a toolkit for senior care pharmacists · · 2017-10-12a toolkit for senior care pharmacists ... ,...

MEDICATIONSAFETYDURINGTRANSITIONSOFCARE:ATOOLKITFORSENIORCAREPHARMACISTS

Thistoolkitisdesignedforseniorcarepharmacistsinanypracticesettingandservesasaresourceguideofavailablebest-practiceclinicalandmedicalinformationforuseduringtransitionsofcare.Itincludespracticalguidancetoassistpharmacistsastheynavigate

thecomplexbillinglandscape.

MedicationSafetyandTransitionsofCareWorkgroupAmericanSocietyofConsultantPharmacists,2016-2017

SPEAKERS

Marylee Grosso,BSPharm,PD,RPh,FASCP,2016-2017Co-ChairHealthCareConsults,LLCAlexandria,VA

AndrewTrella,PharmD,MBAFoulkeways atGwynedd RetirementCommunityGwynedd,PA

AddolorataM.Ciccone,PharmD,BCGP,2017Co-ChairJeffersonHouse,HartfordHealthcareNewington,CT

JosephGruber,RPh,BCGP,FASCP,2016Co-ChairActualMeds CorporationDublin,Ohio

DISCLOSURES

JosephGruberistheChiefClinicalOfficerofActualMedsCorporation.

Theotherspeakersdisclosenorelevantfinancialconflictsofinterestwithregardtothisactivity.

LEARNINGOBJECTIVES

Attheconclusionofthisknowledge-basedactivity,participantsshouldbeableto:

1. Describethetransitionsofcarelandscape.

2. Explaintheimportanceofmedicationsafetyprocessesduringtransitionsofcare.

3. ReviewthecomponentsofASCP'sMedicationSafetyduringTransitionsofCare(MSTOC)Toolkit.

MEDICATIONSAFETYDURINGTRANSITIONSOFCARE:ATOOLKITFORSENIORCAREPHARMACISTS

Thistoolkit,sponsoredbytheASCPBoardofDirectors,wasdevelopedbyavolunteerworkgroupofseniorcarepharmacistsrepresentingmultipleareasofconsultantpharmacistpractice.ASCPLeadershipwouldliketoacknowledge

thededicationandhardworkoftheseindividuals.

JosephGruber,RPh,BCGP,FASCP,2016Co-ChairActualMeds CorporationDublin,Ohio

MaryleeGrosso,BSPharm,PD,RPh,FASCP,2016-2017Co-ChairHealthCareConsults,LLCAlexandria,VA

AddolorataM.Ciccone,PharmD,BCGP,2017Co-ChairJeffersonHouse,HartfordHealthcareNewington,CT

JoanBaird,PharmD,BCGP,ASCPStaffLiaisonAmericanSocietyofConsultantPharmacistsAlexandria,VA

RobertAccetta,RPh,C-MTM,BCGPRivercare Consulting,LLCCortlandt Manor,NY

KatherineAnderson,PharmD,BCGP,FASCP,ASCPBoardLiaisonPharmacistsInternationalConsultingUniversityPlace,WA

DonnaBellamy,PharmD,BCGPDeptofGerontology,FortValleyStateUniversityFortValley,GA

KellyBraham,PharmD.BCGPUpstateCommunityHospitalSyracuse,NY

MarkE.Creasman,RPh,BCGP,FASCPTransylvaniaRegionalHospitalBrevard,NC

KimberlySasserCroley,PharmD,LDE,BCGP,FASCP,FAPhALaurelSeniorLivingCommunitiesLondon,KY

HelenHalchuk,BSPharm,RPhEliLillyIndianapolis,IN

SuzanneKelley,BSPharm,CPhCovenantCarePensacola,FL

EmilyKryger,PharmD,BCGPUniversityofPittsburghMedicalCenterPittsburgh,PA

AnnieLam,BSPharm,PharmD,BCGP,FASCP,ASCPBoardLiaisonUniversityofWashingtonSchoolofPharmacySeattle,WA

MacaylaLandi,PharmD,BCGPVACentralWesternMassachusettsNorthampton,MA

NicoleLopez,PharmDVASouthernNevadaHealthcareSystemLasVegas,NV

JeanneManzi,PharmD,BCGP,FASCP,ASCPBoardLiaisonCVS/CaremarkRockvilleCenter,NY

KimberleeJ.Otto,RPh,FASCPSeniorPharmacyConsulting,LLCOmaha,NE

Tarah Parsons,PharmDWestonCountyHealthServicesNewcastle,WY

ChristinaPolomoff,PharmD,BCACPHartfordHealthcare,IntegratedCarePartnersWethersfield,CT

