Current Issues in Pharmacy Practice AAHP Fall Seminar October 8, - - PowerPoint PPT Presentation

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Current Issues in Pharmacy Practice AAHP Fall Seminar October 8, - - PowerPoint PPT Presentation

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Current Issues in Pharmacy Practice AAHP Fall Seminar October 8, 2015 Christene Jolowsky, MS, RPh, FASHP Executive Director, Applied and Experiential Education University of Minnesota College of Pharmacy Immediate Past-President, ASHP AKA

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Christene Jolowsky, MS, RPh, FASHP Executive Director, Applied and Experiential Education University of Minnesota College of Pharmacy Immediate Past-President, ASHP

Current Issues in Pharmacy Practice AAHP Fall Seminar October 8, 2015

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AKA …

  • What keeps health system pharmacy

leaders up at night

  • What keeps ASHP leaders up at night
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Objectives

  • Attendees will be able to list three changes in

the areas of patient demographics, healthcare economics and pharmacy workforce demographics.

  • Given an example of a change in the

pharmacy workforce, the attendee will identify potential implications to the role of the pharmacist in acute and ambulatory care settings.

  • Attendees will select tools to use to help

assess and improve current practice.

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About Me …

  • ASHP Immediate Past

President

  • University of Minnesota

College of Pharmacy

  • Health System Pharmacy

Leader

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SLIDE 5

I have no relevant financial relationships to disclose regarding this presentation.

Disclosure:

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Who is ASHP?

  • Over 43,000 members

(pharmacists, students and technicians)

  • Founded in 1942
  • Headquarters in Bethesda,

MD

ASHP Mission Statement The mission of pharmacists is to help people achieve optimal health outcomes. ASHP helps its members achieve this mission by advocating and supporting the professional practice of pharmacists in hospitals, health systems, ambulatory clinics, and other settings spanning the full spectrum of medication use. ASHP serves its members as their collective voice on issues related to medication use and public health.

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SLIDE 7

ASHP Strategic Plan

Three sections, which focus on professional,

  • perational, and

leadership & management

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SLIDE 8

Overview

  • Societal & Health Care Economic Trends
  • Health System Alliances, Mergers, and

Acquisitions

  • Work Force Trends
  • Patient Quality and Outcomes
  • Ambulatory Care Innovations
  • Provider Status
  • Developing Strategic Direction
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SLIDE 9

Top Ten Challenges and Opportunities For Hospitals and Health Systems

  • Population health
  • Shifting from volume- to value-based

reimbursement

  • Regulatory demands
  • Infection control (Ebola)
  • Demonstrating the value of mergers and

acquisitions to consumers

Beckers Top Ten Challenges and Opportunities for Hospitals http://www.beckershospitalreview.com/hospital-management-administration/10-challenges-and-opportunities-for-hospitals-in- 2015.html

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Top Ten Challenges and Opportunities For Hospitals and Health Systems

  • Truly integrating systems
  • Overspecialization of the physician workforce

and questions over the physician shortage

  • Hospital closures
  • Reimbursement rate differences
  • Data, data everywhere

Beckers Top Ten Challenges and Opportunities for Hospitals http://www.beckershospitalreview.com/hospital-management-administration/10-challenges-and-opportunities-for-hospitals-in- 2015.html

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SOCIETAL & HEALTH CARE ECONOMIC TRENDS

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The Big Picture

  • Almost half of U.S. adults—approximately

117 million people—have at least one chronic disease.

  • More than 20% of hospitals’ discharges

are re-admitted.

  • Percentage of Americans who used two or

more prescription drugs increased from 25 percent to 31 percent, and the number of patients using five or more drugs increased from 6 percent to 11 percent.

http://www.cdc.gov/nchs/data/databriefs/db42.htm http://www.rwjf.org/content/dam/farm/reports/reports/2013/rwjf404178 http://www.cdc.gov/chronicdisease/overview/

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The Big Picture

  • “Researchers have estimated that inadequate care coordination,

including inadequate management of care transitions, was responsible for $25 to $45 billion in wasteful spending in 2011 through avoidable complications and unnecessary hospital readmissions.”

