Current Issues in Pharmacy Practice AAHP Fall Seminar October 8, 2015 Christene Jolowsky, MS, RPh, FASHP Executive Director, Applied and Experiential Education University of Minnesota College of Pharmacy Immediate Past-President, ASHP
AKA … • What keeps health system pharmacy leaders up at night • What keeps ASHP leaders up at night
Objectives • Attendees will be able to list three changes in the areas of patient demographics, healthcare economics and pharmacy workforce demographics. • Given an example of a change in the pharmacy workforce, the attendee will identify potential implications to the role of the pharmacist in acute and ambulatory care settings. • Attendees will select tools to use to help assess and improve current practice.
About Me … • ASHP Immediate Past President • University of Minnesota College of Pharmacy • Health System Pharmacy Leader
Disclosure: I have no relevant financial relationships to disclose regarding this presentation.
Who is ASHP? • Over 43,000 members (pharmacists, students and technicians) • Founded in 1942 • Headquarters in Bethesda, MD ASHP Mission Statement The mission of pharmacists is to help people achieve optimal health outcomes. ASHP helps its members achieve this mission by advocating and supporting the professional practice of pharmacists in hospitals, health systems, ambulatory clinics, and other settings spanning the full spectrum of medication use. ASHP serves its members as their collective voice on issues related to medication use and public health.
ASHP Strategic Plan Three sections, which focus on professional, operational, and leadership & management
Overview • Societal & Health Care Economic Trends • Health System Alliances, Mergers, and Acquisitions • Work Force Trends • Patient Quality and Outcomes • Ambulatory Care Innovations • Provider Status • Developing Strategic Direction
Top Ten Challenges and Opportunities For Hospitals and Health Systems • Population health • Shifting from volume- to value-based reimbursement • Regulatory demands • Infection control (Ebola) • Demonstrating the value of mergers and acquisitions to consumers Beckers Top Ten Challenges and Opportunities for Hospitals http://www.beckershospitalreview.com/hospital-management-administration/10-challenges-and-opportunities-for-hospitals-in- 2015.html
Top Ten Challenges and Opportunities For Hospitals and Health Systems • Truly integrating systems • Overspecialization of the physician workforce and questions over the physician shortage • Hospital closures • Reimbursement rate differences • Data, data everywhere Beckers Top Ten Challenges and Opportunities for Hospitals http://www.beckershospitalreview.com/hospital-management-administration/10-challenges-and-opportunities-for-hospitals-in- 2015.html
SOCIETAL & HEALTH CARE ECONOMIC TRENDS
The Big Picture • Almost half of U.S. adults — approximately 117 million people — have at least one chronic disease. • More than 20% of hospitals’ discharges are re-admitted. • Percentage of Americans who used two or more prescription drugs increased from 25 percent to 31 percent, and the number of patients using five or more drugs increased from 6 percent to 11 percent. http://www.cdc.gov/nchs/data/databriefs/db42.htm http://www.rwjf.org/content/dam/farm/reports/reports/2013/rwjf404178 http://www.cdc.gov/chronicdisease/overview/
The Big Picture • “Researchers have estimated that inadequate care coordination , including inadequate management of care transitions , was responsible for $25 to $45 billion in wasteful spending in 2011 through avoidable complications and unnecessary hospital readmissions .” • “…nearly one-fifth of fee-for-service Medicare beneficiaries discharged from the hospital are readmitted within 30 days ; three-quarters of these readmissions--costing an estimated $12 billion a year--are considered potentially preventable, especially with improved care transitions .” • “Patients often don't consistently receive follow-up care after leaving the hospital. Among Medicare beneficiaries readmitted to the hospital within 30 days of a discharge, half have no contact with a physician between their first hospitalization and their readmission .” • “Almost one-fourth of Medicare beneficiaries discharged from the hospital to a skilled nursing facility were readmitted to the hospital within thirty days; this cost Medicare $4.34 billion in 2006 .” http://www.healthaffairs.org/healthpolicybriefs/brief.php?brief_id=76 http://content.healthaffairs.org/content/29/1/57.full
The Number of People with Chronic Conditions is Increasing 200 Number of People With Chronic 49% 180 Conditions (millions) 171 164 160 157 149 141 140 133 44% 125 118 120 100 1995 2000 2005 2010 2015 2020 2025 2030 Year Source: Wu, Shin-Yi and Green, Anthony. Projection of Chronic Illness Prevalence and Cost Inflation . RAND Corporation, October 2000.
