The PQA Quality Forum Webinar is a regular, recurring series on healthcare quality topics with a focus on medication use and medication services. It is a forum for educating and engaging with PQA members and quality-focused healthcare professionals.

Interest in telehealth has skyrocketed with the COVID-19 and many advocates hope it will become a regular part of standard care, as social distancing orders continue and patients need to receive care where they are.

Adam Chesler, the director of Regulatory Affairs at Cardinal Health, was our presenter for the April 16, 2020, PQA Quality Forum Webinar. He provided an overview of telehealth with an emphasis on telepharmacy. The adoption of telepharmacy has varied from state to state, and Adam shared examples of effective pharmacy practice models that are leveraging technology to provide remote clinical services.

Telehealth originated in the late 1870s, with the use of telephones to reduce office visits. With the pandemic, it is expanding faster than ever. It is used for live video consultations and remote patient monitoring in primary care, specialty care (mental health, dermatology, cardiology, radiology, etc.) and specific disease states. Chesler believes the growing adoption of telehealth will be one of the biggest paradigm shifts in health care.

Chesler addressed telepharmacy, which is a subset of telehealth. The National Association of Boards of Pharmacy loosely defines telepharmacy as "the provision of pharmaceutical care through the use of telecommunications and information technologies to patients at a distance." Telepharmacy is just like traditional pharmacy in that it can be broken down to inpatient and outpatient settings. Inpatient telepharmacy includes remote order entry review and IV admixture, while outpatient includes retail pharmacy and remote counseling.

Chesler focused on retail telepharmacy, which is the most common model. Retail telepharmacy is provided through a brick-and-mortar location, just like any other pharmacy, but:

• A pharmacist is not on-site;
• Pharmacists verify prescriptions for the telepharmacy through software solutions that provide a live video feed and images; and
• Pharmacists counsel patients via a live video call

Telepharmacy is most common and most needed in underserved areas. In some states, people must drive 50 miles to the nearest pharmacy to obtain medications or receive counseling. With telepharmacy, patients can receive care where they are and medications via delivery or mail. Another benefit is that it allows pharmacists to work remotely and lower their COVID-19 exposure risk.

There are more than 200 telepharmacies nationwide with 24 states permitting retail telepharmacy, though regulations vary drastically. Some of the rules and regulations governing telepharmacy include:

Pharmacist-provided care, as a part of patient-centered team-based care, has an important role to play in improving access to care, patient experiences and health outcomes.

The COVID crisis has multiplied the importance and urgency of access to high-quality care, especially among vulnerable populations and individuals with hypertension, heart disease, diabetes and other chronic conditions. These patients are more likely to suffer severe COVID-19 illness. Even before the pandemic, these conditions were leading drivers of healthcare costs, hospitalizations, premature deaths, disability and lost productivity.

Chris Kotschevar is the 2020-21 PQA Executive Fellow. He is a PharmD graduate from South Dakota State University College of Pharmacy and Allied Health Professions. Kotschevar joined PQA in June and has hit the ground running, helping to finalize and launch projects such as PQA’s Medication Use Quality continuing education and certificate program and the Healthcare Quality Innovation Challenge.  

What drew you to PQA and the Executive Fellowship program?

Statement by PQA CEO Laura Cranston, RPh

“After 15 years of leading PQA from a start-up organization to the nation’s only organization solely dedicated to optimizing health by advancing the quality of medication use, I will step down as CEO by the end of the year. This is a planned transition that will ensure PQA’s work to optimize the safe and appropriate use of medications through the development and implementation of meaningful measures, research and cutting-edge educational initiatives continues its strong momentum.

“As an organization that CMS envisioned 15 years ago as a public-private partnership, it has been my privilege to serve as the founding CEO of PQA, an organization that has grown to 250 members. I continue to be inspired every day by PQA’s mission, and am grateful for the steadfast commitment and engagement of the PQA team, the board of directors and the strong volunteerism of the membership that helps to shape the work we are doing in helping to develop measures through a consensus-driven process that will enhance patient outcomes through appropriate medication management.

“PQA’s ambitious agenda is shaped by the strategic leaders on our board, combined by the strong clinical, measurement science, research skills, and business acumen of our multi-stakeholder membership base. PQA is poised to continue to shape the quality agenda for today’s healthcare system as we emerge from this pandemic. I have the strongest confidence in our leadership, and in the momentum of the organization, and look forward to passing the baton to a new executive leader by the end of 2020.

“I have been humbled by the opportunity to lead PQA, and I am proud of the organization we have built. Together, we have defined medication quality and positively impacted how healthcare is experienced and evaluated. PQA is in a great place today and I am ready for the next chapter in my career.”

Statement by Jamie Chan, PharmD, Chair, PQA Board of Directors

Every session from the 2020 PQA Annual Meeting is now available to be viewed on demand in PQA's new Education Center. Access to these recordings is available exclusively to individuals who registered to attend the meeting and PQA members.

If you registered to attend the meeting, check your email for details on how to access the recordings. If you are a PQA member, you can also obtain login details in our Member Resources Library.