JoshPostolski,PharmDMedicationManagers,LLCCincinnati,OH

NancySchiciano,BSPharm,FASCPDrugWorks,IncToledo,OH

ConnieSmith,RPh,MBA,CCP,CSSGBCompletePharmacyConsultingPhiladelphia,PA

AndrewTrella,PharmD,MBAFoulkeways atGwynedd RetirementCommunityGwynedd,PA

WhitneyZentgraf,PharmD,BCGPWesleyMedicalCenterWichita,KS

MEDICATIONSAFETYDURINGTRANSITIONSOFCARE:TOOLKITTABLEOFCONTENTS

IntroductionSection1 TheTransitionsofCareLandscape

Section2 MedicationSafetyDuringTransitionsofCare:ClinicalImplications

Section3 PayersandBilling:OpportunitieswithManagedCareandotherEntities

Section4 Technology:EmpoweringBestPracticeThroughAcquisition,HarmonizationandInteroperabilityofData

Section5 MSTOCOverviewWebinarSlideDeck

MSTOC=MedicationSafetyDuringTransitionsofCare

SECTION1:THETRANSITIONSOFCARELANDSCAPE

• Healthcaresystemfailuresduringtransitionsofcare:– Rushedpatientcare– Fragmentedresponsibility– Unavailable,incompleteandinoperabledata– Littlerealcommunicationbetweenhealthcareteams

• Section1ofthetoolkit:– Outlineschallengesofimprovingmedicationsafetyduringcaretransitions– Definetransitionofcareandmedicationreconciliation– Identifystakeholdersdrivingchangeandimprovement– Speaktothepharmacist’sroleinprovidingmedicationmanagement

TRANSITIONSOFCARE

• “Transitionsofcare”canbedefinedasthemovementofpatientsbetween:–Healthcarelocations–Differentlevelsofcarewithinthesamelocation–Providers

TRANSITIONSOFCARE:THEPROBLEM

• Anestimated80% ofseriousmedicalerrorsinvolvemiscommunicationduringtransitionsbetweenhealthcaresettings.1

• 20% percentofpatientstransitioningfromthehospitalexperienceanadverse

event.Ofthese,66% arerelatedtomedications.2

• Approximately13% ofnursinghomeresidentstransitioninghomerequireERvisitorhospitalizationwithin 30days.3

• Ineffectivetransitionsofcareareresponsibleforasignificantburdenandexpenseonouroverallhealthcaresystem.HospitalreadmissionscostMedicareanestimated$15billionperyear.4

MEDICATIONRECONCILIATION

“Theprocessofidentifyingthemostaccuratelistofallmedicationsthatthepatientistaking,includingname,dosage,frequency,androute,bycomparingthemedicalrecordtoan

externallistofmedicationsobtainedfromapatient,hospital,orotherprovider.”5

“TheEPwhoreceivesapatientfromanothersettingofcareorproviderofcareorbelievesanencounterisrelevantshould

performmedicationreconciliation.”5

EP=EligibleProfessional

MEDICATIONRECONCILIATION:THEPROBLEM

• Resultsofalargehospital-basedmedicationreconciliationstudydemonstrated36% ofpatientshadmedicationerrorsatadmission,ofwhich85% originatedfromthepatient’smedicationhistory.6

• Additionofnewdrugs,discontinuationofdrugs,changesindoseandomissionofdrugsarethemostfrequentlyreportedmedicationrelatedproblems(MRPs)atdischarge.7

• Medicationerrorsoftenoccurwhenpatientsmovebetweenhealthcaresettings.8

–Half ofhospitalmedicationerrorsoccuronadmission,transferanddischarge.8

–30% ofthesehavethepotentialtocausepatientharm. 8

WHOISDRIVINGCHANGE?

• LegislationandRegulatoryBodies• InstituteforSafeMedicationPractices• QualityMeasureOrganizations• PharmacistsandProfessionalOrganizations

WHOISDRIVINGCHANGE?LEGISLATIONANDREGULATORYBODIES

• HITECHAct(2009)–MedicationreconciliationrequiredatTOCtomeetmeaningfuluse

• AffordableCareAct(2010)– ACOs,TOCprograms

• CMS– IMPACTAct(2014)– measuremedicationreconciliationacross4LTPACSettings

– Reimbursementmodelse.g.BPCI HITECHAct=TheHealthInformationTechnologyforEconomicandClinicalHealthActTOC=TransitionsofCare

ACO=AccountableCareOrganizationCMS=CentersforMedicareandMedicaidServices

IMPACT=ImprovingMedicarePost-AcuteCareTransformationLTPAC=Long-TermPost-AcuteCare

