Mary Baxter, MBA, RPh
healthcare industry expert
That mission can be boiled down to two components: access and quality. As every hospital pharmacist knows, filling medication orders is only one part of their essential job in a value-based healthcare world. To operate as a strategic asset, hospital pharmacists are increasingly focused on helping deliver the highest quality clinical care to their patients, while also supporting their hospital in extending the care they provide to their community.
To position a hospital pharmacy as a strategic asset, Cardinal Health recommends viewing the hospital's strategic agenda in what we call the "Four F Framework." We've discussed how pharmacies can Find Meaningful Growth and how they can Fix Inefficiencies in previous Essential Insights articles. This post provides suggestions on how hospital pharmacies can Fulfill their Quality Care Mission, a pillar directly targeted at improving clinical care.
Not every strategy will work for every hospital pharmacy, yet these are just a few ways pharmacy leaders can help ensure more patients get access to the right medications, medication counseling and other pharmacy services they need to get and stay healthy - while, in turn, helping the hospitals they serve improve their quality care mission.
Introducing new outpatient pharmacy services or expanding your current outpatient pharmacy services can help expand access to medications among patients, your community and employees alike. An increasing number of hospitals are also positioning their pharmacies to become the primary pharmacy for their own employees - making it easier for employees to access medications, and medication counseling services from hospital pharmacy staff. This is an especially helpful strategy if your health system self-insures and functions as payor as well as provider.
Operating an outpatient pharmacy can also further enable a hospital to ensure that patients have access to the drugs and information needed to make post-discharge care successful. By delivering medications to the patient's bedside, pharmacists can discuss potential side effects, dosage issues and even familiarize the patient's family members with the medication regimen. Ensuring that patients are discharged with their medications in hand, and that they understand how to use them, can help reduce the likelihood patients will be readmitted due to lack of adherence to their medication therapy. (For a great example of a ‘bedside pharmacy' program in action, read this Essential Insights post.)
Millions of patients across the United States cannot afford their medications. This includes the cost of hospital-administered inpatient medications, outpatient medications and expensive specialty medications. With an increasing number of patients receiving charity care, an increasing number of hospitals are seeking time- and cost-effective ways to help uninsured and underinsured patients access the medications they need to improve their overall health.
Patient Assistance Programs (PAPs), offered by many pharmaceutical drug manufacturers, provide free prescription medications to qualifying patients who meet specified requirements. However, each manufacturer establishes varying qualifications and requires different proofs of indigent status. Further, each manufacturer uses a unique set of forms which are sometimes difficult to locate.
An increasing number of hospitals are turning to services like Cardinal Health's eRecovery program, which relieve healthcare facilities of the arduous process of connecting patients with and enrolling them in PAP programs. These services help hospitals expand medication access among their most at-risk patients, while also reducing their costs. For example, this story about Summa Health System in Akron, Ohio, explains how one health system was able to provide 750 patients with more than $1.8 million in free medications in just one year, using this service.
Researchers have shown that up to 50 percent of antibiotic usage in hospitals is inappropriate.1 This is problematic not only because it leads to unnecessary medication costs, but because it also leads to adverse events that can negatively impact patient safety and drive up healthcare costs.
Effective antibiotic stewardship programs provide tools, information and processes that enable the pharmacy to improve the appropriate and cost-effective usage of anti-infective medications. To be successful, however, these programs require a high level of collaboration between pharmacists, physicians and the rest of the medical team. For example, one best practice we recommend is that hospitals leverage daily, multi-disciplinary rounds as an excellent setting for the pharmacy to communicate the latest lab results, consult on emerging issues and help streamline anti-infective drug utilization at the hospital.
Time and again, we see that hospitals that implement effective antibiotic stewardship programs benefit in meaningful ways. For example, we worked with one 300+bed hospital in the South to implement an antimicrobial stewardship program for patients seen by its Hospitalist group. The program (which included pharmacist rounds with hospitalists as described earlier) directly led to a nearly 25 percent decrease in the average length of stay for those patients - in a little over a year's time - while significantly reducing direct pharmacy, lab and imaging costs.
Contract labor is expensive, and overtime schedules can often over-tax an already lean pharmacy staff. These are just some of the many reasons why only about one-third of hospitals offer 24/7 pharmacy services. However, these gaps in pharmacy coverage can lead to increased turnaround time in administering medications to patients, and gaps in medication safety that can stand in the way of providing quality care. Remote pharmacy services can be an affordable, practical alternative to this problem, by ensuring that all medication orders have been reviewed by a pharmacist prior to administration, even during peak-hour coverage or during the third shift. With remote pharmacy, a medication order is faxed or scanned to a centralized pharmacy, staffed with licensed pharmacists trained in your hospital's procedures. The pharmacists actually log into your hospital pharmacy's computer system through a secure, encrypted HIPAA-compliant connection, to review and approve the order.
"Remote pharmacy services give us the confidence of knowing that an order has been reviewed by a pharmacist before administration," said Richard Stomackin, director of pharmacy, Lewiston Hospital in Pennsylvania. "In combination with our electronic medication record system, the service has also helped eliminate hand-written records, which decreases the chance for errors."
Access and quality care. Those are the keys to this pillar in Cardinal Health's 4-F Framework of making the hospital a strategy asset in a health system. High quality patient care and expanded access are a win-win-win situation -- for hospitals, pharmacies and, most importantly, for patients.