Latest / Becker’s Healthcare Podcast / Sterling Elliott, PharmD, BCMTMS, Clinical Pharmacist Lead, Assistant Professor of Orthopaedic Surgery at Northwestern Medicine & Affiliate Faculty Member, Purdue University College of Pharmacy

Transcript

Sterling Elliott, PharmD, BCMTMS, Clinical Pharmacist Lead, Assistant Professor of Orthopaedic Surgery at Northwestern Medicine & Affiliate Faculty Member, Purdue University College of Pharmacy · Becker’s Healthcare Podcast

0:00
Welcome to the Becker's pharmacy leadership podcast. I'm
0:03
Ella Jeffries, pharmacy reporter with Becker's Healthcare.
0:06
Today, I'm joined by Sterling Elliott, clinical pharmacist
0:09
lead for the ambulatory surgery practice within surgery
0:11
and procedures at Northwestern Medicine.
0:14
In this episode, we'll be exploring how pharmacists
0:16
are carving out new paths in a changing
0:18
health care environment and the expanding opportunities for
0:21
pharmacist leadership in ambulatory and procedural care. Sterling,
0:24
thank you so much for joining me today.
0:26
To kick things off, can you walk us
0:28
through your background and your role as clinical
0:29
pharmacist lead within the ambulatory surgery practice?
0:32
Absolutely. It's, it's a pleasure to join you
0:35
here on this podcast.
0:37
I started out in in the pharmacy world
0:40
sort of going back to school.
0:43
I was working in different realms before that,
0:46
including things like broadcast journalism,
0:49
and I made a decision to go back
0:51
to school and kinda go back to family
0:53
roots. My family
0:54
owned a a prominent retail pharmacy in the
0:57
North Side Of Chicago for many years.
1:00
So after graduating, I ended up in the
1:02
institutional setting
1:04
starting out at Northwestern Medicine. I spent a
1:07
few years there,
1:09
ended up getting into a position where I
1:11
was running the clean room before I left
1:13
for Florida,
1:15
for business opportunity where I sort of worked
1:17
more
1:18
extensively in in ambulatory
1:21
type settings and and still spent time in
1:23
hospitals there as well
1:25
and came back to Chicago in the 2016.
1:29
And so I've been at back at Northwestern
1:31
Medicine working in,
1:32
the surgical
1:33
pharmacy realm ever since
1:36
and and really sort of found my focus
1:38
in
1:39
the area of ambulatory
1:41
surgery and and sort of looking at new
1:43
and different ways to
1:45
figure out how how do you
1:48
integrate pharmacists into that world, and and how
1:50
do you optimize
1:52
the care of patients in that realm.
1:55
Awesome. Thank you for sharing your background. It's
1:57
great to hear.
1:59
Now from your perspective, what major shifts in
2:01
today's health care environment are opening the door
2:03
for pharmacists to step into expanded or nontraditional
2:06
rules?
2:07
I think the American health care system is
2:11
at this
2:13
sort of,
2:15
you know,
2:17
really extensive crossroads
2:19
here in in in really
2:21
sort of
2:22
fundamentally
2:23
changing
2:24
the way it operates. I mean, for a
2:26
long, long time, the American health care system
2:29
focused a lot on
2:31
revenues
2:32
and optimizing
2:33
streams of revenues.
2:36
And
2:37
I
2:37
I think that
2:39
in the last,
2:41
I don't know, three years maybe, we've really
2:44
seen
2:45
costs
2:46
just skyrocket
2:48
in the American health care system,
2:50
and revenue streams at the same time
2:53
start to decline.
2:55
Third party payers
2:57
are notoriously
2:58
being more
2:59
restrictive
3:00
with what they'll cover and when they cover
3:03
it, how much they'll pay. And so I
3:05
think it's really
3:06
sent
3:07
the
3:08
entire American health care framework
3:11
into
3:12
a cost management
3:14
mode.