The PQA Annual Meeting continues on May 28 with the first of five weekly one-hour online sessions. Each week features a new educational session and an innovation theater, which is a commercial showcase of an organization’s innovations, technology, services or research.

All sessions take place on the 2020 PQA Annual Meeting website. Use the same username and password you used to access the May 13-15 sessions. Log in to your meeting account or update your profile, if needed. If you have any trouble, please email [email protected].

You can still register for the meeting, if you have not previously registered. Below are the upcoming sessions. Visit the meeting's agenda page for updates. 

May 28, 1:00-2:00 p.m. ET

The 2020 PQA Annual Meeting starts in two weeks on Wednesday, May 13. If you haven't made plans to join us, register today! All of the meeting sessions you would experience at our in-person meeting will be delivered online. 

The meeting takes place May 13-15 through five 90-minute sessions. If you can't be online for the full meeting, all sessions will be recorded and available to registrants on demand after the meeting. There is no registration cost for PQA members. 

PQA announced on Monday that the National Quality Forum has endorsed three PQA risk-adjusted adherence measures. These measures are used in the Centers for Medicare & Medicaid Services (CMS) Medicare Part D Star Ratings Program, and they evaluate adherence to medications for diabetes, hypertension and cholesterol.

The updated measures include a valid risk adjustment methodology for sociodemographic status factors. Accounting for these factors may impact patient health outcomes is important for ensuring that quality measures are applied fairly.

NQF recommends that performance-based measures be risk-adjusted for sociodemographic factors if there is scientific evidence that such factors affect the quality outcome measured. That recommendation is detailed in the Measure Developer Guidebook for Submitting Measures to NQF (PDF), which was last updated in September 2019. NQF’s rationale is supported in part by an earlier technical report: Risk Adjustment for Socioeconomic Status or Other Sociodemographic Factors (PDF).

CMS addressed this in the Announcement of Calendar Year (CY) 2021 Medicare Advantage (MA) Capitation Rates and Part C and Part D Payment Policies, which was released April 6. On pages 97-98, CMS discussed PQA’s measures and noted NQF’s recent endorsement, saying:

The risk-adjusted adherence measures were endorsed by the National Quality Forum (NQF) in the 2019 Spring cycle (NQF endorsed #0541). CMS will consider implementation of the PQA recommendations in the future for these Star Ratings measures (i.e., for the 2022 measurement year or beyond). Substantive measure changes must be proposed and finalized through rulemaking.

As the nation's most accessible health care professionals — and through telehealth — pharmacists are being empowered to provide critical patient services; however, this work is not without risk, which also needs to be addressed. PQA members are advocating for and supporting pharmacists as our health system’s medication experts. They are:

• Recommending policies to: authorize test-treat-immunize; ease operational barriers to address workforce and workflow issues; address shortages and continuity of care; and reimburse for services and remove barriers
• Highlighting best practices to ensure the safety of pharmacists, while leveraging their experience and skills to meet the needs of patients
• Establishing guidelines to limit COVID exposures and protocols for pharmacists and pharmacy staff, who have had contact with infected patients

PQA Members in Action

Drug Shortages – and COVID-19

Early refills, drug substitutions, off-label use and supply chain interruptions may all contribute to drug shortages sparked by the COVID-19 crisis. PQA members are anticipating and responding to potential drug shortages. Here are some of the ways they’re taking action.

Access to Care 

Social distancing, unemployment and current or anticipated financial difficulties for millions of Americans are affecting access to care and access to medications. PQA members are taking steps to overcome and eliminate the barriers that reduce patient access to care during the COVID crisis. Those efforts include:

Every PQA member is involved in the fight against COVID-19, which is affecting every aspect of healthcare, including medication use quality. PQA wants to share with you some of the ways our member are addressing COVID challenges as the relate to:

• Access to care -- Social distancing, unemployment and current or anticipated financial difficulties for millions of Americans is affecting access to care and access to medications.
• Drug shortages -- Early refills, drug substitutions, off-label use and supply chain interruptions may all contribute to drug shortages sparked by this crisis.
• Pharmacist empowerment -- As the nation's most accessible health care professionals — and through telehealth — pharmacists are being empowered to provide critical patient services; however, this work is not without risk, which also needs to be addressed.

This week, we will debut an individual blog post dedicated to each of these three areas. The posts will include links to the actions our members are taking. The lists are far from exhaustive and will be updated periodically. We welcome additional online and publicly available resources that our members would like to share. You can email suggested links to us at [email protected]. 

Laura Cranston, RPh
PQA Chief Executive Officer

The COVID-19 crisis is greatly affecting medication use, services and quality. Early refills, potential shortages, drug substitutions, reduced clinical visits and looming financial challenges for patients will all have an impact on medication adherence, patient outcomes and quality measure performance. At the same time, the expansion of telehealth services and growing roles for pharmacy staff could lead to innovative, long-term solutions for improving medication safety and appropriate use.

PQA is launching a blog.

It's a new information channel to keep you updated on our work -- in measure development, research, education and convening.