BPCI=BundledPaymentforCareImprovement

WHOISDRIVINGCHANGE?INSTITUTEFORSAFEMEDICATIONPRACTICES

• Reportsonmedicationadverseevents• Medicationsafetytoolkits• Patient-facingresources• Practiceguidelinesonimprovingmedicationsafetypractices• IOMwhitepaperonmedicationsafety• OverviewofSafetyRecommendationsforMedicationManagementTechnology

IOM=InstituteofMedicine

WHOISDRIVINGCHANGE?QUALITYMEASUREORGANIZATIONS

• NCQA/HEDISandAHRQ–MedicationReconciliationPost-Discharge

• PQA/CMS–MedicationReconciliation• HospitalStarMeasures- MRP• ACOPlanQualityMeasure• IMPACTAct– AcrossLTPACSettings

NCQA=NationalCommitteeforQualityAssuranceHEDIS=HealthcareEffectivenessDataandInformationSet

AHRQ=AgencyforHealthcareResearchandQualityPQA=PharmacyQualityAlliance

WHOISDRIVINGCHANGE?PHARMACISTSANDPROFESSIONALORGANIZATIONS

• TheNationalTransitionsofCareCoalition:9

– Considersmedicationmanagementthefirstessentialelementtosafelyexecutetransitionofcareservices

– Supportsempoweringpharmacistsasmanagersofmedicationreconciliation• Uponimplementationofpharmacist-ledmedicationreconciliationinalargenon-

profithealthcaresystem,prevalenceofMRPsandpost-dischargemedicationdiscrepancieswerefoundtobe80.7% and75.4% respectively.10

WHOISDRIVINGCHANGE?YOUARE!

“Thesolutiontocurtailingpreventablemedicationerrorsandtheconsequentoverutilizationofresourcesisstaringussquare

intheface.Pharmacistsareurgedtoactnowbytakingleadershiprolesinoversightofmedicationmanagementduringcaretransitionsorgettinginvolvedaspartofthecaretransitions

team!”11

SECTION1:THETRANSITIONSOFCARELANDSCAPE:KEYRESOURCES

• TRANSITIONSOFCARE– NationalTransitionsofCareCoalition– http://ntocc.org/Home/tabid/55/Default.aspx

• MEDICATIONRECONCILIATION– MarquisProject– http://tools.hospitalmedicine.org/resource_rooms/imp_guides/MARQUIS/marquis.html– https://www.scribd.com/document/117767285/AHRQ-Medication-Reconciliation

• MEDICATIONSAFETY– InstituteforSafeMedicationPractices– http://ismp.org/– https://www.ismp-canada.org/transitions/download-toolkit.php

• HEALTHCAREINFORMATIONTECHNOLOGY– PharmacyHITCollaborative– www.pharmacyhit.org

• PROFESSIONALORGANIZATIONS– AmericanSocietyofConsultantPharmacists– www.ascp.com/healthinfotech

SELF-ASSESSMENTQUESTION#1:

• Whichofthefollowingpromotesimprovementintransitionsofcareprocesses?

a) IMPACTActb) IOMwhitepaperonmedicationsafetyc) TheNationalTransitionsofCareCoalitiond) Alloftheabove

SECTION2:MEDICATIONSAFETYDURINGTRANSITIONSOFCARE:CLINICALIMPLICATIONS

Theclinicalimplicationsportionofthetoolkitisacollectionoftoolsforpharmacistsinanycaresettingtoutilizeinthe

identificationofkeymedicationclassesanddiseasestateswiththegoalofoptimizingmedicationsafetyduringcaretransitions.


Section2.0 Introduction

Section2.1 Tools toIdentifyKeyDiseaseStates

Section2.2 ToolstoIdentifyHigh RiskMedications

Section2.3 ToolstoIdentifyPotentiallyInappropriateMedications

Section2.4 ToolstoClassifyMedication-RelatedProblems&MedicationErrors

Section2.5 ToolstoManage MedicationsSafely

Section2.6 ToolstoImproveTransitionsofCareProcesses


2.1TOOLSTOIDENTIFYKEYDISEASESTATES• CMSdiagnosesforinappropriatere-admissions:– Pneumonia(includingaspirationpneumonia&sepsis)– Congestiveheartfailure(CHF)– Acutemyocardialinfarction(MI)– Chronicobstructivepulmonarydisease(COPD)– Electivetotalhiparthroplasty– Electivetotalkneearthroplasty– Coronaryarterybypassgraft(CABG)

CMS=CentersforMedicare&MedicaidServices


2.2TOOLSTOIDENTIFYHIGHRISKMEDICATIONS• 2014OIGreport:adverseeventsinSNFsmostcommonlycausedby3HRMclasses:

