Policy Week 2021 Kicks Off with Hospital-at-Home Event

Members of ASHP’s five policy-recommending councils and the Council of Affiliate Relations met virtually Sept. 20–22 during ASHP Policy Week 2021 to discuss how ASHP actions and advocacy can best support members in the upcoming year.

The event brought together 99 ASHP council and board members. The meeting was originally planned as an in-person gathering, but was held virtually because of the COVID-19 pandemic.

ASHP Chief Executive Officer Paul W. Abramowitz thanked attendees for supporting and strengthening the pharmacy profession to meet the future, even as members continue to face an onslaught of challenges from the pandemic and extreme weather events.

“Even during these difficult times, there are opportunities to advance pharmacy practice, optimize care, and make a difference in the lives of our patients,” Abramowitz said. “ASHP is committed to supporting you during this unprecedented and challenging period and beyond. Thank you for your incredible work on behalf of patients and your continued service to ASHP and the profession.”

As in past years, Policy Week featured a special joint session on an emerging or growing trend affecting pharmacy practice. ASHP President Linda S. Tyler introduced this year’s topic, hospital-at-home models of care, which have been expanding, in part, thanks to initiatives from the Centers for Medicare & Medicaid Services (CMS).

“In the past three months, 10 health systems and 23 hospitals have received CMS approval for their programs. As of September 2, CMS has issued approvals to a total of 69 health systems and 156 hospitals,” Tyler said.

She also noted that although comprehensive medication management is a critical component of home hospital programs, anecdotal evidence suggests the existence of wide variability in medication-management practices across these programs.

“That’s why we’ve gathered today to hear from today’s speakers and consider what ASHP professional policy is needed to advance pharmacy practice in this area,” Tyler said.

The session featured presentations from David M. Levine, general internist at Mass General Brigham and leader of the organization’s hospital-at-home program, and Michael Cotugno, director of pharmacy patient care services at Brigham and Women's Hospital.

“It’s all about getting the right care to the right patient at the right time — and the right place,” Levine said. He added that the model is well-suited for the acute care of patients with infections, exacerbations of asthma or heart failure, complications of diabetes, gout flares, and many other conditions — more than 75 diagnoses, in all.

Levine briefly described data from a randomized controlled trial of the Brigham and Women’s program showing that acute care services delivered in patients’ homes were at least as safe and effective as equivalent inpatient care and used far fewer resources. The study identified patients who had a clear diagnosis and a low risk of clinical deterioration that would necessitate admission to the intensive care unit and randomized them to receive inpatient or at-home care. None of the study participants who were cared for in their home required transfer to the hospital.

Cotugno said the hospital-at-home program, which initially used a spreadsheet to track and record patient care, is now fully integrated with the health system’s electronic medical record system.

“We have pharmacists’ review just like it was any other inpatient unit,” Cotugno said. One exception is that the health system’s legal department advised against having the inpatient pharmacy fill orders for controlled substances for at-home patients. Cotugno said these orders are handled as outpatient prescriptions and filled by a local pharmacy, which delivers the medications to the patients’ homes.

Cotugno also noted that the hospital-at-home program is treated as a hospital unit with distinct policies for medication storage, return, labeling, self-administration, and other factors related to medication use in the home environment.

He and Levine emphasized that today’s hospital-at-home care models have flourished under a waiver from CMS. Both clinicians urged pharmacists to advocate for a permanent regulatory framework that supports these models of care. Several ASHP councils met after the presentation to discuss the implications of these care models for pharmacy.

Council members also held robust discussions about a wide range of issues, including white bagging, educating the pharmacy workforce about stigmatizing language in healthcare, and responding to requests to dispense ivermectin or other veterinary medications for human use.

Starting Sept. 27, council members will meet virtually with their representatives in Congress to highlight priorities in pharmacy practice and demonstrate how pharmacists can improve the lives of constituents.

ASHP’s traditional Policy Week activities wrap up Tuesday, Oct. 5, with Rita Shane’s presentation of the William A. Zellmer Lecture. The lecture takes place virtually at 7–8 p.m. EDT. Shane’s remarks will focus on how passion, persistence, and patience have shaped her personal advocacy journey and the importance of leveraging evidence and expertise to effect positive changes. Registration is open to all.

Policy Week is the foundation of ASHP’s policymaking process and advocacy efforts. The participants’ recommendations drive ASHP’s advocacy agenda and form the basis of outreach to decision-makers in Congress, quality organizations, and stakeholder groups.

Watch ASHP’s animated video to learn more about our policymaking process.

[This news story will appear in an upcoming issue of AJHP.]