Pharmacist-Run Medication Reconciliation for Veterans Admitted to Non-Veterans Affairs Hospice Care

2021 ◽  
Vol 36 (1) ◽  
pp. 42-48
Author(s):  
Anne Alley ◽  
Holly Dorscheid ◽  
Kathryn Hentzen
Keyword(s):  
Medication Reconciliation ◽  
Hospice Care ◽  
Medical Center ◽  
Cost Savings ◽  
Retrospective Chart Review ◽  
Transition Process ◽  
Veterans Affairs ◽  
Improvement Project ◽  
Before And After ◽  
The Cost

PURPOSE: The purpose of this quality improvement project was to increase pharmacist involvement in the outpatient hospice transition process to improve care of veterans, prevent medication errors, and to ensure medications are provided to the patient via the appropriate pharmacy.METHODS: This project began with implementation of a pilot process for the pharmacist to complete medication reconciliation for each patient admitted to non-Veterans Affairs (VA) hospice care from the Omaha VA Medical Center. The second step of this project was completion of a retrospective chart review of the interventions made. Statistical analysis was completed via descriptive statistics.RESULTS: A total of 21 patients were eligible for this study. The mean age was 78 years. The average total number of medications per veteran before and after medication reconciliation for VA meds were 13 and 4 and for non-VA meds were 4 and 6, respectively. The average total cost savings for one fill of all medications changed to non-VA was estimated to be $40.08. The pharmacist noted on average 12.6 medication discrepancies during medication reconciliation per veteran. Just less than half of the clinical recommendations made by the pharmacist were accepted by the providers.CONCLUSIONS: All veterans admitted to non-VA hospice care had at least one medication discrepancy noted by the pharmacist during medication reconciliation. A majority of the veterans had at least one VA medication changed to non-VA since hospice was now prescribing and providing. The cost savings on average appear to outweigh the time spent on medication reconciliation by the pharmacist.

Pharmacist-Run Medication Reconciliation for Veterans Admitted to Non-Veterans Affairs Hospice Care

2021 ◽  
Vol 36 (1) ◽  
pp. 42-48
Author(s):  
Anne Alley ◽  
Holly Dorscheid ◽  
Kathryn Hentzen
Keyword(s):  
Medication Reconciliation ◽  
Hospice Care ◽  
Medical Center ◽  
Cost Savings ◽  
Retrospective Chart Review ◽  
Transition Process ◽  
Veterans Affairs ◽  
Improvement Project ◽  
Before And After ◽  
The Cost

Purpose: The purpose of this quality improvement project was to increase pharmacist involvement in the outpatient hospice transition process to improve care of veterans, prevent medication errors, and to ensure medications are provided to the patient via the appropriate pharmacy. Methods: This project began with implementation of a pilot process for the pharmacist to complete medication reconciliation for each patient admitted to non-Veterans Affairs (VA) hospice care from the Omaha VA Medical Center. The second step of this project was completion of a retrospective chart review of the interventions made. Statistical analysis was completed via descriptive statistics. Results: A total of 21 patients were eligible for this study. The mean age was 78 years. The average total number of medications per veteran before and after medication reconciliation for VA meds were 13 and 4 and for non-VA meds were 4 and 6, respectively. The average total cost savings for one fill of all medications changed to non-VA was estimated to be $40.08. The pharmacist noted on average 12.6 medication discrepancies during medication reconciliation per veteran. Just less than half of the clinical recommendations made by the pharmacist were accepted by the providers. Conclusions: All veterans admitted to non-VA hospice care had at least one medication discrepancy noted by the pharmacist during medication reconciliation. A majority of the veterans had at least one VA medication changed to non-VA since hospice was now prescribing and providing. The cost savings on average appear to outweigh the time spent on medication reconciliation by the pharmacist.

scholarly journals A single center retrospective analysis of a protocol for high-dose methotrexate and leucovorin rescue administration

2017 ◽  
Vol 25 (1) ◽  
pp. 76-84 ◽  
Author(s):  
Zak Cerminara ◽  
Alison Duffy ◽  
Jennifer Nishioka ◽  
James Trovato ◽  
Steven Gilmore
Keyword(s):  
Medical Center ◽  
Cost Savings ◽  
Retrospective Chart Review ◽  
Patient Characteristics ◽  
High Dose ◽  
High Dose Methotrexate ◽  
Protocol Implementation ◽  
Dose Methotrexate ◽  
Before And After ◽  
The Cost

