Download Pharmacy Cost

Manage Pharmacy Cost Without
Impacting Quality Care
Charles Borum, MD
The Hospice Promise
• What is the hospice promise?
− Dignity
− Pain free
− Patient & family directed care
The Hospice Promise
The Six Pillars of Success: Why?
• We talk about what we can measure…
• We set goals around what we can measure…
• We improve what we can measure…
The Six Pillars of Success
Balance service efficiency & customer satisfaction
Reining in customer service costs while keeping
customer satisfaction scores high is especially
necessary – and especially difficult. It's a balancing act
so strenuous, many don't even attempt it.
The “Big 5” Expenses
1.
2.
3.
4.
5.
Labor – 65%
Medications – 8-10%
DME – 6%
Mileage – 5%
Medical Supplies – 2%
Totals 86% of all expenses!
Managing Pharmacy Costs
• Pharmacy costs make up 8-10% of all hospice
expenditures.
• This equals hundreds of thousands of dollars every
year.
• The cost of medications is rising much faster than the
hospice reimbursement.
Managing Pharmacy Costs
To help cope with these rising costs and still provide the
most effective medications for our patients,
Pharmacy Services creates tools to empower the
staff and promote formulary compliance.
What Pharmacy Services Provides
•
•
•
•
•
•
Educate agencies regarding new medications and medication trends.
Provide medication utilization reports to all levels of management.
Provide telephone support to pharmacies and programs.
Act as a liaison between pharmacies and our programs to facilitate seamless
medication delivery.
Review reports to verify it is our patient and the meds are our responsibility. These
reports are your chance to catch a high cost non-formulary med quickly.
Provide bi-weekly reports that show your aggregate med orders for a 15-day
period sorted by patient.
– Use these to help identify outlier patients
– Use the graph to benchmark your program against other programs around the
country
Decreasing Pharmacy Cost
Pharmacy Cost
8
6
4
pharmacy cost
2
0
Dec-15
Jan-16
Feb-16
Mar-16
Apr-16
Goals of Quality Assessment
• Allows us to review data about the performance of
our whole organization – how are we doing?
• Helps us identify the most important opportunities
for performance improvement.
• The way we assess and monitor quality is by tracking
quality indicators.
What data must be collected?
The data that must be collected and reported currently
includes two things:
• General information about the kinds of quality
indicators currently being used by hospices in their
QAPI programs.
• Specific data regarding the number of patients who
report being uncomfortable because of pain at the
admission assessment.
Why is NQR important?
Hospices that do not comply with the data collection
and reporting will face a 2% reduction in the payments
they are otherwise qualified to receive from CMS.
Decreasing pharmacy cost without affecting care
8
7
6
5
4
3
2
1
0
pharmacy cost
pain at SIT within 48 hrs
pain above SIT in last
week of life
Dec-15
Jan-16
Feb-16
Mar-16
Apr-16