– Hypoglycemics,anticoagulants,opioids• CMSQAPIresources:

– AHRQ/CMSPotentiallyPreventableAdverseEventsinNursingHomeslistsrelatedto:medications,residentcare,&infections

– AdverseDrugEventTriggerTool– FocusedSurveyonMedicationSafetySystems

• IHIHigh-AlertMedicationSafetyresources• ISMPlistsofHigh-AlertMedicationsincommunity/ambulatoryandacutecaresettings• HEDIS®MeasuresHRMlist

OIG=OfficeoftheInspectorGeneralHRM=HighRiskMedication

QAPI=QualityAssurance&PerformanceImprovementAHRQ=AgencyforHealthcareResearchandQuality

IHI=InstituteforHealthcareImprovementISMP=TheInstituteforSafeMedicationPractices

HEDIS®=HealthcareEffectivenessDataandInformationSet


2.3TOOLSTOIDENTIFYPOTENTIALLYINAPPROPRIATEMEDICATIONS• AGSBeerscriteria• ZhancriteriaforPIMuseintheelderly• Screeningtoolofolderpeople'sprescriptions(STOPP)andscreeningtooltoalertto

righttreatment(START)criteriaforPotentiallyInappropriatePrescribinginOlderPeople:Version2

• AGS/ABIMFoundation’sChoosingWisely®Campaign• “TenThingsCliniciansandPatientsShouldQuestion”

• HanlonMedicationAppropriatenessIndex• Assess,Review,Minimize,Optimize,Reassess(ARMOR)Tool

AGS=AmericanGeriatricsSocietyPIM=potentiallyinappropriatemedication

ABIM=AmericanBoardofInternationalMedicine


2.4TOOLSTOCLASSIFYMEDICATION-RELATEDPROBLEMS&MEDICATIONERRORS• FDAMedWatch• NationalCoordinatingCouncilforMedicationErrorReportingandPrevention(NCC

MERP)MedicationErrorIndex• AHRQMedicationErrorandAdverseDrugEventReportingSystem(MEADERS)• VAVeteransAdverseDrugEventReportingSystem(VADERS)• ChenUniversityofSouthernCalifornia(USC)MedicationTherapyIntervention&

SafetyDocumentationForm

FDA=FoodandDrugAdministrationVA=VeteransAffairs


2.5TOOLSTOMANAGEMEDICATIONSSAFELY• Thissectionisdividedinto8Parts:

Part2.5.1 AnticoagulantsPart2.5.2 HypoglycemicsPart2.5.3 OpioidsPart2.5.4 PsychotropicsPart2.5.5 AntimicrobialsPart2.5.6 NarrowTherapeuticIndexMedicationsPart2.5.7 Anticholinergic/Sedation/FallRiskMedicationsPart2.5.8 Pharmacogenomics


2.6TOOLSTOIMPROVETRANSITIONSOFCAREPROCESSES• Thissectionisdividedinto5Parts:

Part2.6.1 CareTransitionsToolsPart2.6.2 MedicationReconciliationToolsPart2.6.3 MedicationManagementToolsPart2.6.4 DeprescribingToolsPart2.6.5 RiskScreeningTools

SECTION2:MEDICATIONSAFETYDURINGTRANSITIONSOFCARE:CLINICALIMPLICATIONS:

KEYRESOURCES• 2.1TOOLSTOIDENTIFYKEYDISEASESTATES

– https://www.cms.gov/medicare/medicare-fee-for-service-payment/acuteinpatientpps/readmissions-reduction-program.html

• 2.2TOOLSTOIDENTIFYHIGHRISKMEDICATIONS– http://oig.hhs.gov/oei/reports/oei-06-11-00370.pdf– https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/QAPI/Adverse-Events-NHs.html– http://www.ihi.org/topics/highalertmedicationsafety/pages/default.aspx– http://www.ncqa.org/hedis-quality-measurement/hedis-measures/hedis-2017/hedis-2017-ndc-

license/hedis-2017-final-ndc-lists

• 2.3TOOLSTOIDENTIFYPOTENTIALLYINAPPROPRIATEMEDICATIONS– http://geriatricscareonline.org/toc/american-geriatrics-society-updated-beers-criteria-for-potentially-

inappropriate-medication-use-in-older-adults/CL001– http://www.choosingwisely.org/societies/american-geriatrics-society/

• 2.4TOOLSTOCLASSIFYMEDICATION-RELATEDPROBLEMS&MEDICATIONERRORS– http://www.nccmerp.org/types-medication-errors– http://www.ihconline.org/UserDocs/Pages/USC-Medication-Therapy-Intervention-and-Documentation-

