Pharmacy News

Entries for March 2016

Law and Policy Symposium to Offer Six Hours of Live CE

The fourth annual MPA Pharmacy Law and Policy Symposium is quickly approaching! Join us Wednesday, April 27, 2016, at Lansing Community College, West Campus, in Lansing to learn the latest pharmacy law and regulatory updates, including programming on the CMS Waiver, New EPA Rulemaking presented by the Department of Environmental Quality, an MPA Law Update and a Drug Diversion and Fraud program presented by a West Michigan Financial Crimes and Health Care Fraud Task Force Officer, a DEA Agent and an Assistant United States Prosecutor. 

This event offers up to six hours of live continuing education credit, including the pharmacy law credit for technicians. Registration is available online and members are encouraged to sign up by April 20 to save! You won’t want to miss out on this opportunity to receive information on key law and policy changes that affect your everyday practice. 

For further information, please contact MPA Education Program Manager Elizabeth Adado at (517) 377-0225 or Elizabeth@MichiganPharmacists.org.

Posted in: Continuing Education
Northern Michigan Pharmacy Education Seminar to be Held April 9-10

Registration for the Northern Michigan Pharmacy Education Seminar, occurring April 9-10 at Shanty Creek Resort in Bellaire, Mich., is open until April 4. This event offers eight hours of pharmacy continuing education credit on human trafficking, pain in oncology, treatment of acne, COPD guidelines, Beers Criteria and pharmacist prescribed hormonal contraceptives. Additionally, attendees will have the opportunity to network with peers and colleagues while visiting with exhibitor representatives at a reception on Saturday evening and at breakfast on Sunday morning. For additional information, visit the Web site page for this event.

Posted in: Continuing Education
Going Into the Turn

by Frank Zaran, R.Ph., clinical pharmacist specialist - drug informatics, Detroit Receiving Hospital and MSHP Immediate Past President

In MSHP President Jesse Hogue’s January article, “Changing Gears,” he selected pharmacist provider status, as his theme for the year. In announcing the theme, Jesse stated, “I believe that this issue is THE MOST IMPORTANT ISSUE for pharmacy that any of us will see in our professional lifetimes.”  In her February article, “A long time ago, in a pharmacy far, far away:  Provider status,” President-elect Dana Staat, takes off from Jesse’s firing of the starter’s gun and quickly accelerates into hyperspace. She identifies three areas of anxiety associated with our profession obtaining provider status and how to address them with the education of pharmacists, patients and other healthcare professionals. 

But, the course to victory is not without some twists and turns. So, let’s get ready to down-shift as we enter the next corner and then stomp on the gas and ratchet up through the gears coming out of the turn. 

Provider status alone will not change how we practice. It is merely the first step. Provider status will; however, allow us to be reimbursed by Medicare for the cognitive services we provide. This will lead to recognition by other insurers as providers and subsequently reimbursement from them, as well. 

As pharmacists, we’ve long recognized that there are additional services that we could provide to benefit our patients except for the lack of resources which can be attributed to not being compensated for those services. Reimbursement for cognitive services will provide the necessary incentives to inpatient, outpatient, and ambulatory employers to expand pharmacy services that will ultimately benefit patients and reduce overall healthcare expenditures with regards to fewer adverse medication events, improved patient outcomes and reduced emergency room visits and hospital admissions. 

As Jesse and Dana point out, we need to think about the opportunities that provider status offers to the practice of pharmacy to benefit our patients. Some examples can be found in recent legislation passed in California, Washington, Oregon and Ohio regarding collaborative practice and accountable care organizations. These include administration of drugs and biologics ordered by prescribers; provide consultation, training and education about drug therapy; disease management and prevention; prescriptive authority to renew certain types of medications; dispense self-administered hormonal contraceptives (per protocol); furnish CDC-recommended travel medications, provide prescription nicotine products for smoking cessation (per protocol); order and interpret laboratory tests for monitoring and managing drug therapy (in coordination with patient’s physician); perform patient assessments; and refer patients to other healthcare providers. 

But, we shouldn’t stop there. Other possible practice areas may include diabetes, asthma, blood pressure management, geriatrics, pediatrics and psychiatry. Anywhere there’s a shortage of providers or difficulty in obtaining access to a physician is an opportunity for a collaborative pharmacy practice. In fact, at the VA ambulatory care practice, pharmacist specialists have prescriptive authority for many medications and are responsible for managing the drug therapy of their patients, who they see by appointment. 

