare Research and Quality 2014 Meaningful Use Clinical Quality Measures Posted to United States Health Information Knowledgebase (USHIK). http://ushik.ahrq.gov/MeaningfulUseMeasures?system=mu&enableAsynchronousLoading=true . (2012 November 1).

Eligible Hospitals (EHs)and Critical Access Hospitals (CAHs) will submit: a. 9 Clinical Quality Measures (CQMs) from at least 3 of

the National Quality Strategy (NQS) domains out of a potential 64 CQMs across 6 domains.

b. 9 CQMs from at least 3 of the NQS domains out of a potential 29 CQMs across 6 domains.

c. 16 CQMs from at least 3 of the NQS domains out of a potential 64 CQMs across 6 domains.

d. 16 CQMs from at least 3 of the NQS domains out of a potential 29 CQMs across 6 domains.

Audience Response

49

Pharmacists Focus

• Care transitions including MR

– Active reconciled medication list

– Bi-directional exchange

• Patient Engagement

– Electronic access to patients medical record

– “Blue Button” project

MU Stages 2 & 3 Comments

• Pharmacy e-HIT Collaborative Comments– http://www.pharmacyhit.org/index.php/collaborative-

outreach

• Collaborative Measure Comments for

Pharmacists using Pharmacist EHR (Dec 2010)– http://www.pharmacyhit.org/pdfs/collaborative-

outreach/HITPCQMCommentsv1.355180020.pdf

Medication Reconciliation (MR)

• Improving Care Transitions:

Optimizing Medication Reconciliation: March 2012

– http://www.ashp.org/DocLibrary/Policy/PatientSafety/Optimizing-Med-Reconciliation.aspx

50

Foundational Concepts

• Through MR

• Improve care transitions

• Reduce the impact of

medication-related problem

• Pharmacist play an important role in all practice settings

Continuity of Care Document (CCD)

• Exchange of clinical data between EHRs

• Development of metadata standards for structured documents– Clinical Document Architecture, Release Two (CDA

R2)• Standard developed by Health Level Seven (HL7)

• Provides wide coverage across metadata elements

• A single standard would make implementation easier• Contain narrative text

Use of Normalized Terminologies

• Consolidated CDA Release 2– Some contain structured data elements or

clinical statements– Some are coded using standard vocabularies

(e.g. Systematized Nomenclature of Medicine--Clinical Terms, SNOMED CT)

– Extensible Markup Language (XML) structured documents

• Discharge Summary, Patient Care Summary, Imaging Report, Admission & Physical, Pathology Report , Medication Action Plan (MAP)

51

HL7-NCPDP Joint Project

Electronic Documentation

• Medication Action Plan (MAP)

– Active reconciled medication list

– Indications for each medications

– Recommended instructions

– Use RxNorm*, SNOMED CT**, and LOINC® ***

*RxNorm - normalized names for clinical drugs; **SNOMED – clinical terms, ***LOINC® -

universal code system for laboratory and clinical observations

Structured Standard Terminology

• In September 2012, 274 MTM specific SNOMED CT definitions approved for nationwide use by National Library of Medicine (NLM)– Collaborative volunteer PSTAC work group

working on reference guide for med management documentation and exchange of the SNOMED CT clinical concepts

• The reference guide categories the codes by encounters, interventions and outcomes

• To educate pharmacists and PMS vendors on incorporating the MTM SNOMED CT codes into their systems

52

PSTAC WG Next Steps

• Work on IG for Professional Care Plan,

Quality and Value Assessment, and Care Transitions

• More SNOMED CT codes

• CPT Codes for Pharmacists

• Standardized terminology

Pharmacy

Care Note

With

Reconciled

Medication

List

Quality &

Value

Assessment

Pharmacy

Care

Transitions

Document

Medication

Action Plan

Process of Care Structure Documents

The Roadmap for The Roadmap for Pharmacy Health Pharmacy Health Information Information Technology Technology Integration in U.S. Integration in U.S. Health CareHealth Care

Pharmacy e-Health Information

Technology Collaborative

53

Website (www.pharmacyhit.org)

Pharmacists’ Contribute to MU

54

EH View – Download - Transmit

Required data elements to be available for EH “View, Download, and Transmit”

• Patient name

• Admit and discharge date and

location

• Reason for hospitalization

• Care team including the

attending of record as well as

other providers of care

• Procedures performed during

admission

• Current and past problem list

• Current medication list and

medication history

• Current medication allergy list

and medication allergy history

• Vital signs at discharge

• Laboratory test results

(available at time of discharge)

• Summary of care record for

transitions of care or referrals to

another provider

• Care plan field(s), including goals, and

instructions

• Discharge instructions for patient

• Demographics maintained by hospital

(sex, race, ethnicity, date of birth,

preferred language)

• Smoking status

©2012 THE ADVISORY BOARD COMPANY � ADVISORY.COM � 25695

Note: Discharge summary NOT included.

