The Pharmacist’s Role in Improving the Bottom Line

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The Pharmacist’s Role in Improving the Bottom Line

HCAHPS Overview

• Hospital Consumer Assessment of Healthcare Providers and Systems

• Provide a standardized survey instrument and data collection methodology for measuring patients’ perspectives on hospital care

• www.HospitalCompare.hhs.gov

http://www.hospitalcompare.hhs.gov/

Goals of HCAHPS Survey

• Produce data about patients’ perspectives of care that allow objective comparisons of hospitals on topics that are important to consumers

• Incentives for hospitals to improve quality of care

• Enhance accountability in health care by increasing transparency of the quality of hospital care

HCAHPS Reimbursement Impact

• On November 1, 2006 CMS issued a final rule regarding the Outpatient Prospective Payment System that was designed to promote higher quality in outpatient care.

• Although the rule is primarily related to the Outpatient Prospective Payment System, it also includes provisions for expanding the quality reporting requirements for hospital inpatient services and links submission of HCAHPS data - beginning with discharges in July of 2007 - to the hospital’s market basket update for the 2008 fiscal year

• During the June "2010 ANI: The Healthcare Finance Conference" held in Las Vegas by the Healthcare Financial Management Association, it was estimated that HCAHPS scores would account for 10 percent of each hospital's VBP ranking under the Medicare program.

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HCAHPS Questions

• 4 Screening Questions• 5 Demographic Items• 16 Questions on Patient’s Perspectives• 8 Key Topics

– Communication with Doctors– Communication with Nurses– Responsiveness of Hospital Staff– Pain Control– Communication about Medicine– Environmental Cleanliness– Quietness of Hospitals – Discharge Information

HCAHPS Questions

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HCAHPS Questions

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CMS Rules: Communicating with Patients about the HCAHPS

Survey• Hospitals are not allowed to:

– Ask any HCAHPS questions of patient prior to administration of the survey– Attempt to influence or encourage patients to answer HCAHPS questions in a

particular way – Indicate that the hospital’s goal is for all patients to rate them as a “10”,

“Definitely Yes” or an “Always”– Imply that the hospital, its personnel or agents will be rewarded or gain

benefits for positive feedback from patients by asking patients to choose certain responses such as a “10”, “Definitely Yes” or an “Always”

– Ask patients to explain why they did not rate a hospital with the most favorable rating possible

– Offer incentives of any kind for participation in the survey– Conduct any satisfaction or patient experience survey prior to the HCAHPS

survey being completed (While an inpatient or post discharge)

CMS CAHPS Hospital Survey (HCAHPS) Quality Assurance Guidelines, version 4.0

Guidance on Communicating with Patients about HCAHPS

• Do not ask patients HCAHPS questions, questions using the same language and/or response scale found in the HCAHPS survey during patient interactions and administrative rounds

• Do not wear buttons with the word “Always” on them• Do not place posters about patient satisfaction and

experience in areas where the public can view them• Discharge calls should focus on the patients’ clinical

condition and not their satisfaction– The new survey process will provide timely feedback on

patients’ engagement and perception

Pain Management

• Discuss patient pain management expectations at admission

• Discuss pain management options with patient• Incorporate assessment into nursing hourly

rounding• Make pain management changes 24 hours

prior to discharge

Example Pain Management Tools

Pain Assessment

“Ruler”

Medication Use

Evaluation Tools

Opiate Conversion

Chart

Medication Communication

• Medication administer to >99% of patients.

Audience Participation

• Question: When should patients be told they are receiving a new medication that they have not taken before?– A. When the physician prescribes the medication– B. When the nurse administers the first dose of the

medication– C. Every instance of medication administration– D. When the patient is being discharged– E. All of the above

Answer: Audience Participation

• Correct answer is E• Medication education is everyone's

responsibility• Recognize that the patient’s perception of

education may be different than ours• Repeating medication education

reinforces the information

National Council on Patient Information and Education (2007). Enhancing prescription medicine adherence: A national action plan.


• Question: What percentage of patients are aware of potential side effects related to their medication?– A. 1%– B. 27%– C. 51%– D. 74%– E. 99%

Patient Education and Counseling 56 (2005) 276-282

Answer: Audience Participation

• Correct answer is B• Patients may not be aware of the side effects

of their medications• Using the word “side effect” clarifies the

patient’s understanding and perception of the medication

• When patients understand the side effects, they are more likely to take their medication

Patient Education and Counseling 56 (2005) 276-282

HCAHPS: Medication Administration

Role of the Pharmacist: • Become proactive about gathering and providing

medication information to patients and nurses• Ask the nurse and the patient questions to stimulate

dialog• Work with hospital administration to increase

pharmacist/patient contact• Incorporate patient communication skills and new

teaching methods into education sessions

Am J Health Syst Pharm. 2007 Mar 1;64(5):507-20.

