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Long-Term Care (LTC) Collaborative PIP: Medication Review

Tuesday, October 29, 2013

Presenter:Christi Melendez, RN, CPHQAssociate Director, PIP TeamHealth Services Advisory Group, Inc.

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Medication Review

Medication review (including all prescriptions and over-the-counter medications) is important because it allows the licensed nurse or a pharmacist in consultation with the enrollee's physician:

• To assesses whether the enrollee’s medications are accurate, valid, non-duplicative and correct for the diagnosis

• To determine if therapeutic doses and administration are at an optimum level

• To determine if there is appropriate laboratory monitoring and follow-up taking place

• To assess for drug interactions, allergies, and contraindications

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Medication Review

LTC plans will benefit by conducting the Medication Review collaborative PIP. If conducted effectively, the PIP can:• Improve performance in the targeted areas

• Keep plans focused on improving performance

• Improve enrollee satisfaction

• Improve enrollee health outcomes

• Reduce HCBS members’ risk of adverse medication interactions and over/under use of prescription, as well as OTC drugs

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Activity I: Study Topic

• The documentation should include information that this is a collaborative topic across all LTC plans.

• If plan-specific data available, the data should be documented. If no plan-specific data available, an explanation should be provided.

• Describe how this topic has the potential to affect enrollee health, outcomes of care, functional status, or satisfaction

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Activity II: Study Question

Do targeted interventions increase the percentage of enrollees 18 years of age and older who are receiving HCBS and had a review of the enrollee’s medications and a medication list in the medical record or case file during the measurement year?

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The eligible population is defined as:•All enrollees 18 years of age and older as of December 31 of the measurement year who are receiving HCBS. •The enrollee may not have more than one gap in continuous enrollment of up to 30 days during the measurement year.

Activity III: Identify the Study Population

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Activity IV:Select the Study Indicator

Indicator 1: The number of enrollees 18 years of age and older receiving HCBS who had evidence of a list of the enrollee’s medications in the medical record or case file during the measurement year.

Indicator 2: The number of enrollees 18 years of age and older receiving HCBS who had at least one medication review conducted by a licensed nurse or a pharmacist in consultation with the enrollee’s physician during the measurement year.

Denominator: All eligible enrollees 18 years of age and older receiving HCBS.

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Activity IV:Select the Study Indicator

Measurement Periods Baseline

January 1, 2014 through December 31, 2014

Remeasurement 1

January 1, 2015 through December 31, 2015

Remeasurement 2

January 1, 2016 through December 31, 2016

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All plans should use sampling if the eligible population is large enough, i.e. – greater than 411. Otherwise, plans need to use the entire eligible population.•Specify the measurement period for the sampling methods used

•Provide the title of the applicable study indicator

•Identify the population size

•Identify the sample size

•Specify the margin of error and confidence level

•Describe in detail the methods used to select the sample

Activity V:Use Valid Sampling Techniques

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Activity VI:Define Data Collection

• Although the Medication Management service definition in the LTC waiver and the contract do not currently include a pharmacist in the review process, the Agency for Health Care Administration is in the process of making this change. The Agency would like to be proactive in designing the collaborative PIP measure, to avoid future inconsistencies in data collection and outcomes.

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• Administrative data collection or medical record/case file review

• Procedure Codes:Medication Management, Comprehensive medication services,

BSN H2010 HN

Medication Management, Comprehensive medication services, RN H2010 TD

Medication Management, Comprehensive medication services, LPN H2010 TE

Activity VI: Define Data Collection

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HSAG Evaluation Elements: Data Collection

The data collection procedures:

• Identify the data elements to be collected• Include a defined and systematic process for

collecting baseline and remeasurement data

Activity VI: Define Data Collection

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HSAG Evaluation Elements: Data Collection

The manual data collection procedures:•Include the qualifications of staff member(s) collecting manual data•Include a manual data collection tool that ensures consistent and accurate collection of data according to indicator specifications (critical element)

Activity VI: Define Data Collection

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Activity VI: Define Data Collection

HSAG Evaluation Elements: Data Collection

The administrative data collection procedures:

•Include an estimated degree of administrative data completeness•Describe the data analysis plan

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• Medical Record/Case File Review: Documentation must come from the same record and must include the following:

• A medication list in the record and evidence of a medication review by a licensed nurse or a pharmacist in consultation with the enrollee’s physician, and the date when the review was performed.

• Notation that the enrollee is not taking any medication and the date when it was noted.

• A review of side effects for a single medication at the time of prescription alone is not sufficient.

• An outpatient visit is not required to meet criteria.

Activity VI: Data Collection

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Collaborative PIP Completion

• The collaborative PIP should be completed on the new 2013-2014 PIP Summary Form

• For the first year, the PIP Summary Form should be completed through the first six activities “Study Design”

• Plans should use the corresponding PIP Completion Instructions to ensure that all documentation requirements are addressed for each activity

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Collaborative PIP Scoring

• HSAG will be using the outcome focused scoring methodology

• Improvement must be statistically significant over baseline for all study indicators to receive an overall Met validation status

• Activity IX is scored on an annual basis until statistically significant improvement over baseline has been achieved for all study indicators

• Once Evaluation Element 3, in Activity IX, receives a Met score, it will remain Met for the duration of the PIP

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Collaborative PIP Scoring

• HSAG will not validate Activity X until Evaluation Element 3 of Activity IX is Met

• Once statistically significant improvement has been achieved for all indicators, the health plan will need to document a subsequent measurement period demonstrating sustained improvement in order to receive a Met in Activity X

• These scoring changes align the actual outcomes of the PIP with the overall validation status

• Greater emphasis on statistically significant and sustained improvement in outcomes

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Questions and Answers