55


56


Kathleen S. Pawlicki, M.S., B.S.Pharm., FASHP Administrative Director of Professional Services and Director of Pharmaceutical Services William Beaumont Hospital Royal Oak, Michigan Kathleen S. Pawlicki, M.S., B.S.Pharm., FASHP, is Administrative Director of Professional Services and Director of Pharmaceutical Services at William Beaumont Hospital in Royal Oak, Michigan. Over the past 20 years, she has held several administrative roles at small, medium, and large hospitals. Ms. Pawlicki is also a clinical instructor for the College of Pharmacy at the University of Michigan and an Adjunct Assistant Professor for the College of Pharmacy and Allied Health Professions at Wayne State University. Ms. Pawlicki received her Bachelor of Pharmacy degree from Ferris State University in Big Rapids, Michigan, and her Master of Science degree in pharmacy from Wayne State University in Detroit, Michigan. She also completed an ASHP-accredited residency in hospital pharmacy. Ms. Pawlicki was recognized as a Fellow of the American Society of Health-System Pharmacists (ASHP) in 2001. In September, Ms. Pawlicki was elected to the ASHP Board of Directors. Her term will begin in June 2013. She has served in various capacities in regional and state health-system pharmacy associations, including president of both the Southeast Michigan Society of Health-System Pharmacists and the Michigan Society of Health-System Pharmacists (MSHP). For over seven years, Ms. Pawlicki has served as delegate to the ASHP House of Delegates for the State of Michigan. In 2004, she received the MSHP Pharmacist of the Year Award. Ms. Pawlicki is an active member of ASHP and served on the ASHP Council for Administrative Affairs and as Director-at-Large and Chair of the Executive Committee of the ASHP Section of Pharmacy Practice Mangers.

57




The Pharmacist’s Role in the New Health Care Model:

New Opportunities and ChallengesKathleen S. Pawlicki, M.S., B.S.Pharm., FASHP

Administrative Director of Professional Services and Director of Pharmaceutical Services

William Beaumont Hospital

Royal Oak, Michigan

Opportunities

Quality Measures & Financial Impact

Accountable Care Organization (ACO) shared savings when ACO meets specified quality measures and cost controls targets

Value-based Purchasing (VBP) Medicare will be an active purchaser of quality (Core Measures)

Electronic Health Records (EHR) and

Meaningful Use reporting of clinical quality measures

Opportunities

• Acute Care

Reduced readmissions

Core Measures

Patient satisfaction (medication education)

• Ambulatory CareChronic conditions

Medication adherence

• Transitions of Care

Medication histories

Appropriate discharge prescribing

58

Challenges

• 2010 PPMI* Results

– 147 beliefs, assumptions, and recommendations focused on:

• Imperatives

• Optimal pharmacy practice models

• Technology/technicians

• Successful implementation

• Includes barriers to meeting the practice

model imitative

PPMI -The Pharmacy Practice Model Initiative

ChallengesPPMI Results: Top Barriers

• Pharmacists’ commitment:

– Resistance to change from current pharmacy staff is a barrier to optimal pharmacy practice models

Consensus vote: 100%


• Institutional Culture

– Insufficient recognition by health care executives, medical staff, nursing staff, & others outside the pharmacy profession of the value of pharmacists’ provision of drug-therapy management services is a barrier to optimal pharmacy practice models.

– Consensus vote: 100%

59


• Legal & regulatory environment

– State laws that limit pharmacists’ scopes of practice are barriers to optimal pharmacy practice models

- Consensus vote: 100%

Opportunities versus Challenges

Opportunities

• ACO, VBP, Clinical Quality Measures

• External forces, not in our control

Challenges

• Pharmacists, Culture, Regulatory

• Internal forces, within our control

We are our own worst enemy

The Biggest Opportunity and Challenge

Creating Change

– Pharmacists

– Institutional Culture

60

Creating Change

Start with yourself . . . . .

