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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