What exactly does PPD mean and what does it measure?
PPD = (# of patients) x (# of Rxs per patient) x (cost per patient)
Total # of hospice days
PPD is the average price-per-patient per day the hospice agency spends to cover medications for symptom and terminal diagnosis management. There are two main factors that determine PPD: the number of prescriptions per patient and the average cost per prescription. If either or both of these factors are high, the end result is a high PPD.
How can a hospice agency lower their PPD? One way is to work closely with a pharmacist to review an invoice and identify medications that may be discontinued or changed to a less expensive alternative, or that should not be covered by hospice. Identifying these potential problem areas can help you lower the number of prescriptions per patient and the average cost per prescription.
Tips to lowering the #of Rx per patient: Goal < 6 Rxs per patient per month
- Look at how many medications a patient is taking in the same class. For example, does the patient really need to be on Senna, Docusate, Milk of Magnesia, Bisacodyl suppositories, Miralax, and Fibertabs? What is working and what is not? Simple is usually better.
- Identify the number of “goal” medications the hospice is covering. A “goal” medication is one that may provide comfort or treat symptoms of condition(s) not related to the terminal diagnosis, but hospice covers the medication as it aligns with patient care goals (e.g., nystatin powder, antibiotics, GERD medication). Each “goal” medication adds up and increases the overall PPD.
- Identify medications that are no longer beneficial and/or have side effects that may worsen quality of life. For example, Namenda and Aricept are intended to slow disease progress but no studies have shown any benefit during end-stage dementia. However, both of the medications are linked to increased terminal agitation. A best practice is to discontinue such medications, increasing patient quality of life and lowering the # of Rxs per patient.
Tips to lower Cost per Rx: Goal $18-$22 per order per month
- Talk to a pharmacist about less expensive alternatives for expensive medications. An example of this would be switching out Xifaxin 550mg for Flagyl 500mg tabs for a considerable price difference, or using plain Oxycodone instead of Percocet.
- Look at quantities that are ordered. Pharmacies have a minimum charge to cover overhead expenses. This means an order of 2 tablets may be more expensive in the long run than ordering 15 of the same tablets.
- Also see number 3 above.