Specialty Pharmacy Core URAC Standards Overview, Part 3

This overview focuses on human resources issues, including those related to staff licensures and job descriptions, as they apply to URAC specialty pharmacy core standards accreditation.

In the January/February 2013 and May/June 2013 issues of Specialty Pharmacy Times, I provided some context in regard to some of the pharmacy core URAC accreditation standards. The next several standards I will be touching on pertain to human resources (HR). Some of these core standards will be relevant not only to URAC specialty pharmacy accreditation, but other URAC accreditations.

URAC will want you to have job descriptions documented for all of the positions on your organizational chart. Each job description should have required education and training as well as professional experience that is needed. It is also a good idea to have resumes on file for employees. This will help URAC confirm that the staff meets the job qualification requirements.

PROOF OF LICENSES

Licensure is also another key part of the job description. URAC will want the organization to make sure it performs and documents primary source verification of all employees with licenses. A good example would be a pharmacist, for whom you will need to document proof of verification of their licensure. A copy of the license will not suffice because those could technically be falsified. So, the primary source would be the licensing agency or board of pharmacy. Printing a screen shot of the board of pharmacy licensure status for the employee will suffice as proof of evidence for this portion of the core standards. Licensure verification should be done before hiring and no less than every 3 years.

URAC will also require several other pieces of information to be in the employee HR files or records. The first thing is background check and drug testing information. They will also be looking for you to have a policy for drug testing and background checks. Next, they will be looking for a policy on orientation and training. Proof of orientation and annual training should be in the HR files and records for each employee. The training can be broken down further into job-specific training needed for employee job functions, such as HIPAA/HITECH; compliance; fraud, waste, and abuse; and current URAC standards training. Lastly, you should also have annual performance evaluations and staff assessments that review relevant documentation produced by staff in the HR files for review by URAC as well.

EMPLOYEE TOOLS

Employee tools are another key component of the core standards for URAC. They would like to make sure the organization is providing employees the necessary tools to perform their job. Some tools can be online resources such as regulatory requirements (boards of pharmacy, nursing, etc). Some other examples of tools are policies and procedures, training manuals, newsletters, clinical decision tools, drug information resources, and escalation tools.

The next standard I would like to go over is financial incentive policy. Some organizations may not have financial incentives, but those that do will need a policy and attestation for employees who are eligible. Financial incentives are defined as reimbursement, bonuses, or incentives to staff or health care providers that are based directly on patient utilization of health care services. URAC wants to ensure that consumer health is not compromised and that there is oversight by management.

The next standard involves the consumer rights and responsibility policy. Some organizations will provide this information in new patient welcome kits. URAC will also allow you to communicate these policies via website or e-mail. Another consumer communication URAC will be looking for is the consumer safety mechanism. The intent of this standard is to establish at least 1 process that addresses the ability to respond in a timely manner to situations that may expose consumers/claimants receiving benefits to health and safety risks. Employees should understand how to handle situations like callers in crisis (suicide threats, adverse events, clinical question, etc).

I hope this information is helpful to you and your practice, not only for companies undergoing URAC accreditation but also as a good review or refresher for currently accredited organizations. In an upcoming issue of Specialty Pharmacy Times, I will go through the specialty pharmacy—specific standards. SPT

URAC is an independent nonprofit organization that promotes health care quality through its accreditation, education, and measurement programs. For more information on URAC and a complete list of its pharmacy core standards and standards interpretations, please go to www.urac.org.

About the Author

Quintin Jessee. RPh, DPh, is senior consultant, specialty and mail order operations, at D2 Consulting. Prior to joining D2, Quintin was the vice president of mail order operations for BioScrip Pharmacy. Other positions he held with BioScrip include director of quality assurance, pharmacist-in-charge, and special projects manager. He implemented and managed the first medication therapy management (MTM) program at BioScrip and was in charge of facility accreditations and CQI program management.Quintin specializes in accreditation support (URAC, ACHC, Joint Commission, VAWD, VIPPS, DMEPOS, etc) as well as specialty pharmacy management and works with specialty pharmacies on build-out support and overall business needs. This includes access to specialty products, managed care strategies, MTM services, work flow management, staffing models, and policy development.Quintin attended Ohio Northern University and attained a bachelor’s degree in pharmacy. He has served on the faculty of The Ohio State University School of Pharmacy as a professor and also mentors pharmacy students there. He volunteers with the Franklin County disaster relief team to assist with pandemics and other natural disaster relief. Quintin is a registered pharmacist in Ohio and Tennessee and currently resides in Columbus, Ohio.