Manual--Updated-4-6-2012.pdf

• 2.5TOOLSTOMANAGEMEDICATIONSSAFELY– Myriadofresourcesfor8keymedicationclasses/topics

• 2.6TOOLSTOIMPROVETRANSITIONSOFCAREPROCESSES– http://ntocc.org/WhoWeServe/HealthCareProfessionals.aspx– http://www.pathway-interact.com/interact-tools/– http://www.ncqualitycenter.org/wp-content/uploads/2013/01/MRToolkit.pdf– http://deprescribing.org/resources/

SECTION2:MEDICATIONSAFETYDURINGTRANSITIONSOFCARE:CLINICALIMPLICATIONS:

KEYRESOURCES


• Whichofthefollowingmedicationsafetyprocessesmayimprovetransitionsofcare?

a) Medicationreconciliationflowsheetsb) Patient-friendlydischargemedicationlistc) Post-dischargefollow-upphonecallsd) Alloftheabove

Understandingtheroleofpayersandreimbursementintoday’senvironmentisa

challengeandonethatiscontinuallychanging.Offeringassistanceinnavigatingthroughthis

complexlandscapewillincreasethevalueyoubringtothetable.

SECTION3:PAYERSANDBILLING:OPPORTUNITIESWITHMANAGEDCAREANDOTHERENTITIES

Section3.1 MedicareAthroughDandCMSStarRatingsforPlans

Section3.2 UnderstandingLTPAC5StarRatingsandHowthePharmacistCanHelp

Section3.3 Payer-DrivenOpportunities


LTPAC=Long-TermPost-AcuteCare


3.1MEDICAREPARTSATHROUGHD&CMSSTARRATINGSFORPLANS• CMSStarRatings– MeasureQualityMetrics– Provideopportunityforpharmaciststoprovethevaluetheyaddtothecontinuumofcareforpayersandtheirenrolledmembers/patients


3.1MEDICAREPARTSATHROUGHD&CMSSTARRATINGSFORPLANS• Pharmacistparticipation:– Participatesasanemployeeofamanagedcareplan,pharmacybenefitmanager,longtermcarefacility,oremployerself-operatedhealthplan

–Mayalsoengageasanindependentcontractortotheseentitiesandprovideservices

• Interventionscapturedwithmeasurableoutcomesincludedinreimbursementformulatotheproviderentity


3.1MEDICAREPARTSATHROUGHD&CMSSTARRATINGSFORPLANS• Programstomeasurepharmacies’impactoncare:– ElectronicQualityImprovementPlatformforPlansandPharmacies(EQuIPP)– PharmacyQualitySolutions(PQS)EQuIPP program

• RatingsystemsforpharmaciestotracktheirperformanceandhowtheyareaffectingStarRatingsforplans– Neutralintermediary– Ensuresconsistencyacrossplans/PBMs– Providestransparency

PBMs=PharmacyBenefitsManagers


3.2UNDERSTANDINGLTPAC5STARRATINGSANDHOWTHEPHARMACISTCANHELP• OverallCMSStarRatingforLTCfacilities– Formula=StateSurveyResults+StaffingRating+QualityMeasureRatings

• ImportanceofFiveStarRatinginLTPACWorld– CMSBPCImodels– Healthcarepartnerships

LTC=LongTermCareBPCI=BundledPaymentforCareImprovement


3.2UNDERSTANDINGLTPAC5STARRATINGSANDHOWTHEPHARMACISTCANHELP:LongStayPatientsintheLTCFacility• AppropriateClinicalandMedicationManagementcanimprovequalitymeasuresintheseareas:– UTIs– Pain– Fallwithmajorinjury– Antipsychoticusewithoutdiagnosis– Newlyprescribedantipsychoticswithoutdiagnosis– Useofhypnotics/anxiolytics

UTIs=UrinaryTractInfections


3.2UNDERSTANDINGLTPAC5STARRATINGSANDHOWTHEPHARMACISTCANHELP:PostAcute- ShortStayPatientsintheLTCFacilities• Pharmacistinterventioncanimpactqualitymeasuresintheseareas:

NH=NursingHomeER=EmergencyRoom

Re-hospitalization %ofresidentswhowerere-hospitalizedafterNHadmission

ERUse %ofresidentswhohavehadanoutpatientemergencydepartmentvisit

DischargetoCommunity %ofresidentswhoweresuccessfullydischargedtocommunity


3.3PAYER-DRIVENOPPORTUNITIES• MedicationTherapyManagement(MTM)• “Incident-To”Billing– TransitionalCareManagement(TCM)–AnnualWellnessVisits(AWV)–ChronicCareManagement(CCM)


