Evolving Pharmacy Practice in Critical Access Hospital

Evolving Pharmacy Practicein Critical Access Hospital

Lisa Patton, Pharm.D., RPh

August 15-17, 2018

Mid-South Critical Access Hospital Annual Conference

Objectives

• Review the path of one Critical Access Hospital pharmacy over the last two decades

• Explore current strategies utilizing 340B and grant funding to improve patient access and quality of care in a rural community

• Look at future opportunities for growth

Brief History

• Founded in 1956, Mercy Health-Marcum & Wallace Hospital is a licensed 25-bed Critical Access Hospital providing inpatient acute care, outpatient services, emergency services with a Level IV Trauma Center, and primary care with clinics in Estill, Lee, and Powell counties.

Pharmacy Services Timeline

• 1997 – Marcum & Wallace was struggling financially and pharmacist shortage was just beginning.

MW contracted with larger hospital for pharmacy services.

-Allowed for decrease in inventory cost.

-Staffing issues resolved.

-24 hour remote pharmacy coverage provided.

-Freed up space for specialty clinics.

• 1997-2005 Inventory was manual process with multiple day chart

fills and night cabinet. Inventory was hard to control. Pharmacist

was only on site 4 hours a day 3 days a week.

Critical Access Hospital status obtained June 2000.

-Improved reimbursement.

MW hired part-time pharmacy technician to support pharmacist

in 2002.

-Allowed pharmacist to shift main focus from

inventory control to clinical outcomes.

By 2005, hospital received grant funding for hospital remodel which

allowed for ED expansion, creation of private rooms and shared

patient rooms with bathrooms, and addition of automated dispensing

system (ADS).

• Technician position changed from part-time to full-time certified

pharmacy technician.

• Technician would travel between contracted

pharmacy and MW opposite pharmacist.

• ADS lead to IT connection with larger facility

which allowed for access to patient

medication profiles at MW.

2013 – MW registered as 340B CAH to create 340B Contract Pharmacy

relationships in community. (Oversight by CFO instead of pharmacist.)

2014 – Go Live with EPIC as integrated Electronic Health Record as part of

Mercy Health required split from larger hospital from outside network which

utilized incompatible EHR. Suddenly, there was need for in-house pharmacy.

• Pharmacy area expanded. Pharmacy obtained equipment from two

merged hospitals in network including shelving units and sterile glove

box.

• Full-time and PRN pharmacist position created.

• New relationship with network hospitals in Cincinnati for afterhours

order review and verification.

2015-340B Program

transferred to Pharmacy

• Game changer

• Attended 340B University and 340B Coalition in Washington, D.C. for crash course in requirements.

• Made contacts within and outside of Mercy Health network.

• Returned home to begin 340B Program overhaul.

• Made strong case for 340B technician support for required auditing.

• Audits led to correction of issues preventing 340B maximization.

• Mixed use 340B program initiated.

Expanding Pharmacy Outpatient Services

• Access to 340B pricing sparked idea for Outpatient Infusion growth.

• Maximize 340B Contract Pharmacy savings by establishing new relationships.

• Obtain HRSA Grant funding to develop Medication Therapy Management program in ambulatory care setting.

• Assist primary care providers with Annual Wellness Visits.

• Create Pharm.D. rotation site to help expand pharmacy services.

• Investigate possibility of employee and meds-to-meds retail pharmacy.

Challenges

• IT limitations

• Limited resources

• Space

• Staff budget

• Insurance

• Provider support

• Patient skepticism

• Transportation

Encouragement

• CEO

• MW Managers

• Staff support

• HRSA Grant Writer

• Marketing

• Corporate support

• Patient success stories

Successes• 340B contract pharmacy program has grown from 2 to 8 pharmacies with

one additional pharmacy slated before the end of the year.

• Pharmacist obtained Apexus Advanced 340B Operations Certificate to prove knowledge of 340B rules and regulations.

• Outpatient infusions increased from 338 in 2016 to 744 in 2017.

• 24/7 open outpatient infusion area has lead to visits from patients several hours away and even from other states.

• Staff diversification as well as IPPE and APPE Pharm.D. rotations established.

• Ambulatory MTM program in conjunction with 340B CASH program has helped save patients on insulin, inhalers, and numerous other meds.

NRHA Quality Improvement Program MeetingSummer 2018

Moving Forward• Plan to modify the MTM model to help combat the opioid crisis. • Ambulatory RPh working to obtain Certified Pain Educator (CPE)

status.• Plan to see patients one-on-one for education on pain medications as

well as to review their medication regimen to determine appropriateness of planned pain interventions with current drug therapy.

• Help providers determine which patients are showing signs of abuse and diversion from pharmacy standpoint and may benefit from pain management versus primary care

QuestionsThank You

Contact

Lisa Patton, PharmD

Director of Pharmacy Services

Mercy Health-Marcum and Wallace Hospital

60 Mercy Court

Irvine, KY 40336

606-726-2146 (Office)

[email protected]