• Are you ready for the challenge, do you believe in the opportunities and possibilities?

• Are you a great leader?

• Are you an effective leader?

Creating Change

Are you a great leader?

“Great leaders are those who see themselves as having a

responsibility, not those who view themselves as having a job”

- Jim Collins

Creating Change

Are you an effective leader?

Ineffective Leaders

“No, because…….”

Effective Leaders

“Yes, if…….”

61

Leading Change

Kotter JP. Leading change. 1st ed. Boston: Harvard Business School

Press; 1996.

• Eight steps to creating transformational change

Kotter JP, Rathergeber H. Our iceberg Is melting. 1st ed. New York: St.

Martin’s Press; 2005.

• A powerful fable on successfully managing change

• Condenses the eight steps into four stages of success

Leading Change

Creating a culture for change

Make It Happen

– opportunity and empowering others

Make It Stick

– connect to the organization’s goals

• Beaumont Hospital • 1,061 beds (Magnet)

• 57,000 admissions

• 120,000 ER visits

• 52,000 surgeries

• >400 residents/fellows

Our Experience - Beaumont

62

• 2010 – Goal to increase nurses time at bedside– Supported goal through pilot on one nursing unit with

unit-based pharmacists

• 2011 – Expanded unit-based services – Techs, all patient care areas

• 2012 – Model refocused into communities of pharmacists– Services developed per patient population

– Pharmacists developed the programs specific to their patient population

– Involved pharmacists in multi-disciplinary meetings

– Providing tools for pharmacists

Our Experience - Beaumont

5N 6N 7N 8N 9N 8S 9S 5C/6C/7C 8C/9C 4C/4CN

Discharge Counseling (Focus: patients

on anticoagulants, CHF, COPD

diagnosis)

√ √ √ √ √ √ √ √ √ √

Open IVents - Pradaxa/Xarelto

(discharge counseling)√ √ √ √ √ √ √ √ √ √

Open IVents - Moxifloxacin (IV to PO) √ √ √ √ √ √ √ √ √ √

CHF follow up/ Maxys report/open

IVents√ √ √ √ √ √ √ √ √ √

Review AVS for patients discharged to

ECF's√ √ √ √ √ √ √ √ √ √

Discharge Huddles √ √ √ √ √ √ √ √ √ √

Review PTA med lists √ √ √ √ √ √ √ √ √ √

Relabeling of bulks for discharge √ √ √ √ √ √ √ √ 8C √

Stroke follow-up √

Meet & Greet tent cards √ √ √ √ √ √ √ √ 8C √

Elder Care pharmacist protocol √

COPD Teaching √

Check for printed CS scripts for

patients discharged to ECF's8C

CHF rounds √

Beta-blocker SCIP measure √

Review of acute coronary syndrome

patients at discharge√

Tikosyn education √

Neurosurg pain protocol In progress

Patient medication information

handout

In progress

(CHF pts)In progress √

Ortho pain protocol In progress

Discharge prescription service √ √ √ √ √ √ √ √ 8C √

63

Challenges/Opportunities – it starts with you!

“We can lead the change that we believe in or we can just position ourselves to be forced to

accept the change being put on us by others. The choice is quite clear . . . We’re going to lead

the change.”

- William A. Zellmer, M.P.H.

Table Exercise

Situation: You are a pharmacy manager and have begun to evaluate what your Pharmacy

Department can do to address the challenges your hospital is facing with ACO’s, VBP, MU. You have determined that pharmacy can participate in

addressing the challenges the hospital is facing.

Table Exercise

1. How would you create a culture of change in your department?

2. What activities could you engage in with your

staff to “make it happen”?

3. How do you “make it stick”?

64


R E F E R E N C E S A N D S U G G E S T E D R E A D I N G S

Accountable Care Organizations

1. Accountable Care Organizations: a measured view for academic medical centers. University HealthSystem Consortium, May, 2011. The Medicare Shared Savings Program: final rule. The Advisory Board Company, November, 2011.

2. American Hospital Association Committee on Research. Accountable Care Organizations—AHA research synthesis report. American Hospital Association. 2011;1-18.

3. Becker’s Hospital Review. Rodak, S. Implementing ACOs one of top challenges for medical groups, survey finds. 2011. http://www.beckershospitalreview.com/hospital-physician-relationships/implementing-acos-a-top-challenge-for-medical-groups-survey-finds.html (accessed 2012 Sept 28).