3.3PAYER-DRIVENOPPORTUNITIES• MedicationTherapyManagement(MTM)&PartD– AllPartDPlansponsorsmustincorporateanMTMProgramintothebenefitstructuretoensureoptimalmedicationoutcomes

– Pharmacistsperformmedicationreviewsforinsuredhigh-riskpatientswithchronicillnesstopromotetherapycomplianceandahealthylifestyletoremainhospital-free

• ExamplesofcompaniesadministeringMTMprograms:• http://mirixa.com/• http://www.outcomesmtm.com/


3.3PAYER-DRIVENOPPORTUNITIES• “Incident-To”Billing– Servicesmustbeanintegralpartofthepatient’snormalcourseoftreatment– Practitionermustperforminitialserviceandremainactivelyinvolvedinthecourseoftreatment

– Practitionermustprovidedirectorgeneralsupervision– Paymentforpharmacist’sservicesarenegotiatedwithprovider/facilityinadvance


3.3PAYER-DRIVENOPPORTUNITIES• TransitionalCareManagement(TCM)– Pharmacistasamemberofthemedicalteamprovidessafetransitionsinthehealthcarecontinuum

– Requirements:• Interactivecontactwithin2daysofdischarge• Nonface-to-faceservicesundergeneralsupervision• Face-to-facevisitbyprovider

– Anall-inclusiveservicebilledtoMedicarebythemedicalprovider.Thepharmacistisprovidingan“incident-to”serviceandcannotbilldirectly.


3.3PAYER-DRIVENOPPORTUNITIES• AnnualWellnessVisits(AWV)– IncludesaHealthRiskAssessmentofthepatient– BillPartBincident-tosupervisingpractitionerusingcodeG0438(initialvisit)orG0439(subsequentvisit)

– Requiresdirectsupervisionbypractitioner


3.3PAYER-DRIVENOPPORTUNITIES• ChronicCareManagement(CCM)– Primarycareserviceforbeneficiarieswithmultiplechronicconditionsexpectedtolastgreaterthan12monthsthatplacethepatientatriskofdeathorsignificantdecline

– EstablishmentofacomprehensivecareplanusingcertifiedEHR– Incident-tobilling(CPTcodes99490,99487,99489)

EHR=ElectronicHealthRecordCPT=CurrentProceduralTerminology

SECTION3:PAYERSANDBILLING:KEYRESOURCES

• 3.1MEDICAREPARTSAthroughD&CMSSTARRATINGSFORPLANS– http://www.medicareinteractive.org/get-answers/overview-of-medicare-health-coverage-options/changing-

medicare-health-coverage/the-five-star-rating-system-and-medicare-plan-enrollment– https://www.equipp.org/

• 3.2UNDERSTANDINGLTPAC5STARRATINGSANDHOWTHEPHARMACISTCANHELP– http://www.cms.gov/Medicare/Provider-Enrollment-and-

Certification/CertificationandComplianc/FSQRS.html– https://innovation.cms.gov/initiatives/bundled-payments/

SECTION3:PAYERSANDBILLING:KEYRESOURCES

• 3.3PAYER-DRIVENOPPORTUNITIESMEDICATIONTHERAPYMANAGEMENT– https://www.cms.gov/medicare/prescription-drug-coverage/prescriptiondrugcovcontra/mtm.htmlTRANSITIONALCAREMANAGEMENT– https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/MLN-

Publications-Items/ICN908628.htmlINCIDENT-TOBILLING– https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-

MLN/MLNMattersArticles/downloads/se0441.pdfCHRONICCAREMANAGEMENT– https://www.cms.gov/Outreach-and-Education/Outreach/NPC/National-Provider-Calls-and-Events-

Items/2015-02-18-Chronic-Care-Management-new.htmlANNUALWELLNESSVISITS– https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-

MLN/MLNProducts/downloads/AWV_chart_ICN905706.pdf

SECTION4:TECHNOLOGY:EMPOWERINGBESTPRACTICETHROUGHACQUISITION,HARMONIZATIONANDINTEROPERABILITYOFDATA

4.1ELECTRONICHEALTHRECORDS12

“Anelectronichealthrecord(EHR)isadigitalversionofapatient’spaperchart.EHRsarereal-time,patientcentered

recordsthatmakeinformationavailableinstantlyandsecurelytoauthorizedusers.”