3:15
And so
3:16
within the realm of American health care, I
3:19
think the pharmacy,
3:22
component of American health care has been
3:25
managing costs to optimize
3:29
margins and revenues and income
3:32
for a long, long time. And so I
3:34
I would
3:35
think
3:36
that the pharmacy
3:38
departments
3:39
all across the
3:41
country
3:42
could be a real resource for health care
3:45
systems as we all move toward
3:49
this
3:50
chance to
3:51
really
3:52
make our costs sufficient so that we optimize
3:56
our margins
3:58
and our dividend for reinvestment for those of
4:01
us that work in,
4:03
the not for profit sector.
4:06
It really sort of optimize
4:08
the the operating revenues that we get.
4:11
Definitely. That's a really interesting point, and seems
4:13
like those changes are going to create very
4:15
real opportunities on the ground.
4:17
Speaking of that, when you look at ambulatory
4:19
and procedural care specifically,
4:21
where do you see the biggest opportunities for
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pharmacists to fill gaps, take on new responsibilities,
4:26
or lead initiatives that traditionally were considered, quote,
4:28
unquote, pharmacy space? Yeah. I it's it's a
4:31
great question.
4:32
And I think
4:34
that, really, what we're looking at
4:36
is the scenario
4:39
where
4:40
you know, again, we did we talked about
4:42
it. It comes right back to the previous
4:44
conversation we were having, which
4:46
is
4:47
optimizing cost opportunities
4:49
so that you maximize
4:51
your revenue
4:52
opportunities. And it the American health care system
4:56
is making this great move toward value based
4:59
care, and it's a it's a buzz term
5:01
that we've heard bandied about,
5:04
I would say, for years now.
5:06
And whenever you talk about value based care,
5:08
if you're having that conversation with somebody who's
5:12
knowledgeable of everything that swirls around it,
5:15
very early on in that conversation,
5:18
you will hear
5:20
complete agreement amongst the entire group that value
5:23
based care means a million different things to
5:26
a million different people. And we really don't
5:28
know what
5:30
it's going to look like or what it
5:32
could look like. But to me,
5:34
I think the best hope for value based
5:37
care
5:38
is one that
5:40
prioritizes
5:42
outcomes for patients and ties that to optimized
5:46
revenues for those patient care events
5:49
as well as
5:53
setting future
5:54
payments
5:55
to optimize revenues in the future. And, you
5:58
know, so there's an area
6:00
where I think a lot of the the
6:03
care of patients,
6:04
even whether it's acute or it's chronic,
6:08
is ingrained in the use of of drugs
6:11
and the use of drugs effectively and efficiently.
6:14
And so I think there's real opportunities
6:17
for pharmacists
6:19
and the pharmacy profession
6:21
to find ways to integrate into the care
6:24
stream with patients so that we can apply
6:28
our knowledge and our expertise
6:31
in terms of how to use these medications
6:33
effectively
6:34
and advise the patients and their physicians
6:38
so that
6:39
everybody
6:41
has a successful outcome. And when successful outcomes
6:45
are tied to optimal payments for events
6:49
plus
6:50
minimizing
6:51
penalties
6:52
for future payments. There's a huge
6:55
opportunity here for pharmacists
6:57
and the profession of pharmacy
6:59
to make a major impact on the future
7:02
of the American health care system.
7:04
For sure. I definitely agree on that. And
7:07
kind of going a little bit deeper, what
7:08
are some of those specific patient benefits you
7:11
anticipate from pharmacists taking on these roles?
7:13
Well, I I think, for instance, I'm
7:17
we we
7:19
see that in
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diabetes in areas like diabetes and in areas
7:23
like cardiology,
7:25
some of my my colleagues are working
7:28
in the ambulatory
7:29
settings, and they're
7:32
helping the physicians and their patients
7:34
optimize their blood glucose levels and optimize
7:39
their their outcomes. And oftentimes,
7:42
optimizing outcomes
7:44
in chronic
7:45
disease states like that means that patients are
7:49
having fewer acute
7:51
admissions
7:52
for
7:54
events where their health has declined, and
7:58
that is leading to
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fewer
8:02
high cost
8:04
encounters
8:05
that are reimbursed
8:08
at a level that's not,
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you know, that's
8:11
not in line with the costs that it
8:14
takes
8:14
to help somebody get through that. And so
8:17
that's one area. And then very often,
8:21
payments
8:22
can be tied to
8:25
how well your patients perform
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in in the aggregate,
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not necessarily
8:31
in acute settings. So there's an opportunity.