4. Daigle, L. ASHP Policy Analysis: pharmacists’ role in ACOs, January, 2011.

5. Gold, J. FAQs on ACOs: accountable care organizations, explained. Kaiser Health News. 2011.

6. Haywood TT, Kosel KC. The ACO model-a three year financial loss? N Engl J Med. 2011; 364:e27.

7. Keckley, PH, Hoffmann, M. Accountable Care Organizations: A new model for sustainable innovation. Deloitte Center for Health Solutions. 2011;1-19.

8. McCarthy D, Mueller K. Organizing for Higher Performance: case studies of organized delivery systems. The Commonwealth Fund, July 2009.

9. McClellan M, McKethan AN, Lewis JL et al. A National Strategy to Put Accountable Care into Practice. 2010; 29:982-90.

10. Medicare Payment Advisory Commission. Report to the Congress—Improving Incentives in the Medicare Program. MedPac. 2011;39-56.

11. Miller, HD. How to Create Accountable Care Organizations. Center for Healthcare Quality and Payment Reform. 2009.

12. National Committee for Quality Assurance (NCQA) Patient-Centered Medical Home – A New Model of Care Delivery, 2011.

13. Pharmacists as Vital Members of ACOs, Academy of Managed Care Pharmacy (AMCP), April, 2011.

14. Physicians for a National Health Program. – California. Sullivan, K. The history and definition of the “Accountable Care Organization.” http://pnhpcalifornia.org/2010/10/the-history-and-definition-of-the-%E2%80%9Caccountable-care-organization%E2%80%9D/ (accessed 2012 Sept 28).

15. Springgate, BF, Brook, RH. Accountable care organizations and community empowerment. Health Affairs. 2011;1800-1.

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Value-based Purchasing

1. Centers for Medicare & Medicaid Services. Open door forum: hospital value-based purchasing fiscal year 2013 overview for beneficiaries, providers, and stakeholders. http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/hospital-value-based-purchasing/downloads/HospVBP_ODF_072711.pdf (accessed 2012 Nov 1).

2. Medicare and Medicaid Programs: Hospital Outpatient Prospective Payment; Ambulatory Surgical Center Payment; Hospital Value-Based Purchasing Program; Physician Self-Referral; and Patient Notification Requirements in Provider Agreements. Federal Register. Vol 76; No. 230: Wednesday, November 30, 2011. Rules and Regulations.

3. Medicare Program: Hospital Inpatient Value Based Purchasing Program. Federal Register. Vol 76; No. 9: Thursday, January 13, 2011. Proposed Rules.

4. Medicare Program: Hospital Inpatient Value Based Purchasing Program. Federal Register. Vol 76; No. 88: Friday, May 6, 2011. Rules and Regulations.

5. StratisHealth. Is your hospital ready for value-based purchasing? http://www.stratishealth.org/documents/VBP_factsheet.pdf (accessed 2012 Nov 1).

6. U.S. Department of Health & Human Services. Potential future measures for hospital value based purchasing program. http://www.hospitalcompare.hhs.gov/data/VBP/value-based-purchasing.aspx (accessed 2012 Nov 1).

Meaningful Use

1. Agency for Healthcare Research and Quality. 2014 meaningful use clinical quality measures posted to United States health information knowledgebase (USHIK). http://ushik.ahrq.gov/index.jsp?enableAsynchronousLoading=true (accessed 2012 Nov 1).

2. American Society of Health-System Pharmacists. Improving care transitions: optimizing medication reconciliation. http://www.ashp.org/DocLibrary/Policy/PatientSafety/Optimizing-Med-Reconciliation.aspx (accessed 2012 Oct 29).

3. Centers for Medicare & Medicaid Services. 2014 clinical quality measures. http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/2014_ClinicalQualityMeasures.html (accessed 2012 Oct 29).

4. Pharmacy e-Health Information Technology Collaborative. Federal advisory committee public comments. http://www.pharmacyhit.org/index.php/collaborative-outreach (accessed 2012 Oct 29).

5. Pharmacy e-Health Information Technology Collaborative. HIT policy committee measure comments. http://www.pharmacyhit.org/pdfs/collaborative-outreach/HITPCQMCommentsv1.355180020.pdf (accessed 2012 Oct 29).

