Embed Size (px)
Citation preview
2015 Update Pharmacists As Providers
and Current Healthcare Quality Trends
Rebecca P. Snead
National Alliance of State Pharmacy Association
Tara Modisett
Alliance for Patient Medication Safety
Disclosure
Rebecca Snead and Tara Modisett declare no conflicts of interest, real or apparent, and no financial interests in any company, product, or service mentioned in this program, including grants, employment, gifts, stock holdings, and honoraria.
Learning Objectives for Pharmacists/Technicians
At the completion of this knowledge-based activity, the participant will be able to: • Describe what provider status means in the context of federal and
state level. • Describe the current status of efforts to have pharmacists recognized
as providers in the health care system on both federal and state level. • Explain how recognition of pharmacists as providers can impact
patient access to pharmacy services and overall quality of care. • Explain how collecting near miss and error data contributes to overall
quality of care and the credibility of pharmacists as providers on the health care team. • Explain Federally Listed Patient Safety Organizations (PSO) and the
importance of partnering with a PSO.
About NASPA
The National Alliance of State Pharmacy Associations (NASPA) promotes leadership, sharing, learning, and policy
exchange among state pharmacy associations and pharmacy leaders nationwide, and provides education and
advocacy to support pharmacists, patients, and communities working together to improve public health.
NASPA was founded in 1927 as the National Council of State Pharmacy Association Executives (NCSPAE).
Why Provider Status?
Promote consumer access and coverage for
pharmacists’ patient care services. -Tom Menighan
Federal Provider Status Milestones in History
• Late 1990s/Early 2000s Pharmacists Seek Recognition to: • Provide Patient Care Services
• Manage Clinics
• Outpatient Service Lines
• 2001 - Pharmacist Provider Coalition
• Legislation introduced in 2001 and 2002 • To provide for coverage for pharmacist services under Medicare Part B
The Patient Access to Pharmacists’ Care Coalition (PAPCC)
• Publically announced early March 2014
• Currently more than 29 organizations and growing
• Representing patients, pharmacists, and pharmacies, as well as other interested stakeholders
The Patient Access to Pharmacists’ Care Coalition (PAPCC)
•Mission: develop and help enact a federal policy proposal that would enable patient access to, and payment for, Medicare Part B services by state-licensed pharmacists in medically underserved communities.
• Primary goal: expand medically-underserved patients’ access to pharmacist services consistent with state scope of practice law.
2015 Legislative Activity
• January 28, 2015: House Bill 592 introduced • Sponsors: Reps. Brett Guthrie (R-KY), G.K. Butterfield (D-NC), Todd Young
(R-IN), and Ron Kind (D-WI)
• January 29, 2015: Senate Bill 314 introduced • Sens. Charles Grassley (R-IA), Sherrod Brown (D-OH), Mark Kirk (R-IL) and
Bob Casey (D-PA)
• Both titled: The Pharmacy and Medically Underserved Areas Enhancement Act
• Follows 2014’s H.R. 4190
PAPCC – H.R. 592 and S. 314
Scope of Proposal
• Pharmacists – State-licensed pharmacists with a B.S. Pharm. or Pharm. D. degree who may have additional training and certificates depending on state laws
• Services – Services authorized under state pharmacy scope of practice laws
• Patients – Services provided in/ for Medically Underserved Areas (MUA), Medically Underserved Populations (MUP), or Health Professional Shortage Areas (HPSA)
• Reimbursement – Consistent with Medicare reimbursement for other non-physician practitioners, pharmacist services would typically be reimbursed at 85% of the physician fee schedule
PAPCC - H.R. 592 and S. 314
Are only a limited number of pharmacists
eligible under the federal bill?