Engaging Patient Care Staff

• Why is medication education important?– Improves medication adherence / compliance– Increases familiarity with medication side effects– Promotes patient self monitoring – Encourages follow-up with care– The informed patient will understand the side effects

of prescribed medications and take them as prescribed


Medication Adherence

• 50% of patients report they had forgotten to take a prescribed medication

• 31% had not filled a prescription they were given

• 30% had stopped taking a medicine before the supply ran out

• 24% had taken less than the recommended dose


Barriers to Medication Education- Environment

• Patient not in the room• Patient drowsy or unable to understand• Visitors present• Distracting environment

1. Robert M. Smith (1991, April). How people become effective learners. Adult Learning, p. 11.

2. Robert L. Steinbach (1993). The Adult Learner: Strategies for Success. (Menlo Park, CA: Crisp Publications.)

3. http://www.newhorizons.org/lifelong/workplace/billington.htm

http://aaace.org/

http://amazon.com/o/ASIN/1560521759/ref=nosim/agelesslearne-20/

Barriers to Medication Education--Adult Learning

• Patient’s level of knowledge• Patient does not understand the purpose of

education• 75% of what is heard is forgotten after 2 days• Patients may be disinterested in medication

education• Memorization of information is insufficient to

change behavior




http://aaace.org/


Enabling Medication Education

• Begin at a learner’s level• Explain importance of medication

knowledge• Patients remember 80% of what they

hear, see, and do• Learning must be stimulating• New information must be reinforced with

practical application




http://aaace.org/


Medication Teaching Tools

• Drug Information Vendor Partner

• Notepad for patient questions

• “Sorry I missed you” tent

Drug Information Toolkit

• Partnering with Medication Information Vendor for Staff Resources

• Printed Materials• Cover Letter• Sample MedCounselor patient education sheet• Step‐by‐step sheet for accessing and printing patient

education• Order form to request additional printed materials• Printed postcards to promote the online Clinical

Pharmacology quiz• Clinical Pharmacology Quick Reference Guides

HCAHPS Tools: Medication Administration

• Provide a note pad for the patient / family to write down questions about medications

Notepad for Medication Questions

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Medication Questions

Scenario A: Mrs. J. Doe

• 66 year old female• Presented to ED with heart palpitations• BP = 90/70 Pulse = 150 and irregular• Heart: Murmur audible at the apex• EKG: Atrial fibrillation with LBBB• Digoxin and beta blocker continued • Warfarin initiated (patient has never

received an anticoagulant)


• What would the next step be in providing education to this patient?– A. Pause, allow the patient to ask questions– B. Ask the patient a question to assess

understanding– C. Continue describing side effects; ask the

patient to hold all questions until the end– D. Give the patient a handout to reinforce

medication education session

Answer—Audience Participation

• Correct answer is A, B, and D• Always allow patients to ask questions• In order to assess the patient’s

understanding, it is important to ask him/her questions

• Handouts will help reinforce the medication education


• If patients appears not to comprehend the information, what is your next step?– A. Continue teaching and document the details

provided during the education session – B. Conclude the session and give them the

appropriate patient education handout – C. Conclude the session and contact the physician– D. Continue with education and let patients know

that this medication will be discussed throughout their hospital stay

Answer—Audience Participation

• Correct answer is D• Documenting education is important,

however not the complete answer• A handout may provide structure to the

education session, however, additional educational sessions may be necessary

• Communication should extend beyond the physician to include the entire healthcare team

Additional Reference:

National Council on Patient Information and Education (2007). Enhancing prescription medicine adherence: A national action plan. PDF available

Resources for Patients

• www.safemedication.com• http://www.ahrq.gov/qual/pillcard/pillcard.

htm• www.tnpharm.org/BlankUML.pdf

http://www.safemedication.com/

http://www.ahrq.gov/qual/pillcard/pillcard.htm

http://www.ahrq.gov/qual/pillcard/pillcard.htm

http://www.tnpharm.org/BlankUML.pdf

Summary

• Various avenue of opportunity exists for RPhs to improve quality metrics

• Ensure that quality measures are met by integrating into the health care team

• Assess opportunities within the medication administration process to affect or participate in interactions

The Pharmacist’s Role in Improving the Bottom Line

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