UNIVERSITY OF MICHIGAN – DEPARTMENT OF PHARMACY SERVICES

UNIVERSITY OF MICHIGAN – DEPARTMENT OF PHARMACY SERVICES

ANNUAL REPORT FY2006

Pharmacy Home Page | ( Complete report in .PDF format - 404kb )

Welcome From the Department of Pharmacy Services | Inpatient Drug Distribution Services | Clinical Pharmacy Services
Ambulatory Pharmacy Services | Medication Safety | Drug Information and Investigation Services
Research and Education | HomeMed Services | Computerization and Automation
Continuous Quality Improvement | Purchasing, Inventory, Management, and Distribution | Business Operations

HOMEMED

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Christopher Maksym, Pharm.D.
Director, HCS HomeMed operates as a business unit where commodity procurement, receiving, insurance verification, claims processing and cash application operation activities are all completed within the pharmacy located at 2850 S. Industrial Hwy., which is approximately 2 miles south of the main medical campus. A positive net margin is consistently generated in the area and this contributes to the health system margin target and support of non-revenue generating activities. Clinically, patient care, quality and process improvement programs are integrated into the health systems institutional plan and contribute to maintaining the institution’s tradition of leadership in healthcare

Service Description and Background

HomeMed is a licensed pharmacy and home infusion provider responsible for providing a wide range of products and services to safely and effectively facilitate care to UMHS patients in the convenience and comfort of their home. Since 1989, HomeMed has been providing infusion medications, nutritional therapy, specialty drugs, high-tech infusion nursing and care management services throughout Michigan and Northern Ohio. An interdisciplinary team consisting of pharmacists, nurses and dietitians along with technical, administrative and support staff totaling 101 FTEs provide pharmacy compounding, equipment management, dispensing, delivery and care management services to ensure that patient home regimens are safe and effective throughout the course of therapy. Staff have direct access to up-to-date and complete medical and patient drug information which facilitates effective and efficient collaboration with physicians and other caregivers within the health system. In order to ensure a smooth transition to home care, HomeMed has a hospital-based training and education team; this team consists of nurses and dietitians who work with patients and the referring health care team to ensure that home care needs are identified prior to hospital discharge and infusion nurses who provide care for the patient in the home.

Although HomeMed resides within the Home Care Service division in the Hospital and Health Centers corporate structure an administrative relationship exists between HomeMed and the Department of Pharmacy Services. Thus many administrative, pharmacy practice and educational activities are collaborative and integrated. There is HomeMed representation on several Department of Pharmacy and Health System committees. Additionally, most HomeMed clinicians and leaders hold academic appointments within the University reflecting the commitment to teaching, experiential training and research.

2006 Year in Review

Referral Activity

An average census of 1,171 patients was maintained by processing 1,983 (41%) new patient therapy referrals and 2,984 (59%) existing patient therapy or existing patient new therapy referrals. HomeMed referrals are obtained exclusively from UMHS where on average 66.3% of patient referrals (an average 65.3% of therapies) processed by Discharge Planning were referred to HomeMed opposed to other home infusion providers.

The majority (63%) of home infusion therapy referrals originate from inpatient hospital discharges. Thirty-three percent of HomeMed referrals come from ambulatory care areas with the Cancer Center being the predominant origin of referrals in this category. The remaining four percent of referrals originate in either the emergency department, primary care sites or in the home where typically a previous patient is restarted on a therapy previously administered in the home.

Of patients not referred to HomeMed, the majority (81%) were not serviced by HomeMed due to previous provider relationship and preferred provider payor agreements as assessed by the discharge planning clinician. Additionally, the benefit change to Medicare Part D necessitated transfer of many existing “dual-eligible” Medicaid/Medicare patients from HomeMed to another participating provider.

Pharmacy Operation Activity

Selected metrics are presented in the table below and illustrates a decrease in activity and this correlates with the decrease in revenue realized.

	FY '06 Total	Monthly Average FY '06	FY '06 % Change -Vs- FY '05
Total Orders Processed	26,904	2242	-2.8%
Total Prescriptions Filled	43,703	3642	1.7%
Total Units Admixed by Therapy	89,143	7,429	-19.17%
New Therapy Starts	4,281	357	-4.1
Total Infusion Days	315,733	26,311	-5.3%
HomeMed Deliveries	13,858	1,155	-4.3%
Sub Contracted-HomeMed Deliveries	10,141	845	2%
Total Deliveries	24,004	2000	-1.7%
Percent HomeMed Deliveries	57.73

Selected Accomplishments

· Development and implementation of the 340B Purchasing Program for pharmaceuticals exclusive of anti-hemophilia products

· TIE (Transmission of Information Electronically) Steering Committee formalized with staff and structure to contain and coordinate e-projects within and among the 3 service lines for HCS.

· Launch of web-based referral system for ambulatory clinics (HCS Transitions web page) to initiate referrals to HomeMed

· Development and implementation of delivery signature capture process with a 98.5% capture rate

· Implementation of vehicle tracking system for all HomeMed vehicles

· Development and implementation of new pump tracking process pathways with demonstrated increase in compliance

· Development of a First Dose (in the home) for IVIG Therapy

· Development of a Peripheral Nerve Pain Therapy Program

Academic and Professional Activities

HomeMed continues to contribute to the education of Health Science students. There were 14 student placements at HomeMed (i.e., 6 Pharmacy, 8 Dietetics) in FY ’06 and 2 staff members presented one or more lectures in the

College of Pharmacy and School of Nursing. Two pharmacy interns were employed at the pharmacy and there were four active Doctor of Pharmacy student research projects precepted by HomeMed staff.

Professional staff made presentations at the local, regional and national level. Two staff members serve as professional association board of directors at the national level and four staff members serve on various national professional association committees.

HomeMed Leadership

Mangers

Michelle Barnett – Reimbursement

Debbie Kovacevich – Infusion Nursing

Tricia Sirois – Infusion Pharmacy

Supervisors

Terrilyn Cook – Medical Records, Office, Facilities

Lisa Klein – Pharmacy Technicians

Eric Korte – Inventory, Warehouse & Shipping

Mary Mancinelli – Billing & Collections