Accessed from www.pharmacistsprovidecare.com on 2.2.15
Lessons from H.R. 4190
Feedback from Hill
• Positive feedback overall but cost is important
Need to “score” low by Congressional Budget Office (CBO)
Pharmacy challenged to be “saver, not coster”
Concern by pharmacy that savings, especially those that are long-term, are not considered when scoring
• Not full understanding of the services pharmacists are/ can provide
• Hill equates provider status with “fee-for-service”
Current focus is on new payment models (e.g. ACOs) & not “old” system
Lessons from H.R. 4190 • Common questions from Hill:
– Position of the American Medical Association
• At this time neither oppose nor support
• Physician members, Roe (R-TN) and Bera (D-CA) of Congress cosponsored
– Cost of the bill
• Do not have a CBO score; CBO’s lack of dynamic scoring
–Private numbers are less than $1 billion a year over 10 years
– Support from the House
• Total of 123 co-sponsors on the bill by the end of the session
PAPCC Activities
Next Steps • Developing long-term strategy; this is not a sprint
• Education and Outreach
– Meet with Federal Agencies (e.g. HHS, FTC) and comment on regulations
– Continues to educate House and Senate members and their staff on The Pharmacy and Medically Underserved Areas Enhancement Act
– Work to increase membership
• Include patient and other health care provider groups
Provider Status at the State Level The 3 Components and Current Landscape
State vs. Federal Landscape
State • Designation not usually
associated with payment • Scope of practice defined in
state statute • Incremental changes, year
by year • No one solution fits every
state
Federal • Designation in Social
Security Act would likely lead to payment for service
• Scope of practice not defined
• All “asks” are a heavy lift, difficult to go back year after year
• Generally unified goal
Common Goal: Patient Access to Pharmacists’
Patient Care Services
Achieving Patient Access
Provider Designation
Optimization of Pharmacy Practice Act
Payment for Service
Patient Access to Pharmacists’ Patient Care
Services
Provider Designation
• Provider designation 37
• State statute 35
• Medicaid 9
Current Landscape of Provider Designation
Optimization of the Pharmacy Practice Act
What Services?
Collaborative practice provisions
Immunization authority
Order/interpret labs, CLIA waived tests
Statewide protocols to enhance public health
2014 “wins” in Scope Expansion: CPA
Tennessee (effective 7.1.14) • Senate Bill 1992/ House Bill 2139 (Public Chapter 832) • Although pharmacists in Tennessee have been working
with physicians through language that allows for a “pharmacist-physician relationship” through medical orders for individual patients, there was previously no explicit CPA language in Tennessee law
• The new language authorizes one or more pharmacists to provide patient care through a collaborative pharmacy practice agreement with one or more prescribers
Current Landscape: CPA
• 48 states with some sort of CPA authority
• 45 states can modify therapy
• 38 can initiate therapy
• 18 have some extra requirement for pharmacist participation beyond licensing
•Other variances include site restrictions, administrative requirements, which practitioners can collaborate with pharmacists, among others
Current Landscape: Other
• All states allow for some immunization administration, growing number allow without Rx
• A growing number of states are allowing pharmacists to provide an expanded public health role (e.g. smoking cessation products and counseling, fluoride treatment, TB testing, oral contraceptives, naloxone), often under a statewide protocol
Payment for Services
State Provided Medical Benefits
• State Employees and/or State Medicaid programs
• Some states have found success in implementing an MTM or other pharmacy service benefit into one of these state funded programs
• Could be done with or without recognition as a provider in that state
Mandate for Private Insurers
• Addition of a provision within the insurance code could attempt to require that a service that is provided by pharmacists (such as MTM or other services) be covered
• Example: Washington State
Working with Private Insurers/Employers (no legislative action)
• There is nothing stopping private insurers from covering any service they find valuable
•Have to be prepared to demonstrate value and have plan for how the service will be able to be delivered
• Examples: Ohio, Tennessee
• Some kind of Payment 30
• Some Medicaid Service 17
• Medicaid MTM 9 • State Employee
MTM 6
Payment for Services
HI�
AK�
DC�MO�
NH�
FL�
CA�MD�DE�
MA�NY�RI�
IL
CT�
VT�
NJ�
ME�
MN�OR�
ID�
MT� ND�
SD�
NV�UT�
AZ� NM�
TX�
WY�
CO�
NE�
OK�
KS�
AR�
L� GA�
LA�
Based�on�data�collected�by�NASPA��(Updated�Jan�2015)�
CA�
D������
NM
AK�
UTTT��������������
OR�
C
M
WY
MO
E�����������
TX
States�with�Payment�for�Pharmacist�Services�
KS�������������������
What Can You Do?
Advocate
Support
Learn
Advocacy Resources
APhA: PharmacistsProvideCare.com
• Join the Campaign!
• Fact Sheets • Making the case
• HR4190
• State Info
• Public opinion polls
• Scope of practice
• Student Tool Kit
Advocacy Resources
Messaging
• Access to health care is a real issue for patients and pharmacists can help
• People on complex medications benefit from pharmacists’ services
•When pharmacists are on the patient’s health care team, costs go down and quality improves
•While the successful passage of H.R. 592/S. 314 is a priority for our profession—it is critical to our patients
Prepare today for Success Tomorrow
•Are you ready?
