Is SNOMED CT the Key to Demonstrating Pharmacy's Value?
by
Samm Anderegg
So, what’s all the fuss about this SNOMED CT stuff? As a profession, we have been tirelessly working to demonstrate our value to members of the health care team, the C-suite, payers, and our patients. Codifying our interventions and linking what we do to outcomes is what will carry us into the future of value-based health care.
How do you document the care that you provide to patients? I would guess you do so using free text. Patient care providers routinely document within progress notes that are codified into diagnosis and procedure codes behind the scenes. These codes (e.g. CPT codes) are mainly used to submit claims for reimbursement in a fee-for-service payment model. However, healthcare is moving fast in a value-based direction. As we emerge as patient care providers, we need to be ahead of the game when it comes to documentation.
Value-based care is all about improving patient outcomes. Payments based on outcomes are now a reality through both private and federal programs like the Centers for Medicare and Medicaid (CMS) Readmission Reduction Program, the Value-Based Purchasing initiative, and the newly announced Oncology Care Model. While these programs impact a small percentage of the overall reimbursement for health care services, you can guarantee these rates will increase. The Department of Health and Human Services, which oversees CMS, recently set a goal to tie 30% of traditional fee-for-service reimbursement to outcomes or bundled payments by 2016 and 50% by 2018. So, how do we demonstrate that pharmacists are instrumental to improving outcomes? Data.
Imagine a well-staffed inpatient unit in your health-system. The pharmacist on service has some help this month from a PGY-2 resident, a PGY-1 resident, and two pharmacy students. Think about the extent of care the pharmacy team provides to each individual patient. They might complete an admission medication reconciliation, perform a comprehensive medication review daily, dose and monitor an aminoglycoside, ensure the patient is adequately anticoagulated, reconcile their med list prior to discharge, and perform discharge counseling. Maybe the outpatient pharmacy even delivers their home medications to the bedside and the clinic pharmacist performs a follow-up phone call post-discharge. Even if your department performs one or two of these interventions, they must be documented and codified using discrete data. Doing so ensures that each intervention data point is stored in the medical record and can be collected, reported, and analyzed.
Now compare this scenario to a similar unit without that level of staffing. Perhaps one pharmacist covers distributive functions and provides peripheral clinical care in addition to their other operational duties and responsibilities. How do patient outcomes differ? Did the pharmacy team make a difference? If you codify the interventions, you have the data to answer this question.
In the current healthcare environment, your health-system is probably already tracking some key outcome measures. What’s the percentage of diabetics with Hemoglobin A1c levels at goal? How do VTE rates in one unit compare to another unit? How many patients did your pharmacy resident see today? Well, if all the pharmacy interventions were codified, you could run a quick report and capture all the data needed to answer these questions. You would know the percentage of your patients that had an A1c at goal versus another clinic without a pharmacist. Perhaps you could use this information to improve your clinic or make a case for the expansion of pharmacy services to more settings.
Opportunities are endless with the use of pharmacy-specific SNOMED CT codes! These are only a handful of ideas of how codified clinical data can be used to demonstrate value. There are a lot of outcomes measures that interest the C-suite, payers, and patients. Even better, demonstrating that we impact these measures ties us to outcomes-based reimbursement. Provider status, anyone?
I am very excited about the future :)