8:34
Those are opportunities that we know of. In
8:37
my world in which I work in the
8:40
acute
8:41
surgical realm in an ambulatory
8:44
setting,
8:45
one of the major components
8:47
of postoperative
8:48
care
8:49
is pain management and how do you and
8:52
how do you do that effectively? And the
8:54
answer in America right now almost always includes
8:57
the use of opioids
8:59
because they work, but they also, as we
9:01
know, come with a lot of consequences
9:04
that we have to be very,
9:06
very cognizant of. And so I think that
9:09
there's a real opportunity. That's what I'm trying
9:12
to start forging here
9:14
for pharmacy
9:16
and for pharmacists
9:17
like me and others who would wanna
9:20
come on board and help me and join
9:21
me and figure this out
9:23
would be how do we effectively
9:26
teach patients to manage their pain so we
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minimize their use of opioids?
9:31
Because a lot
9:33
of reimbursement
9:34
issues are tied
9:36
to thirty day readmissions
9:38
and
9:40
patient reported outcomes.
9:43
And one of the major things that drives
9:45
patient reported outcomes is their perception
9:48
of the pain after surgery. And so I
9:51
think pharmacists and pharmacy in general has a
9:54
great opportunity to leverage that, and that's really
9:56
what I'm trying to build.
9:59
Mhmm. For sure. Those are great examples. Thank
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you so much for sharing.
10:02
Now kind of switching gears a little bit.
10:05
You know, stepping into new spaces isn't always
10:07
simple. As these roles expand, what barriers or
10:09
misconceptions
10:10
still stand in the way of pharmacists practicing
10:12
at the top of their license, and how
10:14
do you think leaders can address them? Yeah.
10:16
I I think
10:18
let let's let's talk misconceptions
10:21
first
10:22
because I think
10:24
that those
10:26
used to exist
10:27
within
10:29
the health systems.
10:30
And I think those
10:32
have largely been broken down within the health
10:35
systems. There was a time
10:37
where
10:38
pharmacists
10:39
were calling out,
10:41
let us join you. Let us help you.
10:43
Let us be a part of this. And
10:46
there was resistance
10:47
from physicians
10:49
and nurses
10:50
and mid level practitioners
10:52
thinking that
10:53
the pharmacy could potentially
10:56
encroach on on some of their realms.
10:59
And I think what's been learned is that
11:02
that's not at all what's happening
11:04
because the nature of how health care gets
11:07
measured
11:08
and assessed and how those measurements
11:11
and assessments and those results get applied to
11:13
revenue
11:15
is driving things in a direction nobody's happy
11:18
with. And I think there's been this general
11:21
perception
11:22
that pharmacists
11:24
and pharmacy in general can add to the
11:27
optimization of that. So
11:29
the misconception
11:31
within the health system is not there, but
11:33
I think it exists outside.
11:35
I think that a lot of patients
11:38
still
11:39
see the top of mind vision of the
11:41
pharmacist
11:42
as somebody
11:44
in
11:45
a branded
11:46
piece of clothing
11:48
in a retail setting
11:50
moving their medication. And, certainly, those folks
11:54
exist, and we we need them, and they're
11:56
a crucial part of making sure
11:58
that the appropriate drugs get to the right
12:01
patients in the right way, and and that
12:03
that should never go away. But I I
12:05
don't think patients realize
12:07
the other contributions.
12:09
And then I think too
12:10
that
12:11
the
12:13
government
12:15
mechanics out there, legislatures
12:17
at the state and federal levels,
12:19
don't yet
12:20
recognize
12:21
or have mechanisms in place to recognize
12:25
pharmacists and the profession of pharmacy
12:28
as a crucial component
12:30
of the work that gets done for patients.
12:32
So those are misconceptions.
12:34
Now what are the barriers?
