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December 2, 2013

Provider Status in California Paves Way for New Patient-Care Opportunities

California’s new pharmacy practice act expands pharmacists’ scope of practice.

PHARMACISTS IN CALIFORNIA have been on the cutting edge of practice for more than 20 years. Through collaborative practice agreements and progressive employment contracts, they have provided direct patient care and counseling, managed multi-drug medication regimens, participated in discharge planning and follow-up, and become integral members of multidisciplinary care teams.

In essence, they have been health care providers in all but official status. Now, with the October passage of S.B. 493, pharmacists have won legal, if long-overdue, recognition as health care providers. The legislation, authored by state Sen. Ed Hernandez, also provides for the creation of a new category of pharmacists in California, the Advanced Practice Pharmacist (APP), and expands authority for pharmacists in several areas crucial to public health.

Jonathan Nelson, government affairs and special projects manager at the California Society of Health-System Pharmacists

Jonathan Nelson, CSHP government affairs and special projects manager

“The idea behind this legislation is that pharmacists are perfectly educated and trained to provide [direct patient care] services. Until now the law did not keep pace with the changing nature of the profession,” said Jonathan Nelson, government affairs and special projects manager at the California Society of Health-System Pharmacists (CSHP). The ASHP state affiliate partnered with the California Pharmacists’ Association to lead a grassroots effort in support of the law.

Allowing Compensation

By recognizing pharmacists as providers, the new law allows payers such as Medi-Cal (California’s Medicaid program) and private insurance companies to compensate pharmacists for their services. Although compensation is not mandatory, the legislation removes the barrier presented by a lack of official status.

“Basically, we’re not prohibited from billing anymore,” said Candis M. Morello, Pharm.D., CDE, FCSHP, FASHP, associate professor of clinical pharmacy and associate dean for student affairs at the University of California, San Diego, Skaggs School of Pharmacy and Pharmaceutical Sciences.

“This is a gigantic step for us,” she said. “Medicare doesn’t identify us as providers. Insurers, who want to pay the least amount they can, fell back on that. But now we have a platform to say we’ve been recognized and that these are the expanded skills we can provide.”

Morello added that there is plenty of evidence in the literature to demonstrate the positive impact pharmacists have on outcomes, and, therefore, justify compensation. Indeed, that evidence was instrumental in garnering support for the bill in the legislature and deflating counterarguments from groups such as the California Medical Association (CMA), which initially opposed the bill.

Dawn Benton, executive vice president and CEO of the California Society of Health-System Pharmacists (CSHP)

Dawn Benton, CSHP executive vice president and CEO

“Physicians expressed concern about patient safety since providers would not be supervised by physicians. But when we pointed out that pharmacists were already doing [patient care] activities, the CMA stopped outwardly opposing this legislation,” said Dawn Benton, MBA, CSHP’s executive vice president and chief executive officer.

Benton added that timing was everything, given that roughly 7 million Californians are about to enter the health system as a result of the Affordable Care Act, and service is already stretched thin by a shortage of primary care physicians. Other physicians’ organizations, such as the California Association of Physician Groups, were on board from the start, recognizing that pharmacists could help alleviate the upcoming care crunch.

Opportunity Knocks

The legislation grants all pharmacists in California with relevant training the authority to furnish hormonal contraceptives, prescription nicotine replacement products, and, following guidelines by the Centers for Disease Control and Prevention, travel medications. Pharmacists may also order tests related to managing a patient’s medication regimen. However, pharmacists are not required to provide these services.

CSHP President Steven Gray, Pharm.D.

CSHP President Steven Gray, Pharm.D.

“This increased scope of care is permissive, but not mandatory,” said Steven Gray, Pharm.D., president of CSHP. “Pharmacists do not have to offer these services if they don’t feel qualified.”

The new law also provides for the establishment of the APP designation. Pharmacists who seek recognition as an APP will have to meet two of three criteria: certification in an area of clinical practice (ambulatory care, critical care, oncology, etc.), completion of a pharmacy residency where at least 50 percent of the experience includes providing direct patient care, and one year of providing clinical services to patients under a collaborative practice agreement or protocol.

