Quality Measures in the Long-term and Post-acute Care Settings: A Narrative Overview

Area of Science:

• Pharmacy Practice
• Health Services Research
• Quality Improvement

Background:

• Traditional pharmacy reimbursement relies on prescription dispensing fees.
• Modern pharmacy practice, especially in long-term and post-acute care (LTPAC), includes extensive direct patient-care activities.
• The healthcare system is transitioning from fee-for-service (FFS) to value-based care (VBC) models.

Purpose of the Study:

• To examine the limitations of current quality measures (QMs) for pharmacists in LTPAC settings.
• To identify the need for QMs that reflect pharmacists' clinical contributions in VBC models.
• To propose actionable steps for developing LTPAC-specific QMs.

Main Methods:

• Review of existing quality measures relevant to LTPAC pharmacy practice.
• Analysis of the gap between current QMs and pharmacists' clinical activities.
• Examination of efforts by American Society of Consultant Pharmacists (ASCP) workgroups to identify new QMs.

Main Results:

• Current QMs inadequately capture the value of pharmacists' direct patient-care services in LTPAC.
• The lack of appropriate QMs prevents pharmacists from full participation in VBC reimbursement.
• ASCP workgroups identified key areas for developing LTPAC-specific QMs.

Conclusions:

• Development of specific quality measures is crucial for integrating pharmacists into value-based reimbursement.
• Addressing QM limitations will enable pharmacists to demonstrate their value and improve patient outcomes in LTPAC.
• Actionable strategies are needed to create and implement new QMs for LTPAC pharmacists.