Pharmacy Technician Workforce: Oh, the places youll go! Julie F - - PowerPoint PPT Presentation

Pharmacy Technician Workforce: Oh, the places you’ll go!

Neil A. Gilchrist, PharmD, MBA, BCPS

• Sr. Director, Pharmacy Services

UMass Memorial Medical Center Worcester, MA 01655 Julie F Lanza CPhT, CSPT Pharmacy Compliance Specialist Beth Israel Deaconess Medical Center Boston, MA 02215

Ob Objec ectives tives

Pharmacy Technicians

• Define the value of having pharmacy technicians in speciliazed roles
• Describe how taking on a specialized role and accepting deeper

responsibilities can strengthen the pharmacy team

• List the impact of advanced technician roles on job satisfaction

Pharmacists

• Identify emerging roles for pharmacy technicians
• List the potential impact of advanced technician roles in regard to job

satisfaction and retention

• Describe the opportunity for pharmacists created by utilizing pharmacy

technicians in advanced roles

Ne Neil to

• ad

add co d cont ntent ent

• Consensus-seeking event convened by ASHP
• Published Am J Health-Syst Pharm 2011;68:1079-85
• Advancing pharmacy technician roles
• Independent pharmacy technician drug distribution models
• Mandatory training, documented competencies and licensure
• Certification for advanced and specialized technician practice areas

such as sterile compounding should be developed

• Pharmacy has yet to face its responsibility for ensuring the competence
• f pharmacy technicians, and this is holding the profession back from

adequately addressing patients clinical medication-use needs

ASHP P Fo Foundation undation Pharmacy rmacy Fo Forecast ecast

• Strategic Planning Advice Document published annually
• 2019: Future of Pharmacy Education and Workforce
• Pharmacy technicians in patient care
• Competency assured pharmacy technicians will be authorized to

independently perform patient care activities

• 2018 Advancing Pharmacy Technicians roles
• Managing robotics, supervisory, clinical decision support
• 2017 Pharmacy Work Force: Shifts in Roles, Responsibilities and

Training

• Pharmacy Technicians in a new light

2018 18 ASHP P Pharmacy armacy Fo Forecast: ecast: Advanced vanced Pharmacy armacy Te Techni chnician cian Roles: les:

ASHP Foundation Pharmacy Forecast 2018. AJHP January 15, 2018.

MS MSHP HP Ph Phar arma macy cy Te Techn hnician ician Pa Pane nel

Robert Fay, CPhT Pharmacy Revenue Analyst Baystate Health Springfield, MA

 Baystate Health is a not for profit Health System consisting of 4 hospitals and numerous medical practices.  The main hospital, Baystate Medical Center, is a 716 bed facility located in Springfield, MA.  Only Level One Trauma Center in the area.  Inpatient pharmacy with ~100 employees

Professional Pharmacy Background

 Retail pharmacy: 30 years  Job Corps: Technician Training Course, 10 years  Baystate Health: last 2.5 years

• Med Reconciliation Technician
• Billing Technician
• Pharmacy Analyst

 Pharmacy Revenue Analyst:

• Partner with an outside vendor to help analyze purchasing feeds, revenue and usage ,

pharmacy formulary and our Charge Description Master, to maximize charge capture and revenue gains.

• Work closely with Revenue services, to correct billing errors for pharmacy claims and to

participate in billing inquiries to determine the best course of action if errors are found.

• Waste billing compliance with Medicare guidelines (JW Modifier).

 Identify:

• Drugs Purchased to be included for JW Modifier
• Missing HCPCs Codes
• Mismatched HCPCs Codes
• Multiplier Issues
• Financial opportunities for Cost vs. CDM charge

 CDM Workflow developed:

• IT system involvement
• CDM creation with accountability
• Testing CDM before utilization in charge system
• Goal 100% correct pharmacy charges according to Medicare and private insurance

guidelines

MS MSHP HP Ph Phar arma macy cy Te Techn hnician ician Pa Pane nel

Ashley Loverro, CPhT 340B Compliance Coordinator UMass Memorial Medical Center Worcester, MA

UMass Memorial Medical Center

• 3 Main Campuses and 4 Offsite Clinics
• Services: Emergency, Trauma, Inpatient, Outpatient, Surgery,

Maternity, Oncology, Endoscopy, Health Centers, and Outpatient Clinics (Specialties)

• 4 Hospital Pharmacies & 3 Inhouse Retail Pharmacies
• 340B Covered Entity - Registered as DSH Hospital with HRSA
• 125 340B Contract Pharmacies

Current Role as 340B Compliance Coordinator

• Under the direction of the 340B Compliance & Business Office

Manager, oversees the day-to-day operations of the 340B Team, compliance monitoring, and auditing of the 340B drug purchasing program.

• Responsible for maintenance and troubleshooting issues with the

340B software vendors, and assist Pharmacy Buyers, Pharmacy Managers and IS Pharmacists with any questions or issues related to the 340B software.

Tasks as 340B Compliance Coordinator

• Audits the 340B usage to determine usage is compliant as per

the 340B regulations and HRSA guidelines. Audits to ensure prevention of duplicate discounts or diversion to ineligible patients.