These pharmacists will be able to perform physical assessments; order and interpret tests related to drug therapy; refer patients to other health care providers; initiate, adjust, and discontinue drug therapies; and evaluate and manage diseases and health conditions in collaboration with other care providers.

Provider status, expanded authorities, and the APP designation will combine to offer pharmacists in California a plethora of opportunities, said Gray. “They will be able to work in different environments, including private practice in the medical home, ambulatory care, and collaborative group practices with other clinicians.”

Pharmacists who stay in the hospital or health-system setting will see changes to their practice as well. For example, at Kaiser Permanente, dispensing pharmacists will be able to take a more active role in medication management. “If they think there is a problem with adherence, they will be able to order tests to monitor medication therapy, then recommend adjustments based on the results,” said Gray, who is also a pharmacy professional affairs leader for Kaiser.

“The new legislation could also drive up demand for pharmacy specialties,” added Nelson, noting that certification in a specialty is one of the three criteria pharmacists may meet for the APP designation.

Ryan J. Gates, Pharm.D., CGP, CDE

Ryan J. Gates, Pharm.D., CGP, CDE

Ryan J. Gates, Pharm.D., CGP, CDE, residency coordinator and senior clinical pharmacist at Kern Medical Center and adjunct assistant professor of pharmacy practice at the University of Southern California and the University of the Pacific, said the legislation will enable pharmacists to partner with managed care companies for the betterment of public health.

“We’ll be able to provide medication therapy management services, transitions of care, geriatric care, pediatric care, and so on. We can partner with companies that are struggling to meet the demands for care, such as immunizations for children.”

A Plan for the Future

California is the third state to establish an advanced practice designation, behind New Mexico and North Carolina. Montana and Washington State also recognize pharmacists as health care providers. California is also the largest state, by far, to recognize pharmacists as providers.

“This shows other states that this is not an insurmountable issue,” said Nicholas Gentile, ASHP’s director of state grassroots advocacy and political action. “California can serve as a model for other states in terms of moving provider status forward. They’re really given new life to these efforts across the U.S.”

New legislation passed by the California Senate now confers "health care provider status" on pharmacists.

Above, the California Senate in session.

Brian Meyer, ASHP’s director of government affairs, noted that the legislation was passed within a year of being introduced.

“This was pretty fast-tracked. Every state has its own dynamic process and timetable, so our recommendation to members is to not get discouraged,” he said, adding that “a lot was done behind the scenes to educate other clinicians and providers and help make it happen.”

Gates offered tips for pharmacists in other states. “The state pharmacy organizations need to identify pharmacists who are practicing in their state as providers, usually in managed care systems or Veterans Affairs systems, and start promoting them. Get them some awards and build awareness of what they do as providers,” he said. “Start the dialog in the public sector as much as possible so that when it comes up in the legislature, it’s not coming from Mars.”

He added that the need for pharmacists to collaborate with other clinicians and legislators could not be overstated. “Find physicians who can testify before your state senate and assembly, and get behind candidates and representatives who would be favorable to sponsoring a bill,” Gates said.

ASHP is currently developing provider status toolkits for other states, said Gentile. “The toolkits will provide what they need to do and what good legislation looks like.”

From there, the goal is federal recognition as Medicare Part B providers under the Social Security Act, Gentile said. “Efforts by the states will serve as great models and strong evidence of the need for provider status at the federal level.”

