Meeting Minutes

Meeting MinutesMeeting Minutes October 14, 2013

I.  Congrats to our new liaisonsVivian Hong and Nhu Nguyen!

II. Upcoming eventsa. Speaker event with Dr. Alan  Bell

i.      Oct 24ii.     6:00 – 7:30 PM

b. Omnicare Touri.      Nov 6ii.     1:00 – 3:00 PM

Consultant Pharmacy PracticeConsultant Pharmacy Practice

Mark SeyOctober 14, 2013

Definition - Who is a Consultant Definition - Who is a Consultant Pharmacist?Pharmacist?

A pharmacist who is compensated to provide expert advice on the use of medications by individuals or within institutions, or on the provision of pharmacy services to institutions.

Originated in the nursing home environment ASCP focus - defined by their common

commitment to enhance the quality of care for all older persons through the appropriate use of medication and promotion of healthy aging.

The Right AnswerThe Right Answer

YOU !

Today’s DiscussionToday’s Discussion

Evolution of Consultant PharmacyAmerican Society of Consultant

PharmacistsSenior care environmentsKey long-term care professionalsSenior care pharmacy practice

Evolution of Consultant PharmacyEvolution of Consultant Pharmacy

1965- Medicare/Medicaid– Drug regimen review required by charge nurse

and prescribing MD working together– Consultant Pharmacist responsibilities for drug

distribution 1969 – ASCP Established1974 – DRR required by pharmacists in NF!

Evolution of Consultant Evolution of Consultant PharmacyPharmacy

1982 - Indicators developed to help surveyors assess DRR

1980’s – Consultant pharmacists showed their stuff!– Practice roles more clearly defined– Consultant’s effectiveness documented

Decreased inappropriate drug useFewer ADR’sMD’s accepted CP recommendations

Evolution of Consultant Evolution of Consultant PharmacyPharmacy

“Success Breeds Success” Increased mandate for consultant’s services

1987 - Pharmacist review mandated in ICF 1988 - Pharmacist quarterly review mandated in

ICF-MR Pharmacists published their work in Consultant

Pharmacist People took increasing awareness of consultant

pharmacists

American Society of Consultant American Society of Consultant Pharmacists (ASCP)Pharmacists (ASCP)

8,000 members Numerous State chapters National meetings – May and November Well-respected and informative web site Website:www.ASCP.com Website:www.seniorcarepharmacist.com Embraces interdisciplinary initiatives Supported development of Commission for

Certification in Geriatric Pharmacy (CCGP)

The Continuum of Care

NursingFacility

Subacute

Hospital

AssistedLiving Home

HealthCare

Cos

t

Caregiver Skills

High

High Low

High

Low Low

Acu

ity

The Senior The Senior MarketMarket

Other elderlyOther elderly10.2 million10.2 millionresidentsresidents

NORCsNORCs8.5 million residents8.5 million residents

Community-based LTCCommunity-based LTC8.5 million individuals8.5 million individuals

Home careHome care3.5 million beneficiaries3.5 million beneficiaries

Assisted livingAssisted living1.8 million residents1.8 million residents

Nursing homesNursing homes1.8 million residents1.8 million residents

34.3 million individuals 65 years old and older34.3 million individuals 65 years old and older

Nursing Facilities The traditional LTC environment in the U.S. Provide care using a “medical model” that is

somewhat analogous to hospitals Approximately 2/3 of NFs are operated for-profit ~1/2 are operated by chains – 9% bed growth compared in 2010 compared to 2009

– HCR ManorCare, 38,000+ beds; 283 facilities– Golden Living, 33,000+ beds; 332 facilities– Life Care Centers of America, 31,000+ beds; 221 facilities– Kindred Healthcare, 29,000+ beds; 231 facilities

Nursing FacilitiesNursing Facilities Total number of beds 1,725,326

– Medicare 77,023– Medicare/Medicaid 1,413,951– Medicaid 186,086– Noncertified 48,266

Resident payer sources– Medicaid 65%– Private/other 22%– Medicare 13%

Nursing Facilities Nursing Facilities

50 to 99 beds38.7%

100 to 199 beds41.8%

Fewer than 50 beds12%

200 beds or more8%

Typical NF Patient Flow Typical NF Patient Flow

Discharge to home or

assisted living

• Return to hospital for acute event, eg, fracture, symptomatic A-fib, etc

• To nursing facility after initial admission or

• Return to nursing facility after brief hospitalization

• If needed, NF residents will usually need to visit the specialists

• NF attending physicians and selected

geriatric specialists see residents in the facility

Hospital

Nursing Facility

RehabShort Stay

LongStay

• Patient seen in ER for work-up• Patient may be admitted to qualify for Medicare

Part A• Patient worked up based on hospital criteria • Treated and stabilized• Set for discharge