In Michigan, it’s already possible for pharmacists to enter into collaborative practices with physicians; however, provider status means that we can be directly reimbursed for these services. This may finally provide the financial incentive for pharmacies and health-systems to invest in providing these services, which can address this patient need and prevent unnecessary emergency room visits, hospitalizations and costs associated with delays in or management of drug therapy. Such services provide the financial incentives for CMS, insurers and even patients to pay for such services. For example, a physician-collaborated pilot program overseen by Michael Klepser, Pharm.D. of Ferris State University, has community pharmacists clinically assessing patients and when appropriate using rapid diagnostic tests to determine if a patient has the flu or strep. Based on their findings, patients may be treated with oseltamivir, an antibiotic or when necessary referred to their physician, an urgent care clinic or the emergency room. By the way, in this pilot project, patients are willing to pay for this service out of their own pockets, seeing that it was not only quicker than waiting to see a physician, but also cheaper.  

Last July, CMS proposed a rule that would require that long-term care facilities reconcile all of a patient’s pre-discharge medications (prescription and OTC) with their post-discharge medications, as part of the discharge summary to be communicated to the primary care provider. We, in pharmacy, are more capable than any other healthcare profession to conduct this reconciliation; however, without provider status, we are not eligible to be paid for this service. The thing is, by leveraging the use of pharmacy technicians and technology, we can provide this service better and cheaper than other professions. In Michigan, some hospitals are already using pharmacy technicians in this role and in some cases, technicians are also handling third-party prior authorizations, a service that not only ensures that patients receive the medications they need upon discharge, but may also help to avoid delayed discharges or even prolonged hospital stays, as well as, potentially future (re-)admissions. 

However, provider status means more than just being eligible for reimbursement. It's recognition of the role that pharmacists play in patient care. Recognition by not just CMS and subsequently other third party insurers, but also by other members of the healthcare team. It provides the opportunity for us to be seen as a partner (co-owner if you will), in our patients’ outcomes and not just a trustworthy member of the pit crew. 

So let’s step on the gas and head for that checkered flag!

Posted in: Laws and Regulations
Fourth Annual MPA Pharmacy Law and Policy Symposium to be Held April 27 in Lansing

by Michael Ruffing, Pharm.D., pharmacy director, Sinai Grace Hospital

The fourth annual MPA Pharmacy Law and Policy Symposium will be held Wednesday, April 27, 2016, at Lansing Community College, West Campus, in Lansing. Space is limited – so register early to guarantee your seat!

The MPA Pharmacy Law and Policy Symposium provides six hours of live continuing education  credit and is intended to provide pharmacists, pharmacy technicians and student pharmacists from all practice settings with information on important legislative, regulatory and health policy changes that impact their practice. The program will be especially attractive to health system pharmacists and technicians, as many of the recent legislative issues impact health system pharmacies.

The morning program will feature Chris Priest, director of Michigan Medicaid who will discuss the State’s Healthy Michigan Plan and pharmacy policy changes that are included in the new contract with the Medicaid health plans. Pharmacists involved with transitions of care will find it helpful to understand these policy changes and how they might impact patients' medication management after hospital discharge. Immediately following is a program that will feature a representative of the Department of Environmental Quality who will discuss the new Environmental Protection Agency (EPA) proposed rules on waste disposal and the potential significant impact on health systems and all pharmacies, in all practice settings. The potential changes require pharmacists to manage pharmaceutical waste in a more comprehensive and responsible fashion. The morning will conclude with a presentation by Eric Roath, MPA director of professional practice. He will provide the latest information on various laws, rules and other regulations that have been approved or are currently being discussed at the state and federal levels. Staying abreast of  current and recent legislation, such as provider status, compounding, technician licensure, etc., is critical to maintaining a proficient health-system pharmacy practice.

At noon, a select group of members of the Michigan Legislature have been invited to join participants for lunch. This will be a good opportunity to discuss health-system pharmacy issues that merit greater consideration and attention.