—By Terri D’Arrigo

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November 4, 2013

PTAC: A New Collaboration to Expand Pharmacy Technician Education, Training

Filed under: Ambulatory Care,Clinical,From the CEO,Managers,Quality — jmilford @ 3:33 pm
Paul W. Abramowitz, Pharm.D., Sc.D. (Hon.), FASHP

Paul W. Abramowitz, Pharm.D., Sc.D. (Hon.), FASHP

You may have heard about a new collaboration called the Pharmacy Technician Accreditation Commission (PTAC) that has been formed by ASHP and the Accreditation Council for Pharmacy Education (ACPE).I wanted to give you additional information about this significant initiative, which is being undertaken by ASHP and ACPE. This collaboration combines ACPE’s expertise and credibility in accrediting professional pharmacy degree programs with ASHP’s strengths in accrediting pharmacy technician training and pharmacy residency programs.

PTAC will be overseen jointly by ASHP and ACPE’s boards of directors, and, we believe, will greatly advance pharmacy technician training program accreditation and help to move our profession forward.

A Long, Illustrious History

Since 1982, ASHP, advised through its Commission on Credentialing, has served as the only pharmacy professional programmatic accreditor for pharmacy technician education and training programs. Likewise, ACPE, since 1932, has been and continues to be the primary source for accrediting professional degree programs.

ACPE also plays a vital role in assuring the quality of pharmacy education. Currently, there are 258 technician programs that either are accredited or are becoming accredited, and the need for and recognition of standardized technician training programs continues to grow. PTAC was created to address this need.

ASHP envisions that PTAC will create an increased emphasis for the need for accreditation of technician training programs and also assist us in greatly expanding their numbers. It is a “win-win” collaboration, across pharmacy and the health care continuum, for both technicians and the patients who will benefit from their work.

The Details

PTAC will consist of nine voting members, pharmacists and pharmacy technicians from a wide variety of practice areas. There will also be board liaisons from ASHP and ACPE, as well as a staff secretary.

Existing ASHP technician training programs scheduled for survey through May 31, 2014, will remain under the review of ASHP’s Commission on Credentialing. After May 2014, technician education and training programs seeking accreditation will apply for accreditation through PTAC, which will use a similar process to that used by ASHP’s Commission on Credentialing.

ASHP will manage the accreditation process and will continue to schedule surveys, and reports will continue to be sent to ASHP. However, all accreditation recommendations will be made by PTAC and will require final approval of both ACPE and ASHP boards of directors.

PTAC will use ASHP’s new Accreditation Standards for Pharmacy Technician Education and Training Programs that were approved in April 2013 and go into effect starting January 2014.

ASHP’s Regulations on Accreditation of Pharmacy Technician Training Programs will also be used to govern PTAC’s procedures for accreditation. Periodically, standards and policies/regulations will be revised and/or updated following industry best practices for accreditation. These will be approved by both ASHP and ACPE boards.

Growing Need for Well-Trained Technicians

The need for highly skilled and trained pharmacy technicians has long been recognized and continues to grow. ASHP looks to PTAC to create and nurture an effective, universal accreditation process. ACPE and ASHP support the use of qualified technicians in all pharmacy settings and recognize an obligation to develop and endorse standards that will continue to supply well-qualified technicians for pharmacy practice.

This process will ultimately help pharmacists to provide more critical and essential direct care to patients. We hope that you all will support this new collaboration with ACPE and help it to be successful. Click here to learn more about the PTAC and its efforts.

Best wishes for a happy, healthy, and joyous holiday season!

October 18, 2013

State Society Perseveres in Effort to Advance Pharmacy Profession

Filed under: Ambulatory Care,Current Issue,Feature Stories,Managers — Kathy Biesecker @ 5:11 pm
New legislation passed by the California Senate now confers "health care provider status" on pharmacists.

New legislation passed by the California Senate confers “health care provider status” on pharmacists in the state.

THE ROAD TO VICTORY for California Senate bill 493 (PDF) was neither straight nor smooth.

“This was a major fight,” said Dawn Benton, chief executive officer of the California Society of Health-System Pharmacists (CSHP).

Meetings between CSHP staff and state legislators or their staff occurred practically every day throughout the legislative process, she said.

But on September 12, after several Senate and Assembly hearings, votes, and amendments over the course of seven months, the bill emerged from the California State Legislature.