12:35
Well, the barrier sort of the primary barrier,
12:39
I think,
12:40
emanates
12:41
from
12:42
the misconception
12:43
that we were talking about at the legislative
12:45
level, which is
12:47
that there needs to be a commitment
12:50
to
12:51
establish pharmacists
12:53
as a viable
12:55
source of patient care in the American health
12:58
care landscape
12:59
so that when it does,
13:02
the principal barrier,
13:04
which is cost relative to reimbursement,
13:07
can be
13:09
really pushed back on hard because that's the
13:12
key barrier. The key barrier
13:14
is that there are very few
13:17
elements of of the legal and regulatory components
13:20
of the American health care system
13:22
that
13:24
mandate that a third party payer, the insurance
13:26
carriers,
13:27
cover
13:29
the cost of pharmacists'
13:31
intellectual
13:32
services that they provide to patients.
13:35
And
13:36
while there's tacit agreement
13:39
amongst all the members of the American health
13:41
care system that pharmacists do do that and
13:44
that there'd be nothing wrong with paying for
13:47
that,
13:48
there's nothing motivating the payers to do so.
13:51
And until they're motivated, they're not going to
13:54
because they just see it as a cost
13:56
outlay. But in fact, a small cost outlay
14:00
to a pharmacist to join in the process
14:02
to help optimize
14:04
the care of patients when it comes to
14:06
the way medications are used
14:08
could lead
14:10
to
14:11
far fewer
14:12
high cost, high reimbursement
14:15
events that take place
14:17
as a consequence.
14:18
So I really think that's the critical barrier
14:21
that we're facing now.
14:23
Definitely. Those are really helpful perspectives, and I
14:26
think a lot of leaders will appreciate hearing
14:28
those.
14:29
But let's bring us to life a little
14:30
bit more. Can you share an example of
14:32
a program, workflow, or or initiative that you've
14:35
helped build that demonstrates how pharmacists can carve
14:37
out new impactful roles in care, you know,
14:40
despite these barriers and misconceptions?
14:42
Oh, absolutely. And it's it's the work that
14:44
I do,
14:46
at Northwestern Medicine
14:47
in our our flagship location at Northwestern Memorial
14:51
Hospital
14:52
when it comes to ambulatory orthopedic surgery. And
14:54
this is a this is a result of
14:56
a lot of thought about what do you
14:59
say to people, how do you say it,
15:01
when's the best time to say it. And
15:03
it's collaboration
15:04
with my leaders in the pharmacy department,
15:07
collaboration with my colleagues who are surgeons
15:11
in orthopedic surgery and and the leadership of
15:14
orthopedic
15:15
surgery and everybody kind of coming together and
15:17
saying, yeah. This is something really interesting and
15:20
and valuable that we can provide our patients
15:22
that you probably won't get
15:24
anywhere else. And then
15:26
got a lot of lines of of research
15:28
that that teams and I are are pushing
15:31
toward. And as we do our literature research,
15:34
we don't find a lot of examples of
15:36
people writing up the type of thing that
15:39
we're doing. Essentially, what we do
15:41
is on the day of surgery,
15:43
we'll go into
15:45
patients' preop rooms. And I do this in
15:48
conjunction with students that I precept
15:51
from
15:52
Chicagoland area pharmacy schools. And they do a
15:55
lot of the work, and it's great because
15:56
it's great teaching opportunity and to show them
15:58
how to think about doing something differently.
16:02
And we walk in there, and we talk
16:03
to patients, and we tell them we're gonna
16:05
talk about
16:06
your pain management experience
16:09
on the first day you're recovering and afterward.
16:12
And the goal here is to figure out
16:15
how do you know when it's the best
16:17
point in time that you may need to
16:18
use one of those opioid pain pills.
16:21
We set expectations about what pain is gonna
16:24
be like
16:26
after surgery. That's a huge thing to do.
16:28
And we talk to them about their other
16:31
options besides the opioids, chiefly things like acetaminophen,
16:36
the brand name Tylenol,
16:38
and the nonsteroidal
16:39
anti inflammatories.