• Presents results of the internal audit findings to 340B

Compliance Manager and 340B Oversight committee as appropriate, make corrective action plan recommendations, and assist with implementation of the same as appropriate.

Tasks as 340B Compliance Coordinator (continued…)

• Coordinates meetings with the 340B software vendors and

contract pharmacy partners to discuss any issues, system enhancements, and new report requests that would help enhance 340B compliance or help reduce WAC spend

• Assists 340B Compliance & Pharmacy Business Office

Manager with a variety of tasks and projects such as contract management, implementing new contract pharmacies, validation and testing of the new reports or software enhancements, assist in distributing the 340B workload to the 340B team members, etc.

Impact of 340B Compliance Coordinator

• Savings from the 340B Program is critical to allow us to continue to

serve low-income medically underserved population through a variety of programs like providing financial assistance, offering community Benefit programs like Ronald McDonald Care Mobile, etc.

• Monitoring 340B Compliance through regular audits and

implementing appropriate controls is therefore important to ensure that we don’t put our program at risk.

• Government (Health Resources and Service Administration) and

manufacturers could audit us anytime to verify our compliance with the program requirements.

Thoughts on Technicians in Advanced Roles

• Technicians are so familiar with the overall operations of retail,

hospital, and/or compounding pharmacies that we can apply our knowledge and experience to different roles.

• Softens the divided line between Pharmacists and Technicians.

You don’t have to be a pharmacist to be a “340B Expert.”

• Strengthens team morale and respect in the pharmacy itself.

“A Pessimist sees the difficulty in every opportunity. An Optimist sees the opportunity in every difficulty.”

• Winston Churchill

ACCEPT A CHALLENGE!

MS MSHP HP Ph Phar arma macy cy Te Techn hnician ician Pa Pane nel

Erin Smith, CPhT Medication Reconciliation Supervisor Boston Medical Center Boston, MA

Th The e ro role e of

• f Me

Medication dication Re Reconcil conciliati iation

• n Te

Technici chnicians ans at at Bo Boston ston Me Medical dical Ce Center nter

Objectives

• List the two key components of a best possible medication

history.

• Describe the role of a Medication Reconciliation Technician

(MRT).

Boston Medical Center Health System Boston Medical Center BMC Pharmacy Inpatient Outpatient Specialty Ambulatory Boston Medical Healthcare Plan Boston Healthnet Boston Accountable Care Organization

Components of a Best Possible Medication History

Best Possible Medication History Patient presents from home Interview with patient

• r caregiver

90 day fill history from preferred pharmacy or pharmacies Patient presents from skilled nursing facility

• r correctional

institution MAR from facility

Establishment of ED MRTs March 2016

• Day shift hours 7a-3:30p
• Evening shift hours 3p-11:30p
• At the start, average med

recs/shift is 5 due to training and establishing workflow

• After approximately 3 months

and 2 part time positions (32 hours total), average med recs per shift reaches 8

• Majority of evening and

weekend med recs characterized as incomplete

Sunday Monday Tuesday Wednesday Thursday Friday Saturday 7A 8A 9A 10A 11A 12P 1P 2P 3P 4P 5P 6P 7P 8P 9P 10P 11P

Adjustment of Hours January 2018

Sunday Monday Tuesday Wednesday Thursday Friday Saturday 8A 9A 10A 11A 12P 1P 2P 3P 4P 5P 6P 7P 8P 9P 10P

• Day shift hours 8a-4:30p
• Evening shift hours 1p-9:30p
• Consolidated weekend shift
• New hours align with
• utpatient pharmacy hours

and allows technicians to capture patients at peak transport times

• Med rec average per shift

increases to 10 with decrease in incomplete notes

Addition of Inpatient MRT Services

Sunday Monday Tuesday Wednesday Thursday Friday Saturday 8A 9A 10A 11A 12P 1P 2P 3P 4P 5P 6P 7P 8P 9P 10P

• Two FTEs dedicated to

inpatient services, focused on patients at high risk for readmission or enrolled in Boston ACO

• Two additional student per

diem positions (16 hours/month) added to assist with efforts

• Current med rec average per

shift is nearing 12 (sometimes higher!)

MRT Documentation Process

Interview the patient/caregiver Obtain 90 day fill history Document any discrepancies between prescribed and reported regimens Identify and document any medication access barriers Enter note into patient’s EMR, reviewed by pharmacist Enter necessary I- vent documentation

MRT Impact Throughout BMC

• Efficient and thorough information gathered in critical situations

can take less time when completed by MRT as opposed to bedside providers.

• Pharmacists gain time to complete clinical tasks. In addition,

they can focus on discharge med recs, which has been shown by our institution to reduce the 30 day readmission rate by 10- 15%.

• Providers have more time to focus on clinical tasks.