And on October 1, Governor Edmund G. Brown Jr. added his signature.

Come January 1, the California government will recognize pharmacists as “health care providers who have the authority to provide health care services.”

Furthermore, those pharmacists whom the state board of pharmacy recognizes as advanced practice pharmacists may provide certain additional services.

 

Jonathan Nelson, government affairs manager, California Society of Health-System Pharmacists

Teamwork

CSHP and its legislative partner, the California Pharmacists Association, worked in earnest to resolve conflicts with “the opposition,” said Jonathan Nelson, government affairs manager for the health-system pharmacists group.

The pharmacist groups succeeded in part, he said, by explaining some of the bill’s provisions in terms clearer than in earlier versions.

Even the California Academy of Family Physicians and the California Medical Association (CMA) had removed their opposition by the time the bill headed to the Assembly floor.

Hundreds of CSHP members wrote letters to their legislators, Nelson said. Many members in addition helped with the financial part of the legislative effort and met with their legislators to explain the contributions of pharmacists on the health care team.

“Their actions really helped pave the way to victory,” he said.

Collaboration, Not Independence

Something the pharmacists purposely did not do was important as well, said CSHP President Steven Gray.

“We did not claim that we were independent in the sense that we diagnose,” Gray said. “Pharmacists are not trained to diagnose. So we didn’t use the d word in anything.”

Similarly, the pharmacists did not claim to provide primary care, he said.

“In the nonpharmacist world,” Gray explained, “primary care means that you’re the person that sees the patient and diagnoses.  We may see a patient first when they walk in the pharmacy, but we refer them to a physician or other diagnostic profession. And then, once they determine what the problem is, we’re there to assist with the management of the drug therapy.”

More information on the law is available in the nine-page “What Does SB 493 Mean to Me?” fact sheet (PDF) prepared by the two pharmacist groups.

Dawn Benton, executive vice president and CEO of the California Society of Health-System Pharmacists (CSHP)

Dawn Benton, CSHP executive vice president and CEO

Cooperation

Senator Ed Hernandez, who introduced the legislation, had contacted the pharmacist groups last year and relied on them for the bill’s language, Benton said.

His legislation to establish independent practice for nurse practitioners and permit optometrists to diagnose conditions and disorders of the eye, however, are still with Assembly committees.

Benton said the pharmacist groups ensured that their legislation stated the need for communication and collaboration with patients’ physicians.

“In our negotiations with CMA, the physicians were very concerned that the pharmacists not be acting independently,” she said.

The State’s Need

Nelson said the California pharmacist groups looked at New Mexico’s and North Carolina’s legislation on advanced practice pharmacists “as a starting point, as an inspiration.”

But both states passed their legislation more than 10 years ago, which meant the California pharmacists could not rely solely on the language in those bills, he said.

After President Obama signed the Patient Protection and Affordable Care Act in 2010, California’s government started planning to ease the eligibility requirements for the Medicaid program and implement a health insurance exchange.

“We needed something in California, we felt, to handle the increase in demand for health care both in terms of quantity and complexity,” Gray said. “And that was the main reason that we felt that it was imperative to get this bill through and allow pharmacists to be a part of the solution and apply the full breadth of their training and experience.”

Commercial insurers’ interest in having pharmacists provide collaborative drug therapy management in accountable care organizations was also taken into consideration, he said.

“They were starting to run into problems,” Gray said. “They couldn’t find enough of the collaborative drug therapy management pharmacists.”

A 1994 California law allows certain pharmacists to provide collaborative drug therapy management in health care facilities. Those pharmacists have completed a clinical residency training program or had showed clinical experience in providing direct patient care.

Gray said the number of pharmacists wanting to complete such a residency program has outpaced the openings.

CSHP’s members, he said, saw the urgent need for “an alternative pathway.”

The new law, in creating the designation “advanced practice pharmacist” and further expanding the scope of pharmacists’ practice, adds certification in a relevant practice area as a pathway.

Blue Shield of California, which has accountable care organizations in several areas of the state, supported the bill.