  • “…nearly one-fifth of fee-for-service Medicare beneficiaries discharged from

the hospital are readmitted within 30 days; three-quarters of these readmissions--costing an estimated $12 billion a year--are considered potentially preventable, especially with improved care transitions.”

  • “Patients often don't consistently receive follow-up care after leaving

the hospital. Among Medicare beneficiaries readmitted to the hospital within 30 days of a discharge, half have no contact with a physician between their first hospitalization and their readmission.”

  • “Almost one-fourth of Medicare beneficiaries discharged from the hospital

to a skilled nursing facility were readmitted to the hospital within thirty days; this cost Medicare $4.34 billion in 2006.”

http://www.healthaffairs.org/healthpolicybriefs/brief.php?brief_id=76 http://content.healthaffairs.org/content/29/1/57.full

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The Number of People with Chronic Conditions is Increasing

Source: Wu, Shin-Yi and Green, Anthony. Projection of Chronic Illness Prevalence and Cost Inflation. RAND Corporation, October 2000.

118 125 133 141 149 157 164 171

100 120 140 160 180 200

1995 2000 2005 2010 2015 2020 2025 2030

Number of People With Chronic Conditions (millions)

Year

44% 49%

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  • Medical costs

increasing in excess of inflation

  • Threatens

sustainability

  • f core business

Health Care and Reform are Market Issues

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Big Data and Population Health

Define Population Identify Gaps in Care Stratify Risk Engage Patients Manage Care Measure Outcomes

IHN & Local Health Systems

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HEALTH SYSTEM ALLIANCES, MERGERS, AND ACQUISITIONS

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Marketplace

  • AHA Hospital Statistics, 2013 edition

– 4,973 Community Hospitals in USA – 3,007 hospitals are in a system – 1,535 hospitals are in a network

– System is defined by AHA as either a multihospital or a diversified single hospital system. A multihospital system is two or more hospitals owned, leased, sponsored, or contract managed by a central organization. Single, freestanding hospitals may be categorized as a system by bringing into membership three or more, and at least 25 percent, of their owned or leased non-hospital pre-acute or post-acute health care organizations. System affiliation does not preclude network participation. – Network is a group of hospitals, physicians, other providers, insurers and/or community agencies that work together to coordinate and deliver a broad spectrum of services to their

  • community. Network participation does not preclude system affiliation.
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Hospital/Health System Growth Over Past 12- 14 Months

  • Catholic Health Initiatives growth from 70 to 86

hospitals

  • Ascension Health growth from 72 to 102 hospitals
  • Community Health Systems from 150 hospitals to 208
  • Comprehensive Pharmacy Services from mid-300 to

mid-400 contract pharmacies

  • Baylor Health Care / Scott and White merger – 39

hospitals

  • Trinity Health / Catholic Health East merger – 82

hospitals

  • Numerous academic medical centers acquiring or

affiliating with community hospitals; or managing community hospital pharmacies

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Impact on Practice

  • New world of decision making
  • System changes
  • Policy impact
  • Costs and changes
  • Governance
  • Within rapidly changing environment
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WORK FORCE TRENDS

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How many pharmacists are there?

According to HRSA Bureau of Health Care Professions, there are currently 286,400 pharmacists:

  • 63% work in retail settings
  • 23.1% work in hospitals
  • 13.9% work in other settings*

* Managed care, pharmacy education, long term care, home care, consulting, industry, wholesale, associations, GPOs, trade groups, publishers, office practices, etc

For the 2009 National Pharmacists Workforce Study, there were 249,381 licensed pharmacists: 53.8% work in indep, chain, mass merch, or supermarket pharmacies 26.8% work in hospitals 10.4% work in other patient care practices* 9.0% work in other settings (industry and non-patient care)

* Defined as HMOs, clinic pharmacies, mail service, nuclear, home care. Long term care

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  • 10,000

20,000 30,000 40,000 50,000 60,000 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

Year Total FTE 2013 64,224 2012 51,724 2011 57,307 2010 54,368 2009 56,327 2008 55,474 2007 50,572 2006 48,598 2005 49,995 2004 48,637 2003 46,906 2002 42,708

Total Pharmacist FTEs in hospitals continues to grow

Source: 2002-2011 ASHP National Survey

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What does the future hold?