Background Methotrexate has a wide dosing range. High-dose methotrexate is a dose of 1000 mg/m2 or greater. In the 1970s, the incidence of mortality associated with High-dose methotrexate ranged from 4.6 to 6%. In 2012, the University of Maryland Medical Center implemented a standardized high-dose methotrexate protocol. The purpose of this study was to evaluate whether the institution followed recommendations based on the Bleyer nomogram for the administration of high-dose methotrexate more closely after the implementation of the protocol. Methods In this retrospective chart review, 37 patients received 119 cycles of high-dose methotrexate before the protocol implementation (1 January 2009 through 31 December 2010) and 45 patients received 106 cycles of high-dose methotrexate after protocol implementation (1 January 2013 through 31 December 2014). Patient characteristics, protocol data, and complications were analyzed. Results Protocol implementation significantly reduced the deviation of methotrexate level timing at 24, 48, and 72 h: median 7.47 vs. 1.46 h, 7.23 vs. 1.35 h, and 7.00 vs. 1.52 h before and after implementation, respectively (p < 0.0001 for each). The protocol significantly reduced deviation of the first dose of leucovorin administration: median 5.2 vs. 0.675 h before and after implementation, respectively (p<0.0001). After protocol implementation, there was an increase in the use of leucovorin prescriptions written appropriately for patients discharged before methotrexate levels reached a value of ≤0.05 µmol/L. Conclusions Implementation of a protocol for the administration of high-dose methotrexate improved the adherence to consensus recommendations. Further analysis is needed to assess clinical pharmacist involvement and the cost savings implications within this protocol.

Evaluation of the dosing strategies of biologic agents and the theoretical impact of dose rounding

2016 ◽  
Vol 24 (1) ◽  
pp. 47-55
Author(s):  
Savannah Lindsey ◽  
Laura Beth Parsons ◽  
Lindsay Rosenbeck Figg ◽  
Jill Rhodes
Keyword(s):  
Monoclonal Antibody ◽  
Monoclonal Antibodies ◽  
Medical Center ◽  
Academic Medical Center ◽  
Wholesale Price ◽  
Cost Savings ◽  
Retrospective Chart Review ◽  
Potential Cost ◽  
Cost Avoidance ◽  
The Cost

Introduction Monoclonal antibodies possess unique pharmacokinetic properties that permit flexible dosing. Increased use and high costs of these medications have led to the development of cost-containing strategies. This study aims to quantify the cost savings and clinical impact associated with dose rounding monoclonal antibodies to the nearest vial size. Methods This study was a single-arm, retrospective chart review assessing all monoclonal antibody doses dispensed at an outpatient community infusion center associated with an academic medical center between August 2014 and August 2015. All monoclonal antibody doses were reviewed to determine the cost of drug wasted using two methods. The waste-cost analysis described the amount of drug disposed of due to the use of partial vials. The theoretical dose savings described potential cost avoidance based on rounding the ordered dose to the nearest vial size. The theoretical rounded dose was compared to the actual ordered dose to explore clinical implications. Results A total of 436 doses were included. Of these, 237 were not rounded to the nearest vial size and included in the analysis. The cost of waste associated with these doses was $108,013.64 using actual wholesale price. The potential cost avoidance associated with the theoretical dose calculation was $83,595.53. Rounding these doses to the nearest vial size resulted in a median 6.7% (range, 1.4–20%) deviation from ordered dose. Conclusions Rounding monoclonal antibodies to the nearest vial size could lead to significant cost and waste savings with minimal deviation from the actual ordered dose.

