1. PSHP Annual Assembly 2015 Importance of Measuring Pharmacy Department Data: How to Enhance Productivity Through a Scorecard Jill Rebuck, Pharm.D., MBA, BCPS, FCCM, FCCP Director of Clinical Pharmacy Services Penn State Milton S. Hershey Medical Center

2. Objectives l Discuss at least 3 examples of meaningful clinical & operational metrics for a health-system pharmacy department

3. Driving Forces for Change AJHP 2009;66:713

4. Why Measure Performance? l Shift from volume to value-based care n Accountable Care Act n Value based purchasing n Meaningful use l PPMI leaders believe: n Lack of pharmacy resources is barrier to optimal practice models (83%) n Stakeholders have “insufficient recognition” of pharmacy’s value (73%) PPMI Summit 2010; Accessed via ashp.org

5. Pharmacy Department Realities l Limited pharmacy staff l Tighter budgets l Rising drug expenses l Expectation to provide highest quality pharmacy services while decreasing total cost of care l Greater accountability to defined patient outcomes

6. “If you can’t measure it, you can’t improve it” - Peter Drucker

7. Advantages of Pharmacy Scorecard l If adequately constructed & updated frequently: n Represent broad view of performance n Guide for strategic decision making n Improve quality of pharmacy services u Demonstrate impact of pharmacy on organizational alignment Enwere EN, et al. Hosp Pharm 2014;49:579-84

8. Department Alignment Mission Vision Values Strategic Goals Initiatives Department Performance Metrics Adapted by Enwere EN, et al. Hosp Pharm 2014;49:579-84

9. Scorecard Considerations l Tactical indicators of performance metrics based on specific goals l Trend data over time (vs. dashboards) n Monthly or quarterly & YTD l Push vs. pull data considerations n Need to be easily monitored l Resource allocation for data collection

10. Establishing Performance Targets l Obtain institution-specific baseline data l Incorporate external benchmarks n Enhance validity & credibility l Determine frequency of updating info n Monthly, quarterly, annually n Visualization of progress l Evaluate metrics annually

11. Controversy: Scorecard Content l Pharmacy-centric metrics vs. l Organizational wide metrics Examples: n % Med Rec Completed or 30-day Readmission n % Patients receiving anticoagulation or % DVT/PE n % Patients with pain scores < 5 or % Top Box HCAHPS pain control

12. Examples of Med-Related Outcomes Numbers above represent fictitious data for illustrative purposes only

13. Examples: Pharmacy Operations Further consideration on order verification turn-around-time Pharmacy Operations Weighted Drug Orders Processed per Pharmacist FTE ↑ Weighted Orders Dispensed per Technician FTE ↑ Retail Pharmacy: Prescriptions Dispensed per Pharmacist FTE ↑ Code S TPA Preparation Time in Minutes (Prep and Delivery) ↓ % Medications Dispensed as Overrides ↓ % Medications Redispensed ↓ IV Admixture Service Environmental Index (% WNL) ↑ Further consideration of order verification turn-around-time

14. Examples: Pharmacy Operations Further consideration on order verification turn-around-time Pharmacy Operations Weighted Drug Orders Processed per Pharmacist FTE ↑ Weighted Orders Dispensed per Technician FTE ↑ Retail Pharmacy: Prescriptions Dispensed per Pharmacist FTE ↑ Code S TPA Preparation Time in Minutes (Prep and Delivery) ↓ % Medications Dispensed as Overrides ↓ % Medications Redispensed ↓ IV Admixture Service Environmental Index (% WNL) ↑ Further consideration of order verification turn-around-time

15. Examples: Financial & Growth Further consideration on order verification turn-around-time Pharmacy Financial Optimization Inpatient Drug Expense per Discharge ↓ Inventory Turns ↑ % Overtime ↓ Pharmacy Growth % Increase in Employee Prescriptions at Retail Pharmacy ↑ % Increase in Discharge Prescriptions at Retail Pharmacy ↑ Number of Rx-Generated Patient Ambulatory Encounters per Month ↑ Number of Rx Collaborative Drug Therapy Management Protocols ↑

16. Examples: Employee Talent Employee Talent % Pharmacists with Certification/Advanced Training ↑ % Pharmacy Technicians with Certification ↑ Number of Pharmacy Educational Offerings ↑ % of Pharmacists Serving as Preceptors ↑

17. Productivity Monitoring Indicators l Worked hours per unit of service l Drug (or labor) cost per admission l Labor expense per 1,000 doses billed l RPh worked hours per order l Tech worked hours per dose l Clinical interventions per RPh shift l RPh:Technician skill mix ratio l Rx cost as % of total hospital cost Adapted from Rough SS, et al. AJHP 2010;67:380-8.

18. Pharmacy Intensity Score l Resource-based relative value intensity grouping system l Uses pharmaceutical resource consumption data n Produce DRG-specific drug use weights l Generally preferred over CMI n Example: hip replacement vs. kidney transplant Rough SS, et al. AJHP 2010;67:300-11.

19. Scorecards: Summary l Important to promote and justify patient-centered pharmacy services l Update & share regularly with pharmacy employees and stakeholders l Influence ‘right size’ of department

20. Questions