MS MSHP HP Ph Phar arma macy cy Te Techn hnician ician Pa Pane nel

Shawn Wood, CPhT Pharmacy Inventory & Purchasing Supervisor Beth Israel Deaconess Medical Center Boston, MA

Beth th Is Israel ael Deaconess aconess Medical dical Center nter (BID IDMC) MC)

• Patient Care
• 673 Beds; 77 critical care beds, 62 OB/GYN beds
• Approximately 5,000 births per year
• Emergency Services including a level one trauma center and rooftop

heliport

• Located in Boston’s Longwood Area and
• Needham Cancer Center
• 2 Urgent Care Centers
• Clinics at 7 off sight areas

• Employed at Beth Israel Deaconess Medical Center (BIDMC)
• 03/2000-date
• BIDMC - part of Beth Israel Lahey Health
• one of 13 medical centers in this Health System
• Current Role
• Pharmacy 340B and Inventory Supervisor

Pharmacy armacy 340B 0B and d In Inventory ventory Supervi pervisor sor

• Oversees
• Inventory
• Hospital administered 340B program (split-billing)
• Team of 9
• 2 Pharmacy Material Coordinators
• 2 Pharmacy Receiving Technicians
• 2 340B Split Billing Specialists
• 1 Revenue Cycle Analyst
• 1 Pharmacy AP & Billing Technician

Inv nventor entory y Ma Mana nage geme ment nt

• Scope
• Two Campuses
• 7 Offsite Facilities
• Metrics
• 18,000 orders per year
• Over 2,000 different medications
• 76 Wholesaler, Specialty, and Manufacturer Accounts
• Outcomes Measured
• Inventory Turns
• Drug Waste
• Contract Compliance
• Drug Budget/Cost Saving Initiatives

Hospital spital administered ministered 340B 0B program

• gram

(sp split lit-bil billing) ling)

• Split Billing
• 35 specific weekly, monthly, quarterly tasks
• 100 dispensation audits per month
• 800 different medications purchased on 340B every quarter
• Maintain split-billing software and the various cross-walks
• Outcomes Measured
• Total annual savings to the medical center
• Cost avoidance related to neutral inventory
• Successful self audits and independent audits

Collab llabora

• rations

tions wit ith Departm partment ent and d Medica dical l Center nter

• Executive 340B Steering Committee
• 340B Growth Initiatives
• 340B Operations Committee
• CQVA
• Pharmalynx
• Pharmacy Operations
• NPC

Im Impact act to to th the Department partment and d Medical ical Center nter

• Financial Impact
• Cost Savings Initiatives, 340B Savings, Reducing Waste
• All contribute to the financial health of the Medical Center
• Operational Impact
• Improving Communication and Services
• Contribute to Patient Care
• Efficiencies add time back to front line staff
• Pharmacy Organization
• Participated in 3 Pharmacy Design Teams
• Organized pharmacies reduce errors and Joint Commission Readiness

Te Techn hnicians icians in Ad n Advanc anced ed Ro Roles es

• Preparing for an Advanced Role
• Train in as many areas as possible
• Volunteer in Departmental Projects
• Transition Pains
• Hourly to Salary
• Time management
• Work day not as defined
• Opportunities
• More Responsibilities
• Managing Systems
• Witness the effects your presence has made

Ad Adul ult t Le Lear arnin ning g

• Education outside a Pharm D.
• Advanced Certifications
• Advanced 340B Operations Certificate
• Associate and Bachelor Degrees
• More paths to a degree than 2yr and 4yr programs
• Part-time, online, and/or evening programs widely available
• Tuition Reimbursement
• Your current employer may offer assistance

Julie F Lanza CPhT, CSPT Pharmacy Compliance Specialist Beth Israel Deaconess Medical Center Boston, MA 02215

Fut uture ure Ou Outlook

• ok for
• r Pha

harm rmac acy y Tec echnicians hnicians

• PTCB adding five assessment-based certificate programs for advanced roles,

and an Advanced Certified Pharmacy Technician (CPhT-Adv) credential.

• The new assessment-based certificate programs will recognize the important

contributions pharmacy technicians make. Candidates seeking to be a CPhT- Adv will be required to have earned at least four of the new certificates to be

• eligible. Current PTCB CPhTs who have completed at least four of the certificate

programs and 3 years of work experience will be eligible to earn a CPhT-Adv as early as mid-2020

• The five certificate programs under development are:

Technician Product Verification (Tech-Check-Tech) Medication History Controlled Substance Diversion Prevention Billing and Reimbursement Hazardous Drug Management

Fut uture ure Ou Outlook

• ok for
• r Pha

harm rmac acy y Tec echnicians hnicians

Fu Futur ture e Ou Outl tlook

• ok fo

for Pharmacy armacy Te Technicians hnicians

Beginning January 1, 2020, PTCE content will be organized into four knowledge areas rather than the current nine, and will focus only on essential knowledge that applies across practice settings. The recent shift of pharmacists’ roles toward direct patient care has created a void that technicians have an opportunity to fill. With the growing use of clinical pharmacy services, technicians have been increasingly called on to take responsibility for both clinical and operational functions across all patient-care settings. Pharmacy Technician job outlook from 2016-2026 = 12% (faster than average)

Th Thank you!

• Questions for Speakers