Lt Col David A. Gettman, USAFR, BSC Associate Chief, Pharmacy Services Patrick Air Force Base, Florida Global Pharmacy Operations In the Milit
Aug 13, 2015
Lt Col David A. Gettman, USAFR, BSCAssociate Chief, Pharmacy ServicesPatrick Air Force Base, Florida
Global Pharmacy Operations In the Military
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Air Force Medical Service (AFMS) Missions
SHA
PER
ESPON
D
PREPARE
VIGIL
AN
CE R
EAC
H
POWER
Peacetime Engagement & Crisis Response Deterrence & Contingency Operations
War Winning Operations
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THE BUSINESS OF THE AFMS
• Medical Readiness• Provide optimal operational support to three major
functional areas
• War Winning Operations• Humanitarian & Civic Assistance• Disaster Response
• Peacetime Healthcare• Provide quality healthcare to our beneficiaries in a
fiscally-sound manner
• Ensure and improve health and fitness of our beneficiaries by Building Healthy Communities
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What is the Air Force Medical Service (AFMS)?
• $5.3B COST TO DoD
• $3.1B BUDGET AUTHORITY
• 2,300,000+ ELIGIBLE BENEFICIARIES
• 5,000+ CIVIL SERVICE EMPLOYEES
• 12,000+ OFFICERS
• 22,000+ ENLISTED
• 5 ACADEMIC MEDICAL CENTERS
• 53 CONTINENTAL US CLINICS / HOSPITALS
• 18 OVERSEAS CLINICS / HOSPITALS
Notable Benchmark:
General Motors Corporation Health Plan
1.25 million beneficiaries at $3.9 Billion (FY 2000)
Integrity – Service - Excellence
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PHARMACY: Patrick AFB
• Outpatient Clinic• 2 sites (main clinic and satellite building)
• Workload• 2600 new & refills daily
• Budget: $20,600,000 • Beneficiaries : ~ 50K• 3-lane Drive Thru• Point of Service
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PHARMACY: Patrick AFB
• 6 Pharmacists: 4 officers & 2 contractors• 36 Technicians• 19 military • 14 civilian contractors• 4 federal employees
• > 100 Red Cross Volunteers
MANPOWER
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MILITRY vs. CIVILIAN PHARMACY
SIMILARITIES• Profession of
Pharmacy• Staffing• Laws/Regulations/
Company Policies• Accountability• Licensure• Chain of Command• Drug Reps• Etc
DIFFERENCES• Exchange of Cash• Deployments
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ROLES
• Pharmacist• Oversight• Clinicians
• Technician Dispensing• Tech check tech• Patient Counseling
• Red Cross Volunteers
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STAFFING
• AF Technician Training• ASHP accredited training programs
• 14 week didactic / 3 week clinical rotation
• Upgrade training immediately after graduation• 6- 12 months textbook base
• At 5 – 7 year point: additional training
• Competencies• Personnel Issues• Performance• Disciplinary
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RISK MANAGEMENT & PREVENTION
• Technology• Automation
• Computers (screening, patient leaflets)• Provider order entry• Barcoding• Robotics
• Quality Improvement Program• Interventions• Trend analysis• Performance Metrics
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OVERSIGHT
• JCAHO• Federal• State• EPA• DEA• Air Force Inspector General• Secretary of Defense, Health Affairs• Congress
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CHALLENGES & OPPORTUNITIES
BenefitReadinessBenefitReadiness
Interdependent vs Independent MissionsReadiness and Benefit Missions: Synergistic and Cost Effective
Finding the Right Balance
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FISCAL ENVIRONMENT
“Go back to sleep, John. You’re just havin’ a nightmare… of course, we are still in hell.”
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CHALLENGES & OPPORTUNITIES
• Inflation• Formulary Additions: New & Expensive
Drugs• Less Discretionary Spending• Shrinking Funding Stream• Rapidly changing, costly technology• Pharmacoeconomics
FISCAL ENVIRONMENT
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What You Need to Tell the Boss Needs Versus Wants…
• Complete asset inventory• People• Equipment• Contracts• Leases
• Identify “baseline,” requirements; “One-times”• “Most dear – Least dear”
• Where do you need to be?• Where do you want to be?
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CHALLENGES & OPPORTUNIES
• Staffing• Morale• Competency• Retention/shortfalls
• Compliance• Evolving Practice of Medicine• Risk Management• Strategic Planning• Rising Expectations (deployments, patients, etc.)• Leadership