Evaluation of Cost-effectiveness and Clinical Value of Routine Histopathologic Examination of Septoplasty Specimens

2021 ◽  
pp. 019459982110129
Author(s):  
Randall S. Ruffner ◽  
Jessica W. Scordino
Keyword(s):  
Chart Review ◽  
Medical Center ◽  
Academic Medical Center ◽  
Cost Savings ◽  
Retrospective Chart Review ◽  
Clinical Value ◽  
Level Of Evidence ◽  
Significant Pathology ◽  
National Model ◽  
Routine Histopathologic Examination

Objectives During septoplasty, normal cartilage and bone are often sent for pathologic examination despite benign appearance. We explored pathology results following septoplasty from April 2016 to April 2018, examining clinical value and relevance, implications, and cost analysis. Study Design Retrospective chart review. Setting Single-institution academic medical center. Methods A retrospective chart review was compiled by using Current Procedural Terminology code 30520 for septoplasty for indication of nasal obstruction, deviated septum, and nasal deformity. Results A total of 236 consecutive cases were identified spanning a 2-year period. Septoplasty specimens were sent for pathology evaluation in 76 (31%). The decision to send a specimen for histopathology was largely physician dependent. No cases yielded unexpected or significant pathology that changed management. The average total charges for septoplasty were $10,200 at our institution, with 2.2% of procedural charges accounting for pathology preparation and review, averaging $225. Nationally, this results in an estimated charged cost of $58.5 million. The Centers for Medicare and Medicaid Services (CMS) reimbursement for septoplasty pathology charges was $46 in 2018, accounting for 1.3% of hospital-based reimbursements and 2.2% of ambulatory center reimbursements. With CMS as a national model for reimbursement, $11.8 million is spent yearly for septoplasty histopathology. Given that CMS reimbursement is significantly lower than private insurers, national total reimbursement is likely considerably higher. Conclusion Routine pathology review of routine septoplasty specimens is unnecessary, unremarkable, and wasteful. Correlation of the patient’s presentation and intraoperative findings should justify the need for pathology evaluation. This value-based approach can offer significant direct and indirect cost savings. Level of evidence 4.

scholarly journals Pharmacist-Driven Management of Chemotherapy Induced Nausea and Vomiting in Hospitalized Adult Oncology Patients. A Retrospective Comparative Study

2011 ◽  
Vol 2 (3) ◽  
Author(s):  
Ramy Elshaboury ◽  
Kathleen Green
Keyword(s):  
Practice Guidelines ◽  
Primary Outcome ◽  
Medical Center ◽  
Academic Medical Center ◽  
Cost Savings ◽  
Retrospective Chart Review ◽  
Standard Of Care ◽  
Nausea And Vomiting ◽  
P Value ◽  
Potential Cost

Chemotherapy-induced nausea and vomiting (CINV) is a major adverse event associated with cancer treatments. There are clinical practice guidelines that assist practitioners in managing CINV. Many cancer centers develop protocols for physicians and pharmacists to guide prophylaxis and breakthrough treatments of CINV based on published guidelines. The purpose of this study was to evaluate the outcome differences between pharmacist and physician -driven management of CINV in adult hospitalized cancer patients in a large academic medical center. This is a single center retrospective chart review study. The primary outcome of the study was the number of breakthrough antiemetic doses needed throughout the hospitalization. A total of 106 adult patients receiving inpatient chemotherapy were reviewed for CINV management. Fifty-five patients (52%) were managed according to the pharmacist-driven protocol, and fifty-one patients (48%) were managed by the physician. There was no difference between the two groups in the primary outcome. Patients in the pharmacist-managed group needed 6.4 breakthrough antiemetic doses; whereas, patients in the physician managed group needed 5.9 doses throughout the hospital stay (P-value = 0.7). No difference was seen when results were adjusted for length of hospitalization. There was a difference in adherence to the institution CINV guidelines favoring the pharmacist-driven approach (85% versus 33%, P < 0.0001). In conclusion, pharmacist-run protocol for CINV management was as effective as the standard of care. Protocols that are based on practice guidelines may offer the advantage of care standardization and potential cost savings.   Type: Student Project

Impact of an Interprofessional Collaborative Quality Improvement Initiative to Decrease Inappropriate Thyroid Function Testing

2020 ◽  
pp. 001857872092079
Author(s):  
Alyssa B. Bradshaw ◽  
Alex K. Bonnecaze ◽  
Cynthia A. Burns ◽  
James R. Beardsley
Keyword(s):  
Quality Improvement ◽  
Thyroid Function ◽  
Medical Center ◽  
Cost Savings ◽  
Thyroid Stimulating Hormone ◽  
Quality Improvement Initiative ◽  
Published Data ◽  
Free T4 ◽  
Potential Cost ◽  
Before And After

