Pharmacists are involved in four of the seven project applications recently awarded a total of more than $100 million for an initiative to reduce avoidable hospitalizations among nursing facility residents by the Center for Medicare and Medicaid Innovation (CMMI) and the Medicare–Medicaid Coordination Office.
Pharmacists are part of proposed projects from the Alabama Quality Assurance Foundation, Alegent Health (Nebraska), Indiana University, and UPMC Community Provider Services (Pennsylvania), CMS spokesperson Emma Sandoe told pharmacist.com.
Awards ranged from $5 million to $30 million each over a 4-year period of performance, according to Sandoe. On September 27, CMS announced the seven organizations partnering with 145 nursing facilities through this initiative. (The other three organizations are HealthInsight of Nevada, the Curators of the University of Missouri, and the Greater New York Hospital Foundation, Inc.)
Improving the care experience for dual eligibles—patients who are enrolled in both Medicare and Medicaid—is a “critical priority” for the agency, according to a CMS fact sheet. “Hospitalizations can be disruptive, dangerous and costly for Medicare–Medicaid enrollees residing in nursing facilities,” according to the fact sheet. Research shows that almost 45% of hospitalizations in this population are “avoidable, meaning they could have been prevented or treated in a lower intensity care setting.”
The initiative was announced on March 15. The Affordable Care Act established CMMI (also known as the Innovation Center) and the Medicare–Medicaid Coordination Office (also referred to as the Federal Coordinated Health Care Office) within CMS.
Pharmacist.com took a closer look at the Alabama project, which was led by the Alabama Quality Assurance Foundation and awarded $15.2 million. The Samford University McWhorter School of Pharmacy portion of the federal grant is $865,568, according to Charles D. Sands III, PharmD, Dean and Professor, Fred E. McWhorter Dean of Pharmacy of the school of pharmacy.
The school of pharmacy will provide pharmacy consultation services via drug information specialists at the Samford University Global Drug Information Service (GDIS), according to Maisha Kelly Freeman, PharmD, MS, BCPS, FASCP, Associate Professor of Pharmacy Practice and GDIS Director. These three pharmacy consultants are trained to provide evidence-based decision support for health care providers, as well as to educate health professionals regarding the rational use of medications—especially high-risk medications. The consultants will implement quality improvement projects such as Beers Criteria, START (Screening Tool to Alert Doctors to Right Treatment)/STOPP (Screening Tool of Older Person’s Prescriptions), and medication-appropriate index reminders to reduce the risk of high-risk medications and hospitalizations. Among their many responsibilities will be to provide educational interventions to consultant pharmacists, physicians, and nurses to reduce inappropriate medication use.
“Pharmacists are a very important part of the health care team,” Freeman told pharmacist.com. “In this country, older patients are high drug consumers due to a number of comorbid conditions. In addition, drug-related problems are common in the elderly due to changes in pharmacodynamics. Unfortunately, drug-related problems are also associated with hospital readmissions. Since pharmacists are drug experts, it is a natural fit for pharmacists to provide guidance regarding the inappropriate use of medications and discourage the use of inappropriate drug regimens in the elderly.”
The funding will allow the school of pharmacy to hire part-time faculty to cover for time spent by full-time faculty working on the program, according to Sands. The grant will also cover travel expenses for faculty related to carrying out the program.
“Several criteria have been described to evaluate potentially inappropriate medications in the elderly population,” Freeman said. These criteria include Beers and START/STOPP. “Pharmacists can assist by educating other health care professionals regarding these tools and encourage the appropriate use of these tools to ensure optimal patient outcomes.”