Not Done

Benton said CSHP started receiving congratulations from people around the country once word spread about the governor approving the bill.

“We’ve got a lot of work ahead of us, and we’re already getting started,” she said.

The state boards of pharmacy and medicine, for example, must agree on the standardized procedures and protocols for pharmacists to furnish prescription nicotine-replacement products. And, as another example, the state board of pharmacy must develop a process for accepting applications for recognition as an advanced practice pharmacist.

Benton said CSHP will participate at every opportunity.

—By Cheryl A. Thompson

Editor’s Note: This article, which was originally published on www.ashp.org, is reprinted with permission.

Antibiotic Stewardship Team Improves Drug Use, Reduces Costs

From left, Eugene Varoz, clinical pharmacist, consults with Peggy Reap, R.N., and Madhur ??, M.D.

From left, Eugene Varoz, clinical pharmacist, consults with Peggy Reap, R.N., and Madhuri Segireddy, M.D., ID specialist at Chandler Regional Medical Center.

AN AGGRESSIVE ANTIMICROBIAL stewardship program established jointly by Mercy Gilbert and Chandler Regional Medical Centers led to a significant decline in unnecessary antibiotic therapy and a 25 percent reduction in costs for frequently used and expensive antibiotics. Gilbert and Chandler are two Phoenix, Ariz., hospitals in the Dignity Health network.

“Our antibiotic costs were increasing rapidly and had become one of the top drug expenditures in the pharmacy,” said Bina Patel, Pharm.D., pharmacy manager at Chandler Regional, who Patel co-led the cross-site team with Jennifer Ng, Pharm.D., former clinical pharmacy supervisor at Mercy Gilbert.

Dr. Patel noted that just five antibiotics were responsible for 60 to 70 percent of antibiotic costs at the two facilities. “We also found that these broad-spectrum antibiotics were often prescribed inappropriately,” she said.

Neither hospital’s pharmacy regularly reviewed antibiotic order patterns, resulting in inconsistent prescribing practices and antibiotic overuse.

The hospitals formed a multidisciplinary team tasked with creating an antimicrobial stewardship program that could be incorporated into routine medication management. In addition to Drs. Patel and Ng, the team included an infectious disease pharmacist, an infection preventionist, a microbiologist, an infectious disease physician, an emergency medicine physician, and a hospitalist.

Identifying Underlying Causes of the Problem

Using a form of Lean methodology called Transformational Care (TC), the team set out to identify the root causes of the problem and create quick and efficient solutions. TC and Lean methodology help to streamline and simplify systems and eliminate waste. Each team member underwent 12 weeks of TC training.

The team discovered that pharmacists were playing only a limited role in managing infectious disease therapies. Standardized diagnostic order sets, pharmacy reviews, and interventions also were lacking.

In the face of these challenges, the team developed criteria for using broad-spectrum, high-cost antibiotics and formulated evidence-based guidelines for antibiotic use. They also created an antibiogram displaying the sensitivities of various isolated bacterial strains to different antibiotics.

This information was then published in pocket guides and distributed to prescribers. Standardized adult antibiotic order sets based on frequent diagnoses (e.g., pneumonia, cellulitis, and urinary tract infections) were also developed to improve the accuracy of antibiotic selection.

Dr. Bina Patel, Pharm.D.

Dr. Bina Patel, Pharm.D.

“The forms are targeted primarily at hospitalists and emergency department physicians so they don’t have to spend time thinking about what they need to do empirically,” explained Dr. Patel. “The physicians can use the form to simply check off the correct antibiotic based on the diagnosis and send it to the pharmacy. Because the drug choice was selected from the approved form, the order doesn’t need to be reviewed.”

For inpatients, an infectious disease pharmacist reviews orders for the top five targeted antibiotics to ensure that they are well matched to an empiric diagnosis. When culture results become available, the pharmacist rechecks to determine if the therapy is appropriate. If a change is needed, the pharmacist calls the prescribing physician to recommend a more suitable antibiotic, decrease the dose, switch from IV administration to an oral form, or discontinue therapy entirely.