Pharmacist supply and demand by 2020

  • 50,000

100,000 150,000 200,000 250,000 300,000 350,000 400,000 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020

SUPPLY DEMAND Supply drivers: More graduates Baby boomers retire Demand drivers: Prescription volume Changing roles Technicians Technology Health Care Reform Supply drivers: Baby boomers Delayed retirement Fewer Part timers More graduates Demand drivers: Slow economy

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In 2014 appx 20% of graduates (2411) are seeking PGY1 positions And 5% (129) are graduates before 2014

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Impact of Workforce

  • Positive and Negative
  • Educating/ training of students – practice

sites

  • Demand for residencies

– Residencies v pharmacy student training

  • New roles
  • Lead and direct within rapidly changing

environment

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1203 1356 1900 2092 2508 2915 3277 3706 3933 4142 1091 1222 1612 1769 1873 1951 2173 2413 2694 2862

500 1000 1500 2000 2500 3000 3500 4000 4500 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014

Residency Applicants vs Positions PGY1

# applicants # positions Linear (# applicants) Linear (# positions)

1280

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200 400 600 800 1000 1200 1400 1600 1800 2000

ASHP Accredited Pharmacy Residency Program Growth (1980-2015) as of 1/5/15

Hospital Pharmacy Practice PGY1 Clinical Specialized PGY2

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Applicants view on March 20, 2015

1,755 applicants unmatched 1,547 PGY1 & 208 PGY2 3,308 applicants match day 2811 PGY1 matched 497 PGY2 match & 297 Early Commit = 794 PGY2

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Changes with Residencies

  • Revision and streamlining residency

standards

  • Adding second match process
  • Residency Capacity Conference 2011
  • Resources at ASHP.org
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SLIDE 31

515 496 513 524 552 575 600 625 650 675 410 423 457 482 523 569 600 630 660 690 860 956 1083 1244 1421 1648 1850 2050 2250 2500 5567 6657 7766 9422 11608 13961 16000 18000 20000 21570 548 582 627 684 758 824 885 945 1005 1065 518 1000 1539 2000 2500 3000 3500 5000 10000 15000 20000 25000 30000 35000 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 Nuclear Nutrition Oncology Pharmacotherapy Psychiatric Ambulatory Care

Board Certified Specialists

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“By 2020, PTCB will require candidates for initial PTCB certification to successfully complete an American Society of Health-System Pharmacists (ASHP)-accredited education program. ASHP-accredited programs include didactic course work and practical experience, thereby providing well-rounded training for technicians.”

http://www.ptcb.org/about-ptcb/news-room/news-landing/2013/02/27/ptcb-announces- certification-program-changes

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PATIENT QUALITY AND OUTCOMES

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The Big Picture

  • “Researchers have estimated that inadequate care coordination,

including inadequate management of care transitions, was responsible for $25 to $45 billion in wasteful spending in 2011 through avoidable complications and unnecessary hospital readmissions.”

  • “…nearly one-fifth of fee-for-service Medicare beneficiaries discharged from

the hospital are readmitted within 30 days; three-quarters of these readmissions--costing an estimated $12 billion a year--are considered potentially preventable, especially with improved care transitions.”

  • “Patients often don't consistently receive follow-up care after leaving

the hospital. Among Medicare beneficiaries readmitted to the hospital within 30 days of a discharge, half have no contact with a physician between their first hospitalization and their readmission.”

