Question

Ever Increasing Hospital Pharmacy Costs

Each year, hospital executives are faced with the same daunting task of finding ways to tighten the budget belt one more notch. It's a sign of the times against looming — and in some cases significant — reimbursement cuts from Medicare and a regulatory backdrop demanding more for less.

Historically, the pharmacy department represents one of a hospital's highest cost centers. Keeping pace with rising drug costs and staffing needs account for the majority of the pharmacy budget and are the main drivers of annual requests for increases. However, while the clinical side of the house focuses on gaining access to medical advances and newer, more effective drug treatments, the finance department is focused on, at best, maintaining the status quo in terms of pharmacy spending.

It's a double-edged sword. New regulations and quality expectations are requiring that pharmacies allocate more resources to ensure that appropriate initiatives are in place that promote the highest level of patient care and safety. At the same time, the pharmacy represents a prime area of focus for improving cost efficiencies and benchmarks for appropriate reimbursement.

Going forward, hospital pharmacies will have to improve operational practices to ensure staff time is used for the most optimal tasks. What would you suggest as some options/solutions? Answer should be 3 pages long .

Answer 1

Maintain Open Communication with Collaborators

Identifying a practice champion who is enthusiastic about developing an innovative partnership using HIT can help to push the new service forward. The effectiveness of the collaboration can be increased if the champion is willing to continually look for quality improvement opportunities and is able to motivate colleagues to adopt the new model. The ability to effectively communicate with staff at the physician's office and community pharmacy, as well as with patients who may be affected by the changes, is a necessity. The practice champion should feel empowered to take a leadership role during the development and implementation of the new model that meets the needs of both the physician's office and the pharmacy.

In addition to working with a practice champion, it is important to identify a workgroup of physicians, pharmacists, and support staff willing to candidly discuss progress and opportunities for improvement. The workgroup should also share key findings with their colleagues, such as at provider or staff meetings. For example, as the partnership progresses, it is important to review whether the types of communication (e.g., length and style of notes) and the method of communication for urgent (e.g., telephone call) and nonurgent (e.g., EHR notes) questions or concerns are working for each healthcare professional. All individuals should be encouraged to provide feedback to the workgroup to continually improve the collaborative efforts between the physician's office and the community pharmacy.

Determine Goals of the New Practice Model

Before the service was implemented, it was necessary to conduct a needs assessment at both the physician's office and the pharmacy. Practices interested in implementing a new collaborative service may find it helpful to ask for input from clinicians, pharmacists, and support staff, such as through a staff meeting or a short survey. In some cases, an office manager or triage nurse may have excellent input for enhancing efficiency in communication with pharmacists. External goals that focus on providing appropriate services, such as Healthcare Effectiveness Data and Information Set (HEDIS) measures, should be considered as the partnership is being developed. For example, community pharmacists may be able to influence HEDIS measures related to high-risk medications in the elderly; pharmacologic management of chronic conditions, such as asthma, chronic obstructive pulmonary disease, diabetes, and hypertension; immunization rates; and adherence to medications.

The development of goals for both partners that are specific, measurable, attainable, realistic, and timely (SMART) will help to guide the next steps in the collaboration and provide a benchmark for evaluating the success of the service.22 Short-, medium-, and long-term goals should be set. For example, a short-term goal may be to work with the individuals who have experience in HIT from both practices to identify how information will be shared. A medium-term goal might be for the pharmacy to use the EHR to help answer medication-related questions and, when necessary, to communicate more efficiently with the physician's office. A long-term goal could be to expand the partnership to include additional services that align with HEDIS measures, particularly because a significant number of measures include pharmacologic management. An alternative long-term goal would be to integrate the EHR into the medication dispensing system to increase efficiency further at the community pharmacy.

Establish Appropriate HIT Access

Initially, pharmacists were provided read-only access to the EHR. This access allowed the pharmacists to obtain additional information about patient care plans; however, it did not allow for bidirectional communication with the rest of the healthcare team. As a result, pharmacists faxed notes to the physician's office, which then had to be scanned into the EHR by a staff member. This process could take several days, creating a gap between when the pharmacists interacted with the patient and when the provider saw the note. Additionally, it created additional work for the staff at the physician's office. After several months of using this process, pharmacists were granted read/write access in the EHR, which allowed the pharmacists to directly document each patient encounter and route the note to the provider. From an information security standpoint, pharmacies must already achieve a high level of compliance with security based on patient privacy laws. The computer that was used to access the EHR was kept in a locked facility and could be viewed only by pharmacy personnel with appropriate privacy training.