• WhatarethebenefitsofEHRs?– Improvedpatientcare– Improvedcarecoordination– Practiceefficienciesandcostsavings– Increasepatientparticipation– Improveddiagnosticsandpatientoutcomes


4.1ELECTRONICHEALTHRECORDS- SNOMEDCTCODES13

• SystematizedNomenclatureofMedicine– ClinicalTerminology• LanguagethatallEHRswillusetocommunicate• MorespecificandcomplexthanICD-10codes,butcanbemappedtosuchcodingschemes

• Awaytojustifythevalueofourservicesbyassociatingstandardlycodeddocumentationforpharmacistcontributionswithpatientoutcomes

ICD=InternationalClassesofDiseases


4.1ELECTRONICHEALTHRECORDS- SNOMEDCTCODES13• Individualpatientutility:accessibilityofclinicalinformationacrossEHRsystems– Enablecommunicationofpatients’medication-relatedproblemsandmedicationhistorywithothercareteammembersacrosspracticesettings

• Populationhealthutility:allowsforlargescaleoutcomesresearch,evaluationofquality&costofcare,anddevelopmentoftreatmentguidelinesthroughretrievability ofdata

• CMSrequiringplansofferingEnhancedMTMmodeltoreportinSNOMEDcode• PQAadoptingSNOMEDcodingforreportingofnewqualitymeasures



• WHERECANIGOFORMOREINFORMATION?– BenefitsofEHRs– HowtoImplementEHRs–Whataretheadvantagesofelectronichealthrecords(EHR)?–WhatinformationdoesanEHRcontain?– EMRvsEHR– WhatistheDifference?


4.2HEALTHINFORMATIONEXCHANGES(HIEs)14

“Electronichealthinformationexchange(HIE)allowsdoctors,nurses,pharmacists,otherhealthcareprovidersandpatientstoappropriately

accessandsecurelyshareapatient’svitalmedicalinformationelectronically—improvingthespeed,quality,safetyandcostofpatient

care.Thevalueofelectronicallyexchanginginformationisthestandardizationofdata.Oncestandardized,thedatatransferredcan

seamlesslyintegrateintotherecipients'ElectronicHealthRecord(EHR),furtherimprovingpatientcare.”


4.2HEALTHINFORMATIONEXCHANGES(HIEs)14

• Therearecurrentlythreekeyforms:

DirectedExchange Abilitytosendandreceivesecureinformationelectronicallybetweencareproviderstosupportcoordinatedcare

Query-basedExchange

Abilityforproviderstofindand/orrequestinformationonapatientfromotherproviders,oftenusedforunplannedcare

ConsumerMediatedExchange

Abilityforpatientstoaggregateandcontroltheuseoftheirhealthinformationamongproviders


4.2HEALTHINFORMATIONEXCHANGES(HIEs)14WHATARETHEBENEFITSOFHIEs?• Improvequality&safetyofpatientcarebyreducingmedication/medicalerrors• Stimulatepatients'involvementintheirownhealthcare• Increaseefficiencybyeliminatingunnecessarypaperwork• Providecaregiverswithclinicaldecisionsupporttools• Efficientdeploymentofemergingtechnologyandhealthcareservices• TechnicalinfrastructureforleveragebynationalandState-levelinitiatives• ProvideabasiclevelofinteroperabilityamongEHRs• Reducehealthrelatedcosts


4.3MEDICATIONMANAGEMENTDOCUMENTATIONSYSTEMCOMPANIES

ActualMedsCorporation

Agadia Systems,Inc. Aprexis HealthSolutions,Inc

CeutiCare ClinicalSupportServices,Inc

MedicationManagementSystems

PerformRx PharmMD Mirixa Corporation

OutcomesMTM RamsellCorporation SinfoniaRx

SECTION4:TECHNOLOGY:EMPOWERINGBESTPRACTICETHROUGHACQUISITION,HARMONIZATIONANDINTEROPERABILITYOFDATA:

KEYRESOURCES

4.4HEALTHCAREINFORMATIONTECHNOLOGY– TheAmericanHealthInformationManagementAssociation(AHIMA):www.ahima.org

– TheAmericanSocietyOfConsultantPharmacistse-HIT:www.ascp.com/healthinfotech

– HEATHIT.GOV:www.healthit.gov

– TheHealthInformationAndManagementSystemsSociety(HIMSS):www.himss.org

– ThePharmacyHITCollaborative:www.pharmacyhit.org


• Youarecuriousaboutthedifferenttypesofhealthinformationexchanges.WhatsectionoftheMSTOCtoolkitholdsthisinformation?

a) Section1:TheTransitionsofCareLandscapeb) Section2: MedicationSafetyduringTransitionsofCare:Clinical

Implicationsc) Section3: PayersandBilling:OpportunitieswithManagedCare

andOtherEntitiesd) Section4: Technology:EmpoweringBestPracticeThrough

Acquisition,HarmonizationandInteroperabilityofData


• Youareconsideringanopportunitywithaphysician’spracticeasa“medicationspecialist”.Whatsectionwouldyouaccesstofindinformationabout“incident-to”billing?