  • “Almost one-fourth of Medicare beneficiaries discharged from the hospital

to a skilled nursing facility were readmitted to the hospital within thirty days; this cost Medicare $4.34 billion in 2006.”

http://www.healthaffairs.org/healthpolicybriefs/brief.php?brief_id=76 http://content.healthaffairs.org/content/29/1/57.full

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Payment and Quality Market Drivers

DRGs Core Measures and HACs VBP and Re- admissions Bundled VBPAcross Continuum Population Health and Neutral “Site

  • f Care”

Payments

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Health System’s “site of care” Challenges

DHHS 2016 Budget Components:

  • Encourage efficient care by improving incentives to

provide care in the most appropriate ambulatory setting

  • Implement bundled payment for post-acute care
  • Implement value-based purchasing for additional

providers

  • Improving quality and value

http://news.regence.com/releases/regence-selects-walgreens-to-provide-specialty- infusion-medication-services-for-members http://www.hhs.gov/budget/fy2016/fy-2016-budget-in-brief.pdf#page=70

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AMBULATORY CARE INNOVATIONS AND PRACTICE MOVEMENT

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Medication Management Across the Continuum

  • Home Infusion
  • Hospice
  • Community Pharmacy
  • Mail Order
  • MTM
  • Clinic based

pharmacists

  • Ambulatory care

practices

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Ambulatory Care Feedback: Challenges

  • #1 – Efficiency in documentation
  • EMRs don’t meet amb care needs
  • Effectively place pharmacists on the health care team
  • Not just physicians, case managers, care

navigators…

  • Address community pharmacists moving from a

dispensing environment into a cognitive environment

  • Training, other opportunities
  • Demonstrate pharmacists’ value in ACOs and PCMHs
  • State-level information – to advance roles for

pharmacists

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http://connect.ashp.org/ambulatorycareconference14/

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SPECIALTY PHARMACY

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Specialty Pharmacy

“..specialty-drug spend is forecast to increase an additional 63% between 2014 and 2016.”

http://lab.express- scripts.com/~/media/pdfs/drug%20trend%20report/express%20scripts%202013%20drug%20trend%2 0report%20highlights%20online.ashx

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PROVIDER STATUS

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Public Health Policy Problem – Unmet Need: Access to Primary Health Care

  • Growing number of Medicare

beneficiaries

  • Increasing patients with 1+ chronic

conditions

  • Newly covered patients via Affordable

Care Act

  • Projected Physician Shortage
  • Access
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1.9% 3.0% 2.4% 0.9% 0.4% 39.7 47.7 64.3 81.5 88.9 92.4 0% 1% 2% 3% 4% 5% 6% 7% 8% 9% 10% 10 20 30 40 50 60 70 80 90 100 2000 2010 2020 2030 2040 2050

SOURCE: 2013 Annual Report of the Boards of Trustees of the Federal Hospital Insurance and Federal Supplementary Medical Insurance Trust Funds.

Projected Change in Medicare Enrollment, 2000-2050

Medicare Enrollment (in millions) Average Annual Growth in Enrollment

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SLIDE 47

Source: AAMC Center for Workforce Studies, June 2010 Analysis

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Provider Status

  • ASHP: Member of the Patient Access to

Pharmacists' Care Coalition

  • Bi-partisan Legislation: H.R. 592 and S.

314 introduced

  • Amend the Social Security Act
  • Recognize pharmacists as providers in

medically underserved areas under Medicare Part B

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What are medically underserved communities?

