In an earlier post, I explained why hospitals are finding it necessary to provide 24x7 pharmacy coverage, especially if they want to qualify for "Stage 2 Meaningful Use" reimbursements and if they want to comply with regulatory, state pharmacy board and accreditation requirements. In this post, I will focus on the how - that is, how a hospital can determine if remote pharmacy services can be a cost effective approach to providing 24x7 pharmacy coverage and how to determine the best remote pharmacy model.
First, it's important to understand the current labor models hospitals typically implement to provide 24x7 pharmacy coverage:
- Extend onsite pharmacy hours. Hospitals that choose to extend their pharmacy hours hire more onsite pharmacist labor. While this is typically not the most cost-effective model, some hospitals feel this is the best approach.
- Build internal remote pharmacy service. Many health systems try to leverage larger hospitals with 24x7 pharmacy coverage to remotely service smaller hospitals, or hire additional pharmacists to build a separate remote pharmacy team.
- Leverage a remote pharmacy service provider. In this approach, a hospital contracts with a remote pharmacy service provider to ensure they have sufficient pharmacist coverage, 24x7.
Buy it or build it?
Each 24x7 pharmacy staffing model can provide benefits and challenges. That's why "buy or build?" is the first question a hospital administrator considers when expanding pharmacy coverage. "Is it more cost effective to do it ourselves or to leverage another hospital or service provider?"
In my experience, working with hundreds of hospitals that have sought a cost-effective solution to providing 24x7 pharmacy coverage, leveraging a remote pharmacy service provider is usually the best option. Why? The answer is simple: Communications technology, systems redundancy and remote pharmacy expertise provide an innovative, affordable and clinically effective way for hospitals to manage their pharmacy labor capacity.
Remote pharmacy service providers are helpful in enabling hospitals to:
- Scale labor capacity up and down as needed (which prevents hospitals from paying for pharmacist coverage when the volume of pharmacy work can't support the number of FTEs needed);
- Provide supplemental day coverage to ensure sufficient pharmacist coverage during peak order volume times, when the pharmacy experiences staff vacancies, or during pharmacy technology implementations; and to
- Free up clinical pharmacist time to help drive clinical initiatives, which can also drive additional savings.
Providing 24x7 pharmacist coverage can be cost prohibitive if a hospital does not have the order volume to support one or more full time pharmacist(s). In health systems that have sufficient pharmacist coverage, additional challenges need to be addressed and managed such as:
- Ensuring compliance with state board of pharmacy licensure and regulations that continue to change;
- Ensuring quality by managing variation in each hospital's policies and procedures;
- Supporting multiple technology platforms for health systems that are not on a fully integrated technology platform;
- Managing the workload across multiple facilities to ensure orders are processed in a timely manner; and
- Improving pharmacist availability to respond to nursing and medical staff inquiries.
Often times, administrators are surprised to find pharmacies within the same system do not operate under one standard set of policies and procedures -and that, too, can impact quality and nursing satisfaction if not tracked and managed. And, finally, hospital pharmacies that provide remote pharmacy coverage typically prioritize the workload at their facility above the facilities they are servicing, as opposed to centrally managing all hospitals' workloads sequentially and by order prioritization when STAT orders are generated.
All of these challenges can be overcome, of course. Some can even occur with remote pharmacy service providers as well. When evaluating remote pharmacy models, here are some key questions to help determine the best model for your facility's needs:
- Is the remote pharmacy licensed - both facility and pharmacist - to provide remote pharmacy services in your state? State pharmacy regulations vary significantly and are continually changing. Some require remote pharmacy services be performed within the same state as the hospital. Some (such as Louisiana) do not permit remote pharmacy services at hospitals with more than 100 beds. Some states require both the remote facility and the pharmacist to be licensed, while others only require a non-resident, out-of- state license with a designated pharmacist in charge. There are many complexities to consider - but licensure compliance is the responsibility of the provider and the hospital receiving the remote pharmacy service.
- What are the remote pharmacy's service levels pertaining to order processing turn-around times, order clarifications, performing clinical interventions and immediate availability to nursing and the medical staff? For example, Cardinal Health's remote pharmacy service processes orders with an average turnaround time of 22 minutes; STAT orders response times average 10 minutes. Order processing times have a direct impact on patient care, and if delays are excessive, they can often result in a medication being dispensed and administered before a pharmacist reviews it.
- Does the remote provider have redundant connectivity from the remote pharmacy and, if so, what level of redundancy? Clinical care done remotely in real-time demands certainty of service. Inclement weather at a provider's facility shouldn't be your concern. You should have confidence that your remote provider has implemented redundancy in these areas to avoid service disruptions. These redundant systems also help ensure your remote pharmacy provider can step in and provide support to your facility, should 'the unexpected' impact the availability of your onsite pharmacy team.
- How does the remote provider ensure compliance with your hospital's policies and procedures?When a remote pharmacy handles more than one hospital, it needs to have the ability to comply with each hospital's unique procedures. That's why it's essential to understand how the remote pharmacy can handle these variations and measure its compliance to your specific policies and procedures.
- Can the remote pharmacy support multiple pharmacy systems? And how much experience does the remote pharmacy have with your specific pharmacy information system?
In a third and final post on this topic, I will discuss additional considerations - for example, remote service pricing models and the quality and assurance processes. I'll also provide a real-world example of how Geisinger-Lewistown Hospital, a 123-bed acute care community hospital in Pennsylvania, saved more than $200,000 in labor costs last year from implementing a remote pharmacy model.