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NEWS

1834 AM J HEALTH-SYST PHARM | VOLUME 74 | NUMBER 22 | NOVEMBER 15, 2017

Zellmer lecturer provides insights into future of healthcare, opportunities for pharmacists

Pharmacists are poised to make strong contributions in the areas of postacute care, behavioral health, and population health, says Mark L. Hayes, 2017 recipient of the William A. Zellmer Lecture Award.

The award recognizes leadership in advancing public policy that improves medication use through the efforts of pharmacists.

Hayes, senior vice president for federal policy and ad- vocacy for Ascension, the nation’s largest nonprofit health system, is the eighth recipient of the award. Hayes deliv- ered his lecture on September 26 in Bethesda, Maryland, as part of ASHP’s annual Policy Week activities.

The annual lecture takes place the day before Policy Week participants meet with their representatives on Capitol Hill to discuss issues important to the pharmacy profession.

Hayes said professional opportunities for pharmacists are related to the national shift from fee-for-service to value-based models of healthcare delivery that attempt to control rising healthcare costs.

“The payment model is what drives the delivery of healthcare. The fee-for-service model says, ‘Do more services, and you get paid more,’” Hayes said, citing lessons he learned as a Senate healthcare staffer and as chief health counsel for the Senate Finance Committee’s Republican staff.

He said movement away from fee-for-service pay- ments started decades ago, when policymakers first be- gan bundling Medicare-covered inpatient services into diagnosis-related groups, or DRGs, with the government setting fixed rates for reimbursement.

“This is the first time we went from a cost-based payment in hospitals to a bundled payment. It turns everything in the hospital from a revenue center to a cost center,” Hayes said. As a result, he said, hospitals began to deliver care in ways that better manage costs.

And by later bundling Medicare reimbursement in outpatient settings and introducing penalties for early readmissions, he said, policymakers have created new incentives for hospitals to be accountable for what hap- pens to patients after they leave the hospital.

“That’s going to really transform how postacute care happens. And I want to ensure that’s on [pharmacists’] radar screen,” Hayes said.

Behavioral health is another area that pharmacists should pay attention to, he said.

The Substance Abuse and Mental Health Services Administration estimates that the United States will spend $238 billion for prescription medications to treat behavioral health problems in 2020, up from $179 bil- lion in 2014.

To reduce costs and provide better care for people with behavioral health conditions, Hayes said, it’s important to tackle the stigma of mental illness and treat it as just another medical condition.

And Hayes said healthcare providers “are just now be- ginning to talk about social determinants of health,” such as income, education, and housing, that affect day-to-day health status outside of healthcare settings.

Hayes referred the audience to AJHP’s September 15, 2017, special issue on population health for specific examples of how pharmacists are “doing amazing things and changing the delivery of healthcare.”

But he cautioned that pharmacists still need to docu- ment and track the return on investment for pharmacy services in order to convince healthcare administrators to support expansion of the profession’s efforts.

Hayes described himself as a “policy pharmacist” but said he didn’t know in advance that he would follow that professional path.

He said that while serving as ASHP executive resident in association management in 1988, he learned about the role played by Capitol Hill staff in shaping health- care policy and delivery. After completing his residency

ASHP President Paul W. Bush (right) presents a plaque to Mark L. Hayes honoring his receipt of the 2017 William A. Zellmer Lecture

Award. Hayes delivered the Zellmer lecture on September 26.

Continued on page 1836

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1836 AM J HEALTH-SYST PHARM | VOLUME 74 | NUMBER 22 | NOVEMBER 15, 2017

at ASHP, Hayes served for 5 years as a legislative assistant for Christopher Bond, of Missouri, his state’s U.S. senator.

Hayes later served as a policy adviser for the Senate Committee on Health, Education, Labor, and Pensions and for Senator Olympia Snowe of Maine. In late 2002, he became the health policy director and chief health coun- sel for the Senate Committee on Finance. He served for

Continued from page 1834 8 years and was involved in the drafting of major federal health legislation, including portions of the 2003 Medicare Modernization Act, which created the Part D prescription drug benefit and the Medicare Advantage program.

He called the awarding of the William A. Zellmer Lecture Award an “unexpected honor.”

“I am really humbled to be a part of this,” Hayes said.

—Kate Traynor DOI 10.2146/news170074

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Nursing home evacuation turns medication reconciliation into emergency

The sudden arrival of nearly 120 nursing home resi-dents without medication administration records 3 days after Hurricane Irma knocked out the home’s air conditioning system meant “all hands on deck” for phar- macy personnel at Memorial Regional Hospital in south Florida, said Sara Eltaki, clinical coordinator for transi- tions of care at the facility.

Nursing home records arrived, she said, but they had no information about the residents’ current medications.

The electronic records system for the unaffiliated nurs- ing home—Rehabilitation Center at Hollywood Hills— remained inaccessible to hospital personnel for hours, she said.

As for who the residents were, Eltaki estimated that only 20–30 of them bore an identification wristband.

“It was extremely eye-opening for a lot of the providers and even for ourselves that when we have absolutely no information on these patients in terms of medications . . . the medication reconciliation process is extremely important,” she said.

Madeline Camejo, vice president of specialty and ambulatory pharmacy services for Memorial Healthcare System, the parent organization, said the events on September 13 reminded her of mass casualty event drills at the 553-bed hospital, which is a level 1 trauma center.

“On top of that,” she said, “the staff was already stressed because we had just finished [working through] the storm.”

In less than 5 hours, the hospital had received 141 residents from the nursing home, according to the Hollywood Police Department.

Of those 141 residents, the police said, 119 were pro- cessed by the hospital and 39 were admitted as inpatients at the facility or another hospital in the health system.

The emergency evacuation started early on September 13 when, according to the police, rescue crews found 3 residents dead in the “excessively hot” nursing home and “others in need of immediate transport” for medical care.

Eltaki said the hospital’s emergency department staff called on her to assist because they knew of her prior work with the nursing home, which is across the street.

“I actually knew the administrator very well,” she said. “Unfortunately, I wasn’t able to contact him.”

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