2015 Annual Convention

Transcription

1 2015 Annual Convention Date: Tuesday, October 13, 2015 Time: 11:30 am 1:00 pm Location: Gaylord National Harbor Resort and Convention Center, National Harbor 11 Title: Activity Type: Speaker: Managing the Clinical Aspects of Long Term Care Pharmacy ACPE # L04-P 0.15 CEUs ACPE # L04-T Application-based Sharon Clackum, PharmD, CGP, President, American Society of Consultant Pharmacists Pharmacist and Pharmacy Technician Learning Objectives: Upon completion of this activity, participants will be able to: 1. Outline the job description of a clinical consultant in a skilled nursing facility. 2. Discuss basic contracting terms that are covered in skilled nursing facility contracts. 3. Describe effective metrics that can be utilized to measure consultant pharmacist performance. Disclosures: Sharon Slackum declares no conflicts of interest or financial interest in any product or service mentioned in this program, including grants, employment, gifts, stock holdings, and honoraria. NCPA s education staff declares no conflicts of interest or financial interest in any product or service mentioned in this program, including grants, employment, gifts, stock holdings, and honoraria. NCPA is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education. This program is accredited by NCPA for 0.15 CEUs (1.5 contact hours) of continuing education credit.

2

3 Managing the Clinical Aspects of Long Term Care Pharmacy Sharon F. Clackum, PharmD, CGP Attac Consulting Group Disclosure Sharon F. Clackum, PharmD, CGP, President of American Society of Consultant Pharmacists I have no actual or potential conflict of interest in relation to this activity. Learning Objectives Pharmacist and Pharmacy Technician Learning Objectives: 1. Outline the job description of a clinical consultant in various institutional settings. 2. Identify the components of a good consulting report. 3. Describe effective metrics that can be utilized to measure consultant pharmacist performance. 4. Discuss basic contracting terms that are covered in skilled nursing facility contracts. 1

4 Opportunities to Expand Your Business Different practice settings for consultants What s required by practice setting Understand the needs of the customer may be different for the same type of customer (e.g. short stay skilled nursing facility with Electronic Health Records {EHR} vs. traditional long term care skilled nursing facility without EHR) Different Pharmacy Opportunities that require a Consultant Pharmacist Skilled Nursing Facility (SNF) Assisted Living Facility (ALF) MR/DD Group Homes SurgiCenters Treatment Centers Hospice Correctional Institutions Consulting requirements vary by state for all but SNF Skilled Nursing Facility Federal Requirement for Medication Regimen Review for each patient/each month Change of Condition and Transitions of Care Review Regulatory Compliance (F-Tag and SOM) Med Pass Observation and Med Room Checks Antibiotic Stewardship and QAPI involvement Specific rules of Medicare participation Education and In-services 2

5 Federal Law Mandates for Long Term Care Federal Law Mandates Decrease medication errors and adverse drug events Assure proper medication selection Monitor drug interactions, overmedication, and undermedication Improve the documentation of medication administration Medicare Rules for Participation for Long Term Care Pharmacies 1. Comprehensive Inventory and Inventory Capacity 2. Pharmacy Operations and Prescription Orders 3. Low Income Subsidy (LIS) 4. Special Packaging 5. IV Medications 6. Compounding/Alternative Forms of Drug Composition 7. Pharmacist On-call Service, ( ) 8. Delivery Service Pharmacy policies and procedures 9. Emergency Boxes 10.Emergency Log Books 11.Miscellaneous Reports, Forms and Prescription Ordering Supplies Medicare Rules for Participation LTCP Services Specialized medication carts, emergency drug supplies, and equipment to assist in the storage control and dispensing of medications Preparation of computerized medical records for facilities (medication administration records, physician s monthly order sheets, treatment records, etc) Specialized services such as intravenous and infusion therapy services Emergency back-up systems Pharmacy policies and procedures Facility and resident specific reports 3

6 Medicare Rules for Participation Consulting Pharmacy Services Medication Regimen Reviews (MRR) Counsel patients Present in-services, attend policy meetings Transitions of Care and Discharge Planning (proposed) Skilled Nursing Facilities Billing Challenges ESRD Hospice Part B vs D Areas Insulin Supplies Tube feedings Catheters Wound Supplies Long Term Care Participation References Medicare Part D Chapter 5, Section anualchapter5_ pdf Systems/Statistics-Trends-and- Reports/Reports/downloads/LewinGroup.pdf 42 CFR title42-vol3/pdf/cfr-2011-title42-vol3-sec pdf ceandservicecriteriaformedicarepartdltc.pdf 4

7 Assisted Living / Group Homes Rules and Regulations vary by State Medication Regimen Review Quarterly or Biannually (if required) Certified Medication Aide training by RPh,RN,MD Skills Checkoff Med Pass Observation and Med Room Check Prescription Requirement Medication Management in Assisted Living: A Handbook for Pharmacists with CD - Second Edition Surgi-Centers Know your state rules and regulations, they vary Accreditation JCAHO Joint Commission on Accreditation of Healthcare Organizations AAAHC Accreditation Association for Ambulatory Health Care AAAASF - American Association for Accreditation of Ambulatory Surgery Facilities Policies and Procedures Surgi-Centers Consulting Pre- operative Medication Review Crash Carts Medication Room Reviews Ambulatory Surgery Center Handbook: A Guide for Consultant Pharmacists with CD 5