Physician Education and Metrics

The program has been a great success. During its first year, pharmacists conducted 1,966 interventions at both hospitals, 93 percent of which were accepted by physicians.

“We also conducted physician education to increase awareness of antimicrobial stewardship and what it means to the quality of patient care,” said Dr. Patel. “That helped to win acceptance.”

To gauge the impact of the initiative, the team tracked, among other metrics, the average daily defined doses (DDD) of the five target antibiotics, the number of patients prescribed the target drugs, the length of therapy, and drug costs.

The results have been impressive. During the program’s first year, the average DDD decreased for all of the top five targeted antibiotics—in one case by more than 70 percent (see box). The cost per inpatient day for the five drugs decreased 26.4 percent, and the total antibiotic cost per inpatient day dropped 14.2 percent. The number of patients prescribed the target antibiotics for more than five days also declined.

After the first year, the changes leveled out, which Dr. Patel expected. Now, near the end of the program’s third year, the challenge is to hold onto the gains and widen the net.

“We achieved a significant reduction from baseline in both drug usage and costs. Now we need to maintain that progress,” she said. “We’ve also expanded the program to look at other antibiotics.”

Recruiting Champions

The initiative has raised the visibility of clinical pharmacists, according to Dr. Ng, now a clinical pharmacist at Banner Baywood Medical Center in Mesa, Ariz.

Jennifer Ng, Pharm.D.

Jennifer Ng, Pharm.D.

“Initially, some of the physicians were not used to pharmacist interventions, at least with antibiotics,” she said. “Later, their responses became far more positive, and they said they appreciated and even expected the calls. Resistance really dissipated once the doctors understood what we were trying to accomplish.”

Dr. Ng emphasized the importance of a multidisciplinary team and having a physician advocate on the team.

“Having at least one physician champion goes a long way,” she said, noting the support of an infectious disease doctor on their team. “It shows the rest of the hospital that the program is not just the pharmacy out there on its own, and it drives home the point that there’s a bigger goal in terms of patient care.”

Administrative support, another factor that was crucial to the program, was present from the start.

“The pharmacy and the infection control physicians led the way,” said Peter Menor, vice president of operations at Chandler Regional and the executive sponsor for the initiative. “My role was to give them the resources to get the job done. The program spread very quickly. Before we knew it, the entire medical staff was involved. It’s been very well received and it’s had an enormous impact on patient care.”

–By Steve Frandzel

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August 8, 2013

Leadership: Central to Pharmacy Practice Advancement

Paul W. Abramowitz, Pharm.D., Sc.D. (Hon.), FASHP

Paul W. Abramowitz, Pharm.D., Sc.D. (Hon.), FASHP

EFFECTIVE, FOCUSED LEADERSHIP AND EXECUTIVE PRESENCE are essential to driving pharmacy practice advancement, thus optimizing patient care. ASHP and the ASHP Foundation are committed to supporting pharmacists in their professional and leadership development journey to achieve this goal.

Leadership in clinical practice and effectively working collaboratively on interprofessional teams are what drives practice change. And, through a number of initiatives, ASHP and the Foundation are dedicated to assisting pharmacists across the complete spectrum of their career… from student, to new practitioner, to emerging clinical and administrative practice leaders, and, ultimately, as experienced leaders.

No other pharmacy organization has the depth and level of commitment to your practice leadership development that ASHP does. Please let me review with you this level of commitment and showcase examples of leadership development opportunities that ASHP and the Foundation are offering our members.

Pharmacy Leadership Academy

The Pharmacy Leadership Academy (PLA) has been in existence for five years, and nearly 400 practitioners have completed this transformational leadership development program. The Academy is helping to launch talented new clinical practice leaders and assisting other established leaders in reaching new heights in their careers.