Focused View of NF ResidentFocused View of NF Resident

LPN

• LPNs need to know how to manage NF residents

Medical Director

• Medical Directors need to make the best medication choices for their patients

Nurse Practitioner

• Nurse Practitioners may see patients for the physician group

Nursing Facility

RehabShort Stay

RehabLongStay

Consultant Pharmacist

• Consultant Pharmacists regularly review medications

Nurse

• Nurses continually monitor resident’s health status through the plan of care

Assisted Living Facility ModelsAssisted Living Facility Models

NF Alternative/ Replacement Model

Hospitality Model

Personal Care Model

Assisted Living Target MarketAssisted Living Target Market

75-85 years of agemostly female$25,000 income (supports $1,600-

1,750/month using 75-85% of resident’s income)

2+ ADL support

Typical AL Patient Flow Typical AL Patient Flow

Assisted Living Facility

AttendingPhysician

• Resident may visit Attending Physician, or Attending Physician may visit facility

Specialist

• Resident usually visits specialist. Specialists rarely visit assisted living facility. Resident would see specialist for monitoring of medications and therapies

Community

• Residents may come from the community or move back to the community for various reasons

““The goal of assisted living is The goal of assisted living is to keep them in assisted living.” to keep them in assisted living.”

Nursing Director National Nursing Director National Assisted Living ProviderAssisted Living Provider

““The goal of assisted living is The goal of assisted living is to keep them in assisted living.” to keep them in assisted living.”

Nursing Director National Nursing Director National Assisted Living ProviderAssisted Living Provider

Hospital

Nursing Facility

• If resident becomes less independent or needs short-term rehab

• Patient seen in ER for work-up • Patient may be admitted• Patient worked up based on hospital criteria • Treated and stabilized• Set for discharge

Assisted Living vs. Assisted Living vs. Nursing FacilitiesNursing Facilities

Nursing Facilities– Elderly population– Multiple medical dx– Multiple medications– Federal regulations– Skilled staff– Mandated DRR

Assisted Living– Elderly population– Multiple medical dx– Multiple medications– Regulated by State– Less skilled staff– DRR mandate varies

Key LTC Professionals Key LTC Professionals AdministratorMedical DirectorAttending PhysicianConsulting PhysicianNurse Practitioner/ Physician’s Asst.Nursing Staff

– Director of Nursing (DON)– Charge Nurse, Head Nurse– Nursing Supervisor– MDS Nurse – Staff Nurse– Nurse Aides

Key LTC Professionals Key LTC Professionals Pharmacists – consultant and dispensing Therapy Staff (physical and occupational

therapy) Dietitian Activity Directory Social Services Geriatric Case/Care Managers Staff development coordinator Family members

LTC Pharmacy LandscapeLTC Pharmacy Landscape

OmniCare 1,400,000 NF/ALF beds PharMerica Corp. 360,000 NF bedsRegional pharmacy providers

– Green Tree, South Central IllinoisSmaller pharmacy providersNew, evolving provider and consultant

companies, some specializing in ALIndependent consultant pharmacists

LTC Pharmacy LTC Pharmacy ServicesServices

Drug DistributionServices

Consultant PharmacyServices

Pharmacy Providers ServicesPharmacy Providers Services

Efficient and accurate distribution– Emergency kits – medication administration record

Standardized services between facilities Improve pharmaceutical care

– formulary Pharmacy providers influence market share

– Consultant pharmacists recommendations– Formulary preferred products– Disease management initiatives– Educational initiatives

What is a Consultant What is a Consultant Pharmacist?Pharmacist?A patient advocate for best clinical careLicensed by state to practice pharmacyNo degree requirementNo specific credentials required by most

StatesTypically involved in many activities

LTC Pharmacists LTC Pharmacists Employment ModelEmployment Model

LTC PharmacistsLTC PharmacistsPractice InvolvementPractice Involvement

Consultant Pharmacist’s Consultant Pharmacist’s DomainDomain

Pharmaceutical careMedication-related problemsAppropriate useMedication Regimen Review “MRR”Anything drug-related

– Side effects, dosage, switch to alternative products, monitoring, add drug for untreated indication, etc.

PharmacistsPharmacistsPractice ActivitiesPractice Activities

Medication Regimen ReviewMedication Regimen Review

Resident-specific Pharmacist-conducted Required in all NFs as a Medicare/Medicaid

Condition of Participation and by OBRA ‘87 Performed at least monthly Retrospective or prospective Encourage appropriate medication use Provide optimal Pharmaceutical Care

Components of Effective Components of Effective Medication Regimen ReviewMedication Regimen Review

Interdisciplinary Concise Accurate Neat Non judgmental

Well documented Evidence-based Referenced when

necessary Follow up included

MRR Challenges for MRR Challenges for PharmacistsPharmacistsAdequate trainingClinical skills and experienceExploding knowledge baseRecognition/CooperationAdequate reimbursementWork load

Thank-you!