8 Outpatient Treatment Centers Small quantity of medications Consulting Medication Room Reviews Rules and Regulations vary by State Hospice Medicare Regulations Patient E-kit (individualized vs facility) Compounding Delivery Challenges Guidance/Guidance/Manuals/downloads/bp102c09.pdf Policies & Procedures Manual for Hospice with CD Correctional Facilities Generally local or state facilities Emergency supplies Contract Medical Teams Compliance Packaging Contracting 6

9 Consulting Standards Where to find How to stay updated Organizations to join Why join?? Expanded Marketing Opportunities What is a Consultant Pharmacist Clinical Practitioner Resident Care Advocate Member of Resident Care Team Educator Regulatory Expert Immunization Advocate Provides MTM services Management Expert Resident Assessment Expert What is a Consultant Pharmacist MTM Comprehensive Medication Regimen Review Assessment of Resident s Ability to Self Medicate Effective Communicator Resident, Family, Pharmacy, Facility Staff, Medical Professionals Entrepreneur Innovator Problem Solver 7

10 Consultant Pharmacist Skills 1) Trainable Clinical Skills Regulatory Review Desire for Positive Patient Outcomes Customer Service ** 2) Inherent Ability to think on your feet and problem solve Business Acumen Customer Service ** Flexible and Self Motivated Consultant Pharmacist Visit Entrance Notification and Facility Problem Solving Medication Regimen Review Complete Chart Review Med Pass Observation / Med Room Check Immediate Clinical Problem Resolution Reports for Nursing and Physicians CMR (Comprehensive Medication Review) Discharge Planning Exit Interview Consultant Pharmacist Report Overall Summary of Services Provided Executive Summary What the facility should focus on to improve Listing of Recommendations, RN, MD, Psych team Recommendations for Pharmacy/Medical Records Psychotropic Medication Report Anticoagulant Report Antibiotics Report 8

11 Consultant Pharmacist Report Formulary Management (PA, ST, etc) Discharge Planning Med Pass/Med Room Check Report Quarterly QA report Specialty reports as requested by facility Controlled Substance Reconciliation/Destruction Paper vs Electronic Copy- encryption for Copy of Report for Pharmacy SNF Needs during Survey Pharmacy Enhanced Delivery and Stat Orders as Needed Quick Response for Issue Resolution All hands on deck attitude Consultant Be available go to facility if requested Talk with surveyor to resolve questions and prevent tags Read 2567 Report and Offer suggestions for Plan of Correction Evaluating Consultant Performance Metrics used to Evaluate Consultant Performance Facility Satisfaction Productivity Patient Outcomes Survey Results 9

12 Evaluating Consulting Performance Facility Satisfaction Consultant can make or break your relationship with the facility Many times a facility will stay with the pharmacy even through major errors/frustration if they like the consultant pharmacist Consultant is YOUR face in the facility and the initial contact for problem solving Good consultant can bring you business (ADM/DON change facilities, SurgiCenters, Treatment Centers) Evaluating Consulting Performance Productivity Number of chart reviews per hour # recommendations Recommendations response rate # of recommendations with positive response Time spent in various activities med pass observation, in-services, exit interviews, drug destruction Evaluating Consulting Performance Patient Outcomes Percentage decrease in Antipsychotics (D/C or decrease in strength) # of dose changes dependent on renal function % of insulin dependent diabetics using SSI > 30 days Percentage decrease in High Risk Medications # comments made on patients with falls Comments made on clinical relevance 10

13 Evaluating Consulting Performance Patient Outcomes (cont) # comments made in specific disease states (DM, HTN, CKD, Dementia, etc) Skills questionnaires (initial hires/training) Competency Testing Performance Evaluation and Coaching Plan Evaluating Consulting Performance Survey Outcomes F-tags related to Pharmacy Services F-309 Quality of Care F-329 Unnecessary Drugs F-332 Medication Errors F-425 Pharmacy Services F-428 Medication Regimen Review F-Tag 431: Storage, Labeling, and Controlled Medications Employee vs Contractor 3 types of Consultants Employee Individual Contracted Consultant Consultant Group Contract Advantages and Disadvantages 11

14 Consulting Software Several Main Players Geri-Med RxPertise Evaluate monthly costs and Licensing fees Evaluate Interoperability with Dispensing System Does it provide multiple report types (SNF< ALF< MTM< SurgiCenters) Contracting Contracts with Facility Separate contracts for Pharmacy Services Consulting Services Part B services Contract with Consultant Pharmacist (not employee) Contract for Delivery Contract for Backup Pharmacy Services (24/7/365) Contract Pitfalls to Avoid READ CONTRACTS CLOSELY Read Fine Print closely use a lawyer familiar with healthcare facilities Avoid Performance Guarantees/Penalties Watch Terms want shortest payment terms, offer discount for less than 30 day payment Watch for 30/60 day cancellation without cause Choice of law if servicing multiple states-home state advantage 12

15 Contract Pitfalls to Avoid Providing equipment that does not enable business interoperability --- Evaluation to prevent anti-kickback issues AVOID Per diems unless you really understand them and make sure they include risk sharing (these may become popular again with value based payments) Who pays for excessive stat deliveries who pays for back-up delivery costs Know the acuity of the resident base Contracting Positives 90 days to resolve cure problems Specifics on who pays for excess services and the terms Electronic Health Record Access Consultant Contract Pay by bed (actual vs licensed) vs Hourly Rate Provision of inservices how many or how often Reimbursement for CMR or TMR Reimbursement for Extra Services (e.g. doing Med Pass Observations for every nurse vs random quarterly review) 13

16 E-MARS Contracting Make sure your contract covers your costs PPPM vs Flat Monthly costs Provision of equipment you don t want to become an IT department provide services not equipment Back up plan Summary of Take Home Points Questions 14

17 15