  • Medically

Underserved Areas

  • Medically

Underserved Populations

  • Health Professional

Shortage Areas

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DRUG SHORTAGES

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Drug Shortages

  • ASHP in collaboration with the University
  • f Utah and FDA – leading provider of

information and advocacy for over 10 years

  • Legislation was passed in 2012 giving

FDA enhanced authority

  • ASHP continuing to working with various

stakeholders to find long-term solutions

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ACCREDITATION PROGRAMS

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Center for Pharmacy Practice Accreditation (CPPA)

  • Partnership between APhA, NABP, and

ASHP

  • Develops and implements comprehensive

programs of pharmacy practice site accreditation

  • Initial focus on community pharmacy

accreditation

  • Other ongoing explorations
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Pharmacy Technicians

  • Pharmacy Technician Accreditation

Commission (PTAC)

– Partnership between ACPE and ASHP – Assuring and advancing the quality of pharmacy technician education and training programs – Conduct document reviews and site surveys, recommend final accreditation actions

  • Pharmacy Technician Certification Board

– ASHP, NABP, APhA, ICHP, MPA

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WRAP IT UP

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Practice Will Change - PPMI

“ To bring about change within a diverse profession such as pharmacy, one needs a large number of people pulling in the same

  • direction. Before one can get folks pulling in

the same direction, one needs general agreement about the best direction in which to move” …

William A. Zellmer

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Translating the Landscape

  • Patient care
  • Quality of care
  • Technological revolution
  • Health care reform and payment
  • Evolution of pharmacy workforce
  • Growing complexity and cost of medications

and medication use systems

  • Further move to corporate governance
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Keeping Me Up at Night

  • Patient need to be the center of care
  • Products – integrity, distribution,

availability

  • Patient safety
  • Quality outcomes
  • Competent workforce – techs, students,

pharmacists

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SLIDE 59

Keeping Me Up at Night

  • Growing complexity and cost of

medications

  • Complex medication use systems in a

complex health care system

  • Shift in practice and care into

ambulatory care settings – readiness?

  • Impact on Acute Care
  • Balance (more acute patients left)
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SLIDE 60

Bring It Home – Pharmacy Practice Advancement

  • Care for the patients
  • Role at transition points
  • Assessment of your practice
  • Personal plan
  • Work plan
  • Know your resources
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Bring It Home (cont.)

  • Working with States, Boards of

Pharmacy

  • Support of technician roles and

advancement of roles

  • Support of increasing use of technology
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SLIDE 62
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Support…

  • Be a member
  • Be involved
  • Think Locally!
  • Support initiatives
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SLIDE 64

Research and Education Foundation (REF)

ASHPFoundation.org

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ASHP Foundation

Focus: Leadership Development/Practice Advancement Research & Tools for Pharmacists Key Leadership Programs

  • Student Leadership Speakers Bureau
  • Whitney Lectures/Conversations Videos
  • Residents Visiting Leaders Program
  • Pharmacy Leadership Academy
  • Pharmacy Leadership Institute
  • Leadership Resource Center
  • Pharmacy Forecast 2015-2019
  • C-Suite Toolkit
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SLIDE 66

ASHP Foundation

Focus: Leadership Development/Practice Advancement Research & Tools for Pharmacists Research/Practice Advancement Programs

  • Residents Research Tips/Webinars
  • PGY1 & Master’s Residents Grant Programs
  • New Investigator Grants & Residency Expansion Grants
  • Complexity Index Research- 23 preventable ADEs
  • Traineeships- Crit. Care/Oncol./Pain/Med.

Home/Anticoag

  • Practice Tools- Insourcing/Outsourcing/Antithrombotic

Assessment/Insulin Safety

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SLIDE 67

PAC (Political Action Committee)

  • Legislative Issues
  • Provider Status
  • Drug Shortages Bill
  • Compounding
  • Supporting Pharmacy Practice
  • ASHP.org Advocacy
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SLIDE 68

What are your questions? (and thank you … again)

jolow001@umn.edu

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References

  • http://www.jacksonhealthcare.com/media/191888/2013physiciantrends-

void_ebk0513.pdf

  • http://www.beckershospitalreview.com/hospital-physician-relationships/number-of-

ncqa-recognized-medical-homes-passes-6-000.html

  • http://www.beckershospitalreview.com/hospital-management-administration/50-

things-to-know-about-the-hospital-industry.html

  • http://www.beckershospitalreview.com/hospital-transactions-and-valuation/the-most-

influential-hospital-transactions-of-2013.html