a) Section1:TheTransitionsofCareLandscapeb) Section2: MedicationSafetyduringTransitionsofCare:Clinical

Implicationsc) Section3: PayersandBilling:OpportunitieswithManagedCare

andOtherEntitiesd) Section4: Technology:EmpoweringBestPracticeThrough

Acquisition,HarmonizationandInteroperabilityofData

ASCP.com/MSTOC

“RealWorldApplicationoftheMedicationSafetyDuringTransitionsofCareToolkit– Parts1and2” willbepresentedatASCP’s2017AnnualMeetingandExhibition.ThesessionswillprovideabriefoverviewofthepurposeandcomponentsoftheMSTOCToolkitandutilizeaseriesofcasestudiesfollowingasinglepatienttransitioningthroughmultiplecaresettingstodemonstratetheclinicalandpracticalvalueofthetoolkit.

Registernowatwww.ascp.com/annual2017

REFERENCES1. JointCommissionCenterforTransformingHealthcareReleasesTargetSolutionsToolforHand-OffCommunications.Joint

CommissionPerspectives.Availableat https://www.jointcommission.org/assets/1/6/tst_hoc_persp_08_12.pdf .AccessedAugust31,2017.

2. ForsterAJ,HarveyJ,Murf HJ,etal.Theincidenceandseverityofadverseeventsaffectingpatientsafterdischargefromthehospital.AnnInternMed.2003;138:161-7.

3. ImprovingCareTransitionsinNursingHomes.JournalofAmericanSocietyonAging.Availableathttp://www.asaging.org/blog/improving-care-transitions-nursing-homes.AccessedApril23,2017.

4. HostetterM,KleinS.AvoidingPreventableHospitalReadmissionsbyFillinginGapsinCare:TheCommunity-BasedCareTransitionsProgram.QualityMatters.August/September2012Issue.Availableat:http://www.commonwealthfund.org/publications/newsletters/quality-matters/2012/august-sept/in-focus.AccessedJuly21,2017.

5. EligibleProfessionalMeaningfulUseMenuSetMeasures.Availableathttps://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/downloads/7_Medication_Reconciliation.pdf.AccessedAugust30,2017.

6. GleasonKM,McDanielMR,Feinglass J,etal.ResultsoftheMedicationsatTransitionsandClinicalHandoffs(MATCH)study:ananalysisofmedicationreconciliationerrorsandriskfactorsathospitaladmission.JGenInternMed.2010;25:441-7.

7. Garcia-Caballos M,Ramos-DiazF,Jimenez-Moleon JJ,etal.Drug-relatedproblemsinolderpeopleafterhospitaldischargeandinterventionstoreducethem.AgeandAgeing 2010;39:430-8.

8. Theimportanceofmedicationreconciliationforpatientsandpractitioners.AustralianPrescriber.Availableathttps://www.nps.org.au/australian-prescriber/articles/the-importance-of-medication-reconciliation-for-patients-and-practitioners.AccessedAugust20,2017.

REFERENCESCONTINUED…

9.NationalTransitionsofCareCoalition(NTOCC)RecommendationsforImprovingTransitionsofCare.http://www.usahealthsystem.com/workfiles/com_docs/gme/2011%20Links/GME-Today-Transitions-of-Care.pdf.AccessedApril23,2017.

10.Surbhi S,Munshi KD,BellPC,etal.Drugtherapyproblemsandmedicationdiscrepanciesduringcaretransitionsinsuper-utilizers.JAmPharmAssoc.2003;56:633-42

11.ASHP-APHAMedicationManagementinCaretransitionsBestPractices.AmericanSocietyofHealthSystemsPharmacistsandAmericanPharmacistAssociation.Availableat:http://media.pharmacist.com/practice/ASHP_APhA_MedicationManagementinCareTransitionsBestPracticesReport2_2013.pdfAccessedSeptember29,2017

12.Whatisinanelectronichealthrecord?.Availableathttps://www.healthit.gov/providers-professionals/faqs/what-electronic-health-record-ehr.AccessedAugust202017.

13.PharmacyHITCollaborative.MedicationTherapyManagementClinicalDocumentation:UsingaStructuredCodingSystem-SNOMEDCT.Availableathttp://www.pharmacyhit.org/pdfs/workshop-documents/WG2-Post-2014-02.pdf.AccessedAugust20,2017.

14.HealthcareInformationandManagementSystemsSociety(HIMSS).“EvaluatingaPotentialHIEOpportunity WebSiteDisclaimers”,HIMSSGuidetoParticipatinginHIE.2009November.

a toolkit for senior care pharmacists · · 2017-10-12a toolkit for senior care pharmacists ... ,...

Documents