16:41
And we've crafted it so that we can
16:43
talk about
16:45
the NSAIDs
16:46
in terms of how do you use them
16:48
effectively if the doctor wants you to use
16:50
them as needed,
16:51
or and or how do you incorporate
16:54
prescribed
16:55
scheduled doses?
16:57
And we talk to patients about evaluating their
17:00
pain, not in terms of a pain score,
17:02
but in terms of functionality.
17:05
How are you doing with the pain? And
17:08
let your functionality
17:10
drive whether or not you need an opioid.
17:13
And we give them seven
17:14
factors that they can assess,
17:17
and we tell them that once
17:20
you know that your pain never reaches the
17:22
level
17:23
that you're even asking yourself those seven questions,
17:27
Well, you no longer have pain that comes
17:29
anywhere near needing an opioid,
17:31
and we teach them the importance of getting
17:33
rid of it and how to
17:35
find take back day events, how to find,
17:38
you know, kiosks that exist that are regulated
17:41
by DEA. And so I think all of
17:43
those things are really fascinating concept.
17:46
The surgeons
17:47
appreciate it, and very often, they'll tell me
17:50
about experiences that they have with patients on
17:53
post op visits
17:54
who mention,
17:56
that they thought it was helpful, number one.
17:58
Number two, one of my colleagues always says,
18:00
I can always tell the patients who listened
18:03
to the part about the anti inflammatories because
18:05
their course of progress after surgery
18:08
is the best. So I think we're seeing
18:11
tangible results as a matter of how do
18:12
you bring that out to the masses now.
18:16
For sure. It's great to hear about the
18:17
work that you're doing for both pharmacists and
18:19
patients.
18:20
Now thinking bigger picture, what should hospitals and
18:23
health systems be doing right now to better
18:25
support pharmacists as they move into expanded or
18:28
nontraditional roles?
18:30
I think that what health systems need to
18:33
do
18:34
is what I can tell you I know
18:36
the leaders at my health system are doing,
18:39
which is
18:40
to listen to these ideas,
18:42
to think about them, to understand the value,
18:45
and and then to work
18:47
effectively
18:49
at finding
18:51
paths forward
18:52
for how to make this happen. Right?
18:56
You know, I think one of the
18:59
the things in in sort of looking at
19:01
this and in some of the conversations that
19:03
I've had with folks,
19:04
you know, they talk about
19:06
certainly, they talk about
19:09
recognizing the importance of
19:11
creating cost efficiency.
19:13
But I what I think we have to
19:15
realize as a pharmacy profession is that the
19:18
true success of this is going to be
19:21
figuring out how to incorporate
19:24
revenue generating
19:26
activities,
19:26
whether that's partnering
19:29
with
19:30
physician practices
19:31
to generate revenue that
19:33
goes alongside
19:35
time with the pharmacist,
19:37
or I think very importantly,
19:39
advocating
19:41
for laws and legislation
19:44
that recognizes
19:45
pharmacists
19:47
as legitimate providers of health care services to
19:50
patients because that will generate the ability to
19:53
to create revenue streams from the third party
19:56
payers, which predominate
19:58
the flow of money through the system.
20:01
And then I think too it's being creative.
20:03
In our case,
20:05
we have conversations about how do we build
20:08
out
20:09
lines of investigation
20:10
to
20:12
describe the merits of what we're doing
20:14
that cannot only
20:16
put our name out there and motivate other
20:19
colleagues throughout the country to do this, but
20:22
can also motivate
20:24
benefactors,
20:25
philanthropists
20:26
who wanna support
20:28
innovation in health care
20:30
to join in and provide funds to do
20:32
that as well. So I think it's it's
20:34
gonna take a lot of thoughtful creativity and
20:37
the willingness to have these conversations.
20:40
Definitely.
20:41
Well, Sterling, this has been such an insightful
20:44
conversation. Thank you so much for sharing your
20:46
perspective and experience with us. That's all the
20:48
time we have for today's episode of the
20:50
Becker's Pharmacy Leadership Podcast. A big thank you
20:53
again to Sterling Elliott for sharing his insights
20:55
on how pharmacists are carving out new paths
20:57
in today's evolving care environment. Thanks for listening,
21:00
and we'll see you next time.