The first program of the afternoon features the topic of drug diversion and fraud. Recent citations by the Drug Enforcement Agency (DEA) at large academic facilities for diversion noncompliance, resulting in significant fines and remedial actions, highlight the importance of appropriately managing diversion in health systems. The speakers include an insurance fraud investigator, a DEA investigator and a fraud attorney from the U.S. Department of Justice. Following the two-hour program, an additional hour will be dedicated to answering questions from participants about pharmacy law, health policy, diversion and fraud. The question and answer panel will consist of Eric Roath and Amanda Lick from MPA, insurance fraud investigator, DEA investigator and the U.S. Attorney.  With the growing expectation from regulatory agencies for health-system pharmacies to be more compliant and proactive in diversion management, health-system pharmacists and technicians should find this section of the program very beneficial. 

Online registration is available until 4:30 p.m., Wednesday, April 20. In addition, visit the event page to view the latest programming information. Space is limited, so be sure to register early!

Posted in: Member News
Nearly Universal Prospective Order Review - Can Automation Help?

by Kenneth Risko, B.S. Pharm, MBA, director, pharmacy informatics, Detroit Medical Center 

Historically, pharmacists are the gatekeepers in the medication use process. A pharmacist’s primary function is to review and verify patient specific medication orders for safety and efficacy. The Joint Commission, American Society of Health-System Pharmacists, and state boards of pharmacy mandate that nearly all medication orders be prospectively reviewed by a licensed pharmacist prior to dispensing, except where a physician is present; hence the term, nearly universal prospective order review (NUPOR). The expanding role of the pharmacist in the transitions of care and bedside clinical services has placed a premium on the pharmacist’s time. How can pharmacy resources be best allocated? It has been suggested that integrated clinical decision support (CDS) within the electronic medical record (EMR) could provide tools for order review and “automatic verification” of targeted medication orders in a controlled environment. A basic task is automated to free-up time allowing the pharmacist to focus on more complex medication assessments.

 

In the NUPOR world, high-alert and complex medication orders require additional scrutiny by the pharmacist during the verification process. Should  a docusate order be treated with the same rigor as a narrow therapeutic index drug like carbamazepine or phenytoin? Should the same effort be expended on a sodium flush order as with amiodarone? There is an opportunity with CDS to identify certain medications in specific circumstances where this automated system could verify the medication order without any pharmacist intervention.

 

Is technology up to the challenge? What are the key ingredients required within the EMR using computerized physician order entry (CPOE) and medication ordering/dispensing systems to provide a failsafe method to auto-verify certain types of "routine" medication orders where the probability of causing harm is negligible? At a minimum, an integrated EMR system would need to have allergy, drug-drug interaction, drug duplication and dose range checking functionality. Access to lab values and disease and problem lists would also be essential data points to assess order validity. Order sets with standard doses and frequencies for designated disease states would provide another level of safety. Integrated drug therapy reference content would also need to be continually updated to provide the most current drug information. 

 

Additionally, the system would need to be customizable to set specific order verification parameters. These may include order details such as dose, route and frequency; ordering venues such as nursing units or ambulatory clinics; and even specific ordering provider positions. For example, auto-verify could be set on a one time only aspirin 81 mg by mouth in the emergency department written by a specific prescriber provided there are no clinical alerts.  Auto-verification would not apply if the specific criteria were not met or any clinical alert was activated.     

 

Auto-verification can allow for “verification by exception” by placing the focus on medications that need attention. This could lend itself to a profile review of medications rather than a real time line-by-line review. Orders could be weighted by priority, based on a set of criteria or policy. There is no data or peer reviewed studies that show that auto-verification can positively impact pharmacists’ time: however, auto-verification could play a role in specific venues allowing pharmacists to focus on more pressing clinical activities.        

There is at least one EMR system that has the functionality described above. As pharmacy leadership looks for innovative ways to reallocate their pharmacy resources more efficiently, automation via the EMR can provide alternative solutions such as auto-verification. The CDS system must be robust enough to provide a safe and effective process to evaluate medications in a multi-variable environment. Pharmacists need to work with their EMR vendors to provide a system that can be used more effectively as pharmacy roles continue to expand. 

 

References:

Flynn AJ.  Opportunity cost of pharmacists' nearly universal prospective order review.  Am J Health-Syst Pharm.  2009;66;668-70.

Poikonen J.   An informatics perspective on nearly universal prospective order review.  Am J Health-Syst Pharm.  2009;66:704-705

 

Posted in: Member News
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