At the Foundation’s ASHP Summer Meeting Donor Breakfast, I heard three pharmacists speak about their life-changing PLA experiences. I was touched and thrilled to hear their heartfelt stories of professional success, and I suggest that you read their inspiring messages and view the video on the Foundation’s website.

What impressed me about the graduates’ messages was their self-confidence, poise, passion, and full commitment to their patients and to leading our profession to new heights. This month, 68 pharmacists began the year-long, distance-based PLA program. They are poised to reach new heights in practice leadership.

If you are interested in catapulting your career, I encourage you to consider enrolling in the next class. In addition, directors and chief pharmacy officers should also identify members of their staff who are primed for success and enroll them in the 2014 class.

leadersINNOVATION Masters Series

ASHP and the Foundation also offer the leadersINNOVATION Masters Series, which consists of two, six-week distance-learning programs: “Developing Transformational Leadership Skills” and “Designing Transformational Change: Strategy and Tactics.”

This leadership development series is an excellent option for pharmacists who may not be able to fulfill a year-long commitment, or who seek a program before the start of the next PLA class. The leadersINNOVATION Masters Series begins August 18. Courses position practitioners to deal effectively with rapid changes in the health care environment and to position pharmacy for the type of transformational change that can expand and advance pharmacy practice.

The series is ideally suited for an emerging leader, a recent pharmacy resident graduate, or for an established leader needing guidance on how to move pharmacy practice to the next level. It also may be exactly what you need for your own professional development or what you have been seeking for one or more of your staff.

leadersEDGE Webinar Series

The new leadersEDGE Webinar Series is another leadership development program that will be launched by the Center for Health-System Pharmacy Leadership in September 2013.

This 90-minute program will address major, cutting-edge leadership challenges facing pharmacy practitioners in health systems. The first program will address the current state of the “Business of Pharmacy.” Webinar faculty will focus on the critical capability and capacity necessary to transform practice. It is the perfect program for pharmacists interested in staying in front of major leadership issues facing our profession.

Opportunities for Students, Residents

At ASHP, we believe that our student pharmacists and pharmacy residents are the lifeblood of our profession.

Pharmacy students face a competitive environment when they graduate and are looking for opportunities to develop and ultimately showcase their leadership talents. ASHP has a host of opportunities through the Student Societies of Health-System Pharmacy, Leadership Speakers BureauASHP Student Leadership Award ProgramStudent Leadership Development Workshops, and the national Clinical Skills Competition.

The future of our profession is in the hands of our pharmacy students and pharmacy residents. ASHP remains committed to providing leadership opportunities for them, including the Visiting Leaders Program, which has been developed explicitly for pharmacy residents.

Showcasing ASHP’s Many Leadership Offerings

During my many years working in hospitals and health systems, I relied upon ASHP, as my professional organization, to assist me in that journey at all steps along the way. It was a challenge for me to keep up with the many offerings of ASHP, and I know many of you face the same challenge.

That is why, at this critical juncture, I am taking the time to showcase ASHP’s commitment to our leadership development programs. Please take the time to share this message, and have your colleagues or your staff members review these fantastic program opportunities.

Feel free to share your thoughts with me about your leadership development needs, and remember that focused and effective leadership is central to pharmacy practice advancement at the bedside, in the pharmacy, in the clinic, and in the administrative office.

July 15, 2013

West Penn Clinic Successfully Treating Underserved Patients

Pharmacists at West Penn are a key part of the transition-of-care team as indigent patients move from inpatient care to care at the Health and Wellness Clinic.

PITTSBURGH KNOWS A THING OR TWO about comebacks. The Rust Belt capital suffered big losses when the steel industry collapsed in the 1980s, but returned to prosperity with a diversified economy. The West Penn Hospital also faced its own budgetary crisis a few years ago, after peaking in patient volume in 2008.

In 2010, we were forced to significantly downsize and reduce patient care services due to the financial difficulties of our parent organization. After an acquisition and two years of rebuilding and revitalization, we have turned things around with the reopening of a transformed emergency department, an increase in patient beds, technology upgrades, and the biggest transformation yet: the opening of a “new concept” health and wellness clinic in downtown Pittsburgh.