Background: Published data show that thyroid function laboratory tests are often ordered inappropriately in the acute care setting, which leads to unnecessary costs and inappropriate therapy decisions. Pilot data at our institution indicated that approximately two-thirds of the thyroid-stimulating hormone (TSH) laboratories were unnecessary, correlating to a potential cost avoidance of more than $20,000 annually. The purpose of this study was to improve the appropriateness of thyroid function test ordering with a multipronged initiative. Methodology: This controlled, single-center, before and after study included inpatients or emergency department (ED) patients at Wake Forest Baptist Medical Center who were at least 18 years of age and had a TSH level ordered during the study period. Patients with a history of thyroid cancer were excluded. The initiative included an electronic ordering intervention, direct education of providers (medical residents, attendings, and clinical pharmacists), and distribution of pocket information cards with appropriate ordering criteria. The primary outcome was the number and percentage of inappropriate TSH tests ordered before and after implementing the 3 interventions. Secondary outcomes included cost savings, inappropriate changes in thyroid therapy based on improperly ordered tests, and the number of free T4 lab tests ordered on patients with a TSH within the therapeutic range. Results: All 3 interventions were implemented, except for education of ED residents and faculty, who chose to forgo the direct education component. Inappropriate ordering of TSH levels decreased from 63 to 50 (13% reduction, P = .062) after implementation. Inappropriate TSH ordering decreased across all services, except in the ED. Inappropriate Free T4 orders decreased from 191 to 133 (30% reduction, P = .01). There were no therapy changes based on inappropriate TSH orders. Extrapolated annual cost savings were approximately $6,000. Conclusion: This multipronged interprofessional collaborative quality improvement initiative was associated with a nonstatistically significant reduction in inappropriate TSH orders, statistically significant reduction in inappropriate free T4 orders, and cost savings. There was a reduction in inappropriate ordering across all services except the ED, which may have been due the ED not participating in the direct education component of the initiative.

scholarly journals Cost Savings of Using Updated Thai Red Cross Intradermal Regimen in a High-Throughput Anti-Rabies Clinic in New Delhi, India

2019 ◽  
Vol 4 (1) ◽  
pp. 50 ◽  
Author(s):  
Bijit Kundu ◽  
Girish Meshram ◽  
Shrinath Bhargava ◽  
Omprakash Meena
Keyword(s):  
High Throughput ◽  
Financial Burden ◽  
Cost Savings ◽  
Red Cross ◽  
Post Exposure Prophylaxis ◽  
New Delhi ◽  
Before And After ◽  
Exposure Prophylaxis ◽  
The Cost ◽  
Rabies Vaccination

Replacement of the Essen intramuscular (EIM) by the updated Thai Red Cross intradermal (UTRCID) regimen for rabies post-exposure prophylaxis (PEP), in high-throughput hospitals of India, has been advocated since 2006 thanks to its cost-effectiveness. However, several anti-rabies clinics in India and other parts of the world have not initiated this switchover of regimens because of the paucity of financial literature, generated in realistic settings, regarding the same. We calculated the procurement costs of various items required for providing rabies vaccinations via the EIM regimen and UTRCID regimen, on an annual basis, a year before and after the switchover. From a healthcare provider’s perspective, the cost of vaccination per patient was calculated to be 5.60 USD for the EIM regimen and 2.40 USD for the UTRCID regimen. The switchover to the UTRCID regimen from the EIM regimen reduced the financial burden of the rabies vaccination by almost 60%. Procurement of vaccine vials contributed to the majority of the cost (>94%) in both of the regimens. Procurement of syringes with fixed needles contributed negligibly (<6%) to the financial burden in both the regimens. A policy to progressively switch over to the UTRCID regimen from the EIM in all high-throughput anti-rabies centers of India would dramatically reduce the economic burden of running a successful anti-rabies program.

scholarly journals Fits, faints, falls and funny turns: cost and capacity savings in Queensland from the accelerated transient attack pathway initiative (ATAP)

2019 ◽  
Vol 48 (5) ◽  
pp. 745-750
Author(s):  
Robin Blythe ◽  
Sanjeewa Kularatna ◽  
Nicole White ◽  
Nicholas Graves ◽  
Kevin Clark ◽  
...  
Keyword(s):  
Emergency Department ◽  
Monte Carlo ◽  
Cost Savings ◽  
Monte Carlo Analysis ◽  
Adverse Outcomes ◽  
Large Hospital ◽  
Admission Rates ◽  
Transient Ischaemic Attacks ◽  
Before And After ◽  
The Cost