Health Care and Reform are Market Issues • Medical costs increasing in excess of inflation • Threatens sustainability of core business
Big Data and Population Health Define Population Identify Measure Gaps in Outcomes Care IHN & Local Health Systems Manage Stratify Care Risk Engage Patients
HEALTH SYSTEM ALLIANCES, MERGERS, AND ACQUISITIONS
Marketplace • AHA Hospital Statistics, 2013 edition – 4,973 Community Hospitals in USA – 3,007 hospitals are in a system – 1,535 hospitals are in a network – System is defined by AHA as either a multihospital or a diversified single hospital system. A multihospital system is two or more hospitals owned, leased, sponsored, or contract managed by a central organization. Single, freestanding hospitals may be categorized as a system by bringing into membership three or more, and at least 25 percent, of their owned or leased non-hospital pre-acute or post-acute health care organizations. System affiliation does not preclude network participation. – Network is a group of hospitals, physicians, other providers, insurers and/or community agencies that work together to coordinate and deliver a broad spectrum of services to their community. Network participation does not preclude system affiliation.
Hospital/Health System Growth Over Past 12- 14 Months • Catholic Health Initiatives growth from 70 to 86 hospitals • Ascension Health growth from 72 to 102 hospitals • Community Health Systems from 150 hospitals to 208 • Comprehensive Pharmacy Services from mid-300 to mid-400 contract pharmacies • Baylor Health Care / Scott and White merger – 39 hospitals • Trinity Health / Catholic Health East merger – 82 hospitals • Numerous academic medical centers acquiring or affiliating with community hospitals; or managing community hospital pharmacies
Impact on Practice • New world of decision making • System changes • Policy impact • Costs and changes • Governance • Within rapidly changing environment
WORK FORCE TRENDS
How many pharmacists are there? According to HRSA Bureau of Health Care Professions, there are currently 286,400 pharmacists: • 63% work in retail settings • 23.1% work in hospitals • 13.9% work in other settings* * Managed care, pharmacy education, long term care, home care, consulting, industry, wholesale, associations, GPOs, trade groups, publishers, office practices, etc For the 2009 National Pharmacists Workforce Study, there were 249,381 licensed pharmacists: 53.8% work in indep, chain, mass merch, or supermarket pharmacies 26.8% work in hospitals 10.4% work in other patient care practices* 9.0% work in other settings (industry and non-patient care) * Defined as HMOs, clinic pharmacies, mail service, nuclear, home care. Long term care
Total Pharmacist FTEs in hospitals continues to grow Year Total FTE 2013 64,224 2012 51,724 2011 57,307 60,000 2010 54,368 2009 56,327 50,000 2008 55,474 40,000 2007 50,572 2006 48,598 30,000 2005 49,995 20,000 2004 48,637 2003 46,906 10,000 2002 42,708 - 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 Source: 2002-2011 ASHP Nati o nal Survey
What does the future hold? Pharmacist supply and demand by 2020 400,000 350,000 SUPPLY 300,000 DEMAND 250,000 Supply drivers: Supply drivers: 200,000 Baby boomers More graduates Baby boomers retire Delayed 150,000 retirement Demand drivers: Fewer Part timers 100,000 More graduates Prescription volume Changing roles Technicians Demand drivers: 50,000 Technology Slow economy Health Care Reform - 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020
In 2014 appx 20% of graduates (2411) are seeking PGY1 positions And 5% (129) are graduates before 2014
Impact of Workforce • Positive and Negative • Educating/ training of students – practice sites • Demand for residencies – Residencies v pharmacy student training • New roles • Lead and direct within rapidly changing environment
4500 Residency Applicants vs Positions PGY1 4142 3933 4000 3706 1280 3500 3277 2915 3000 2862 2694 2508 2413 2500 # applicants 2173 2092 # positions 1951 1900 2000 1873 Linear (# 1769 applicants) 1612 Linear (# 1500 1356 positions) 1222 1203 1091 1000 500 0 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014
Recommend
More recommend
