2. Manage Pharmacy Cost Without Impacting Quality Care
Charles Borum, MD

3. The Hospice Promise What is the hospice promise? − Dignity − Pain free
− Patient & family directed care
The first thing I would ask is what is the hospice promise we make to our pts and family's and how do we make sure that these promises are fulfilled?

4. The Hospice Promise The Six Pillars of Success: Why?
We talk about what we can measure…
We set goals around what we can measure…
We improve what we can measure…
Compassus is founded on six pillars of success that help each program make sure they are able to fulfill the hospice promise to each and every individual we serve.

5. The Six Pillars of Success
I am going to touch on 2 of these pillars today. How to manage financial cost while not affecting the quality of service we provide.

6. Balance service efficiency & customer satisfaction
Reining in customer service costs while keeping customer satisfaction scores high is especially necessary – and especially difficult. It's a balancing act so strenuous, many don't even attempt it.
There is always an ongoing struggle to manage cost while still providing high quality care.

7. The “Big 5” Expenses Labor – 65% Medications – 8-10% DME – 6%
Mileage – 5%
Medical Supplies – 2%
Totals 86% of all expenses!
This is a list of the top 5 expenses in hospice care

8. Managing Pharmacy Costs
Pharmacy costs make up 8-10% of all hospice expenditures.
This equals hundreds of thousands of dollars every year.
The cost of medications is rising much faster than the hospice reimbursement.
Pharmacy cost is the second highest expense in providing hospice service.

9. Managing Pharmacy Costs
To help cope with these rising costs and still provide the most effective medications for our patients, Pharmacy Services creates tools to empower the staff and promote formulary compliance.
With the help of pharmacy services and good team communication these cost can be managed and decreased without affecting our hospice promise.

10. What Pharmacy Services Provides
Educate agencies regarding new medications and medication trends.
Provide medication utilization reports to all levels of management.
Provide telephone support to pharmacies and programs.
Act as a liaison between pharmacies and our programs to facilitate seamless medication delivery.
Review reports to verify it is our patient and the meds are our responsibility. These reports are your chance to catch a high cost non-formulary med quickly.
Provide bi-weekly reports that show your aggregate med orders for a 15-day period sorted by patient.
Use these to help identify outlier patients
Use the graph to benchmark your program against other programs around the country
Pharmacy has several tools to help each program maintain the most efficient pharmacy budget as possible. Pharmacy often provides recommendations for alternate more cost efficient medications. I am going to give you a list in case you want to discuss some of these.

11. Decreasing Pharmacy Cost
Pharmacy cost decreased from an average of 7.53 in december to 4.13 in april. This was done with little to no change in pt care and satisfaction.

12. Goals of Quality Assessment
Allows us to review data about the performance of our whole organization – how are we doing?
Helps us identify the most important opportunities for performance improvement.
The way we assess and monitor quality is by tracking quality indicators.
The second pillar we will be discussing is quality and the importance of quality assesment in each program.

13. What data must be collected?
The data that must be collected and reported currently includes two things:
General information about the kinds of quality indicators currently being used by hospices in their QAPI programs.
Specific data regarding the number of patients who report being uncomfortable because of pain at the admission assessment.
Pain management both on admission and in the last 7 days of life has been a focus of both QAPI and monitoring NQR scores.

14. Why is NQR important?
Hospices that do not comply with the data collection and reporting will face a 2% reduction in the payments they are otherwise qualified to receive from CMS.

15. Decreasing pharmacy cost without affecting care
Placing our quality indicator scores next to our pharmacy cost shows the decrease in Pharmacy cost was done with little to no change in pt care and satisfaction.