PSHP Annual Assembly 2015PSHP Annual Assembly 2015

Importance of Measuring Pharmacy Department Data: How to

Enhance Productivity Through a Scorecard

Jill Rebuck, Pharm.D., MBA, BCPS, FCCM, FCCP

Director of Clinical Pharmacy Services

Penn State Milton S. Hershey Medical Center

Objectives

Discuss at least 3 examples of meaningful clinical & operational metrics for a health-system pharmacy department

Driving Forces for Change

Pharmacy

Practice change

Quality payments

Complex drug therapies

Technology advances

Care Transitions

Greater pharmacist

accountability

Provider movement

AJHP 2009;66:713

Why Measure Performance? Shift from volume to value-based care

Accountable Care Act Value based purchasing Meaningful use

PPMI leaders believe: Lack of pharmacy resources is barrier to

optimal practice models (83%) Stakeholders have “insufficient recognition”

of pharmacy’s value (73%)

PPMI Summit 2010; Accessed via ashp.org

Pharmacy Department Realities

Limited pharmacy staff

Tighter budgets

Rising drug expenses

Expectation to provide highest quality pharmacy services while decreasing total cost of care

Greater accountability to defined patient outcomes

“If you can’t measure it, you can’t improve it”

- Peter Drucker

Advantages of Pharmacy Scorecard

If adequately constructed & updated frequently: Represent broad view of performance Guide for strategic decision making Improve quality of pharmacy services

Demonstrate impact of pharmacy on organizational alignment

Enwere EN, et al. Hosp Pharm 2014;49:579-84

Department Alignment

Mission

Vision

Values

Strategic Goals

Initiatives

Department Performance Metrics

Adapted by Enwere EN, et al. Hosp Pharm 2014;49:579-84

Scorecard Considerations

Tactical indicators of performance metrics based on specific goals

Trend data over time (vs. dashboards) Monthly or quarterly & YTD

Push vs. pull data considerations Need to be easily monitored

Resource allocation for data collection

Establishing Performance Targets

Obtain institution-specific baseline data Incorporate external benchmarks

Enhance validity & credibility Determine frequency of updating info

Monthly, quarterly, annually Visualization of progress

Evaluate metrics annually

Controversy: Scorecard Content

Pharmacy-centric metricsvs.

Organizational wide metrics

Examples: % Med Rec Completed or 30-day Readmission % Patients receiving anticoagulation or % DVT/PE % Patients with pain scores < 5 or % Top Box

HCAHPS pain control

Examples of Med-Related Outcomes

Metric ( ↑ = Higher numbers are better ↓ = Lower numbers are better) FY15 Baseline

Goal July Aug Sept

MEDICATION-RELATED PATIENT OUTCOMES

Number of Rx Interventions per 100 Discharges ↑ 800 900 815 830 910

Weighted Rx Inteventions per 100 Discharges ↑ 2,000 2,700 2,100 2,800 2,900

Percentage of High Risk Patients Receiving Medication Counseling ↑ 20.0% 70% 35.0% 50.0% 60.0%

Number of Reported Serious Medication Events per Month ↓ 0.9 0 0 0 0

H-CAHPS Communication About Medicines (% Always) ↑ 65.0% 68.0% 64.0% 66.0% 69.0%

% Rx Referred Ambulatory Patients with HTN Controlled ↑ 50% 60% 55% 58% 62%

Numbers above represent fictitious data for illustrative purposes only

Examples: Pharmacy Operations

Further consideration on order verification turn-around-time

Pharmacy Operations

Weighted Drug Orders Processed per Pharmacist FTE ↑

Weighted Orders Dispensed per Technician FTE ↑

Retail Pharmacy: Prescriptions Dispensed per Pharmacist FTE ↑

Code S TPA Preparation Time in Minutes (Prep and Delivery) ↓

% Medications Dispensed as Overrides ↓

% Medications Redispensed ↓

IV Admixture Service Environmental Index (% WNL) ↑

Further consideration of order verification turn-around-time

Examples: Pharmacy Operations

Further consideration on order verification turn-around-time

Pharmacy Operations

Weighted Drug Orders Processed per Pharmacist FTE ↑

Weighted Orders Dispensed per Technician FTE ↑

Retail Pharmacy: Prescriptions Dispensed per Pharmacist FTE ↑

Code S TPA Preparation Time in Minutes (Prep and Delivery) ↓

% Medications Dispensed as Overrides ↓

% Medications Redispensed ↓

IV Admixture Service Environmental Index (% WNL) ↑

Further consideration of order verification turn-around-time

Examples: Financial & Growth

Further consideration on order verification turn-around-time

Pharmacy Financial Optimization

Inpatient Drug Expense per Discharge ↓

Inventory Turns ↑

% Overtime ↓Pharmacy Growth

% Increase in Employee Prescriptions at Retail Pharmacy ↑% Increase in Discharge Prescriptions at Retail Pharmacy ↑

Number of Rx-Generated Patient Ambulatory Encounters per Month ↑

Number of Rx Collaborative Drug Therapy Management Protocols ↑

Examples: Employee Talent

Employee Talent

% Pharmacists with Certification/Advanced Training ↑% Pharmacy Technicians with Certification ↑

Number of Pharmacy Educational Offerings ↑% of Pharmacists Serving as Preceptors ↑

Productivity Monitoring Indicators

Worked hours per unit of service Drug (or labor) cost per admission Labor expense per 1,000 doses billed RPh worked hours per order Tech worked hours per dose Clinical interventions per RPh shift RPh:Technician skill mix ratio Rx cost as % of total hospital cost

Adapted from Rough SS, et al. AJHP 2010;67:380-8.

Pharmacy Intensity Score

Resource-based relative value intensity grouping system

Uses pharmaceutical resource consumption data Produce DRG-specific drug use weights

Generally preferred over CMI Example: hip replacement vs. kidney

transplant

Rough SS, et al. AJHP 2010;67:300-11.

Scorecards: Summary

Important to promote and justify patient-centered pharmacy services

Update & share regularly with pharmacy employees and stakeholders

Influence ‘right size’ of department

Questions