Abstract Background falls, seizures, syncope and transient ischaemic attacks (TIA) are common presentations to emergency departments sharing overlapping clinical features and diagnostic uncertainties. These transient attacks can be markers of serious adverse outcomes and are associated with high admission rates. We evaluated the effects of an integrated suite of pathways for transient attacks designed to improve adherence to best practices and reduce costs through fewer admissions. Methods a suite of clinician-designed pathways based on initial presenting diagnosis was developed to support ambulant care in a large hospital in Queensland, Australia. We performed a set of regression analyses to identify the differences in total cost and length of stay (LOS) before and after implementation. We conducted a Monte Carlo simulation to estimate the cost savings of the freed capacity in the patient cohort. Results pathway implementation was associated with reduced admitted LOS and costs. Falls patients admitted LOS declined by 32.5%, and admission costs by 19.5%. Syncope, seizure, and TIA patients admitted LOS declined by 22% with no change in admitted costs. Despite a small increase in 90-day representations, total emergency department LOS was unchanged. Emergency department costs were similar between falls and non-falls patients. The Monte Carlo analysis showed that the most likely outcome was a cost savings in freed capacity of $71 per patient episode. Conclusion the ATAP suite of pathways was associated with reduction in LOS, release of capacity and reduction in costs. Further study is needed to evaluate mechanisms and clinical outcomes in this vulnerable population.

Cost savings of biosimilar pegfilgrastim in a Medicare OCM population.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e19362-e19362
Author(s):  
Jennifer Webster ◽  
Robert E. Smith ◽  
Danielle Wieland ◽  
John Verniero ◽  
Jeffrey A. Scott
Keyword(s):  
Cost Savings ◽  
Cost Curve ◽  
Significant Cost ◽  
Financial Outcomes ◽  
Steady Rate ◽  
Before And After ◽  
Medicare Part B ◽  
Medicare Patients ◽  
Oncology Care ◽  
The Cost

e19362 Background: Pegfilgrastim is a key supportive care agent in oncology patients, providing significant febrile neutropenia prophylaxis for patients on chemotherapy. However, pegfilgrastim also accounts for 5.3% of the total cost of cancer care for all patients in the Oncology Care Model (OCM). Fluctuations in the cost or quantity of pegfilgrastim can have significant impact on a practice’s performance under OCM. One such cost fluctuation is the introduction of biosimilars to the marketplace. This study seeks to understand how CMS reimbursement for pegfilgrastim has been impacted by the introduction of two pegfilgrastim biosimilars into the market. Methods: We tracked average CMS reimbursement for pegfilgrastim (Neulasta, Udenyca and Fulphila) from 7/1/2016 through 6/30/2019. We compared the average reimbursement and the average change in reimbursement before and after the introduction of biosimilars. Results: Prior to the introduction of biosimilars, the Medicare Part B reimbursement (80% of ASP +6%) of pegfilgrastim increased at a steady rate of $292 per year through the first 30 months of the OCM program, resulting in an average reimbursement of $3636 per administration in Q3 2018. However, since the introduction of biosimilars, average pegfilgrastim reimbursement has held steady, averaging $3543 for the time period from 7/1/2018 through 6/30/2019. The change in reimbursement has decreased from $292/year to -$93/year. Conclusions: In 2018, 88,847 Medicare patients received pegfilgrastim, resulting in $1.39 billion in Medicare reimbursement. Assuming that the patterns we’ve detected in our OCM data sample can be applied to the general Medicare population, we have estimated that the introduction of biosimilars resulted in a $4.8 million in savings (1.39%) compared with what the total reimbursement would have been without biosimilars in the market in Q4 2018. This bending of the cost curve is projected to result in savings of $79.1M (5.7%) in 2019 and $157.9M (11.5%) in 2020. Importantly, most of this cost containment is not due to patients utilizing biosimilars. 90.6% of patients in Q2 2019 are still receiving branded pegfilgrastim. However, the introduction of biosimilars has caused even the branded agent to stabilize and possibly even drop net acquisition cost prices. Introduction of biosimilars has created enough pressure on the market to result in significant cost savings, increasing the overall value proposition of pegfilgrastim. This results in significant cost saving to CMS, and also makes it easier for practices participating in OCM to have successful financial outcomes.

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