The West Penn Hospital Health and Wellness Clinic, which opened in February 2013, helped us to re-establish our reputation as a cornerstone of medical care in Pittsburgh and the surrounding Bloomfield-Garfield community. Funded 100 percent by proceeds from the hospital’s 340B drug discount program, the clinic provides critical medical services to underinsured and otherwise underserved patients.

Jennifer Davis, Pharm.D.

Jennifer Davis, Pharm.D.

Since its inception, the pharmacy services department has been a driving force behind West Penn’s 340B program.  As the system director for outpatient pharmacy services, I’ve taken the lead in the overall operations of the new clinic. We run the clinic as efficiently as possible, saving time and resources by using existing space and personnel, including on-staff physicians. The funds generated by our 340B program pay for medications that patients might not otherwise be able to afford and for the cost of staffing the clinic.

As a 340B-covered entity, West Penn Hospital contracts with local pharmacies to fill prescriptions using inventory purchased by the hospital at the 340B price. Through this contract pharmacy network, we provide discounted medications to uninsured patients and generate much-needed supplemental revenue from prescriptions covered by insurance.  The revenue, in turn, is used to cover the cost of the downtown Health and Wellness Clinic as well as costs associated with other uncompensated care.

Clinic Grows, Hospital Readmission Shrinks

Physicians at the clinic see uninsured and underserved patients weekly, and we expect to see more patients as word spreads. With funding generated by the 340B program, we help patients offset the costs of their medications. They literally benefit twice from the same 340B savings—patients now have increased access to care and their prescription costs are lower.

As with most hospitals today, readmission is a hot topic at West Penn. Pharmacists at the clinic help keep patients from using the hospital’s emergency department by providing disease management, medicine adjustments, and lab monitoring services. In addition, we receive prescription compliance data from our 340B program administrator to help clinicians monitor the patients who use the program. In February alone, the clinic saw 52 patients. We were also able to hire a full-time receptionist. By year’s end, the clinic hopes to see 800 patients.

Transitioning to Better Care

At the clinic, we are strong advocates for the “transition of care” program, which helps patients use the wellness clinic and Allegheny General Hospital (AGH) Apothecary (one of the hospital’s 340B contract pharmacies) and other local contract pharmacies. This program helps to ensure the coordination and continuity of care as patients transfer between different locations or different levels of care within the same location.

Another service we offer at the clinic is bedside medication counseling at discharge and seeing these patients at the clinic for medication management. AGH Apothecary fills prescriptions as needed. Pharmacists also provide post- hospitalization follow-up for patients who are unable to see their regular doctor.

Key Partners in Setting up the Clinic

With the health and wellness clinic, we have made the best possible use of the hospital’s 340B savings. Starting the clinic, however, took planning, resourcefulness, hard work, and a partnership with a contact pharmacy administrator, Wellpartner, to manage the program.

Wellpartner has expertise in creating custom 340B retail pharmacy networks that include both chains and independents.  Our network is well balanced with the right geographical coverage, which helps increase 340B program utilization.

The hospital first implemented its 340B contract pharmacy program in 2011, after a local pharmacist noted that uninsured and underinsured patients from the hospital’s Joslin Diabetes Center could no longer pay for their medications. Currently, West Penn’s 340B program uses 29 contract pharmacies, filling more than 8,800 prescriptions in 2012.

I also credit the hospital’s C-suite for helping to get the clinic started. They were huge champions for us, and I believe that with strong C-suite support any hospital can implement such a program.

The economy has caused plenty of setbacks for us and for people in need throughout our service area.  But the West Penn Hospital Health and Wellness Clinic proves that with hard work and ingenuity, positive results are possible, even in the worst of times.

–By Jennifer Davis, Pharm.D., Director of Outpatient Pharmacy Services, West Penn Health System, Pittsburgh

 

 

 

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