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6. Pharmacy e-Health Information Technology Collaborative. The roadmap for

pharmacy health information technology integration in U.S. Health Care. http://www.pharmacyhit.org/pdfs/11-392_RoadMapFinal_singlepages.pdf (accessed 2012 Oct 29).

7. The Advisory Board Company. Meaningful use - the whiteboard story - meaningful use stage 1 final rule compared to stage 2 final rule objectives and measures. www.advisory.com/MUwhiteboard (accessed 2012 Oct 29).

8. The Advisory Board Company. Pocket quick guide comparison stage 1 to stage 2 meaningful use final rule objectives and measures. www.advisory.com/MUpocketguide. (accessed 2012 Oct 29).

The Pharmacist’s Role in the New Health Care Model

1. Kotter JP. Leading change. 1st ed. Boston: Harvard Business School Press; 1996.

2. Kotter JP, Rathergeber H. Our iceberg is melting. 1st ed. New York: St. Martin’s Press; 2005.

67


S E L F – A S S E S S M E N T Q U E S T I O N S

1. Which of the following is a stated goal of Accountable Care Organizations (ACOs)?

a. Improving the care of populations. b. Improving reimbursement of primary care practitioners. c. Maintaining a base of inpatient referrals. d. Improving medication safety.

2. Strategies to improve care under ACOs include all of the following EXCEPT:

a. Using a team of professionals to provide the best care to patients. b. Avoiding unnecessary and duplicative services. c. Increasing admissions for high risk patients. d. Using practice guidelines.

3. Is the following statement true or false? ACO payments structures may be either

one-sided (only share in savings) or two-sided (could share in savings but also could

be at risk for a share of losses).

a. True. b. False.

4. All of the following are fundamental steps in preparing pharmacists to function

effectively within an ACO model EXCEPT

a. Developing a systematic and standardized pharmacy practice model to provide comprehensive patient care.

b. Establishing collaborative practice agreements with physicians. c. Obtaining special clinical privileges endorsed by a credentialing committee. d. Obtaining independent prescribing privileges.

5. Of the following statements, which statement on value-based purchasing (VBP) is

incorrect?

a. For Federal Fiscal Year (FFY) 2013, process measures account for 30% and HCAHPS scores account for 70% of VBP scores.

b. For Federal Fiscal Year (FFY) 2013, VBP is budget neutral in that some hospitals will lose money and some hospitals will make money depending on established measure performance.

c. Beginning FFY 2013, one percent of each hospital’s Medicare funds were at risk based on measure performance.

d. Hospitals are currently in the measurement period for FFY 2014 VBP.

68


6. Which of the following is NOT one of the elements of value-based purchasing for

Federal Fiscal Year (FFY) 2014?

a. Mortality Measures. b. Hospital Acquired Conditions (HAC). c. Process Measures (Core Measures/Surgical Care Improvement Project

Measures). d. Patient Experience Measures Hospital Consumer Assessment of Healthcare

Providers and Systems (HCAHPS).

7. Readmission Measures for Federal Fiscal Year (FFY) 2013 include all of the

following except

a. Pneumonia. b. Heart Failure. c. Chronic Obstructive Pulmonary Disease. d. Acute Myocardial Infarction.

8. When will reporting of clinical quality measures (CQMs) for all providers begin?

a. 2014. b. 2015. c. 2016. d. 2017.

9. Eligible Hospitals (EHs) and Critical Access Hospitals (CAHs) will be required to

submit which of the following data?

a. 9 Clinical Quality Measures (CQMs) from at least 3 of the National Quality

Strategy (NQS) domains out of a potential 64 CQMs across 6 domains. b. 9 CQMs from at least 3 of the NQS domains out of a potential 29 CQMs across 6

domains. c. 16 CQMs from at least 3 of the NQS domains out of a potential 64 CQMs across

6 domains. d. 16 CQMs from at least 3 of the NQS domains out of a potential 29 CQMs across

6 domains.

10. Is the following statement true or false? The results of the PPMI revealed that a top

barrier to advancing the practice model is resistance to change from current

pharmacy staff.

a. True. b. False.

69


11. Opportunities in the new health care model include which of the following tasks?

a. Pharmacists/technicians taking medication histories. b. Pharmacists participating in core measures. c. Pharmacists assisting with patient medication adherence. d. a and b. e. all of the above.

Answers

1. a. 2. c. 3. a. 4. d. 5. a. 6. b. 7. c. 8. a. 9. d. 10. a. 11. e.

70