• Is your practice ready?
•Are you ready to be held accountable for quality and outcomes?
About APMS
A Patient Safety Organization (PSO) The mission of APMS is to foster a culture of quality within the profession of pharmacy that promotes a continuous systems analysis to develop best practices that will reduce medication errors, improve medication use and enhance patient care. APMS is a non-profit 501(c) 3 A supporting organization of the National Alliance of State Pharmacy Associations
About APMS….
• First listed as a PSO on 12/10/2008..relisted in 2011 and again in 2014
• 3500 plus pharmacies in 47 states and Puerto Rico
• Collect over 13,000 QREs each month
Crack the Code
Patient Safety Organization PSO Continuous quality improvement/quality assurance CQI/QA
Quality Related Events – errors and near misses QRE
Just Culture
The shift to Value-Driven Healthcare
• The U.S. health care system is rapidly moving to value-based purchasing or “value-driven healthcare”
• Value is the balance of quality and costs, thus we can optimize value by improving quality while reducing costs
• Will see increasing focus on accountability and outcomes
Provider Status = Accountability
Accreditation Credentialing
Certification Performance Reports
Proof of Quality Assurance
Process
Patient Safety and Quality
Improvement Act of 2005
• Provided for the creation of patient safety organizations (PSOs) • The goals of the Patient Safety Act are:
• To encourage reporting
• To promote rapid learning
• To share what is learned
2
PSOs…
• Are federally listed non-governmental organizations that collect QA data from members
• Operate independently, without a relationship to regulatory and/or accrediting bodies
• PSO benefits only extend to member pharmacies
• Duties to maintain confidentiality and security for collected data
• Duties to analyze data and provide feedback
PSOs….. • Engage in specific patient safety activities with their provider
clients in a protected environment
• Create foundation of data collection, aggregation and analysis.
• Can assist in identifying patterns and trends and help put best practices into place
• Help eliminate the risks and hazards associated with the delivery of healthcare
PSO privileges do not protect:
• Patient's medical record, billing and discharge
information, or any other original patient or provider record. • Prescription vials, labels, dispensing documents
• Information that is collected, maintained, or
developed separately, or exists separately, from a patient safety evaluation system.
The PSO and CQI/QA
Connection
• Pharmacies Required to have a Continuous Quality Improvement Program: • CMS Regulations (network contracts) • State Requirements (13 States) • Quality of Care • Valuable metrics for improved risk management
and workflow • Verification or certification = You have DATA and CQI/QA work Working with a PSO protects all of the above
Elements of a CQI program
• Safety Culture • Workflow assessment
• Policies and Procedures
• Commitment to and structure in place for evaluation and
prevention of future quality related events • An “active” continuous quality improvement cycle
CQI Loop
� Establish a continuous quality improvement (CQI) program. � Establish written CQI Policies and Procedures. � Ensure that staff CQI training and/or education is provided to
pharmacists and other pharmacy personnel. � Ensure that QREs are documented, reported, and analyzed.
� Maintain security of patient safety data by adhering to a Patient Safety Evaluation System, reporting to a federally listed Patient Safety Organization
� Assure that reporting and documenting complies with state and
federal laws in all applicable jurisdictions.
“No news” IS NOT
“good news”
• The fundamental feature of a CQI program that
distinguishes it from a simple medication error reporting system is the pursuit of WHY the QRE occurred. • Peer Review is an evidence-based method to answer the
“WHY” questions. • The challenge is to answer the WHY questions in a way
that avoids creating a punitive culture.
Development of a Peer Review System Basic Concepts
• Communication?
• Training provided?
• Had procedures been reviewed?
• Staffing?
• Work area?
• Policy & Procedure followed?
How to analyze – questions to
consider
?
• Increasing focus on accountability and outcomes
• Pharmacies required to have a Continuous Quality Improvement/Quality Assurance Program
= Safer outcomes for patients and workflow improvement
ADD working with a PSO…..
• Shared learning opportunities within pharmacy and healthcare team
• Privilege and confidentiality for quality assurance work
• Lessons learned across healthcare
Rebecca P. Snead Executive Vice President
National Alliance of State Pharmacy Associations
Tara Modisett Executive Director
Alliance for Patient Medication Safety [email protected]
QUESTIONS?
