Hospital Pharmacists Pitch In to Improve Care While Keeping Costs Down

Pharmacy departments facilitate transition of care

As rising drug prices intensify cost pressures, hospital pharmacies are striving to improve care and expand services without breaking the bank, according to an article in Hospitals & Health Networks. For example, the current interest in ensuring care continuity has prompted many hospitals to involve pharmacists in patients’ transitions out of the hospital.

At Lifespan, a Rhode Island health system, pharmacists visit patients at risk of readmission while they’re in the hospital. They go over medications with them and describe how the drugs work in the body, Christine Berard-Collins, director of pharmacy, told H&HN. The pharmacists ask patients to repeat what they’ve heard to make sure they understand their medications before they leave the hospital.

A clinical pharmacist oversees the transitions-of-care program offered at Lifespan’s Rhode Island Hospital and The Miriam Hospital. Three pharmacists handle the patient visits. After discharge, case-management nurses call patients to follow up on a number of issues, including medications.

Comprehensive Pharmacy Services, which serves more than 550 hospitals and health care facilities, launched a transitions-of-care program in 2014. Under RxTransitions, pharmacists conduct patient discharge teaching as well as admission and discharge reconciliation. They follow up with patients 24 and 48 hours after they’ve been discharged from the hospital to talk through their medications and to answer any questions.

Interest in maintaining continuity of care into the outpatient setting also is prompting an increasing number of hospitals to create their own retail pharmacies. Access to patients’ electronic health records means that hospital retail pharmacists can check physicians’ notes, what drugs a patient was on in the hospital, lab values, and the last time a patient visited a hospital clinic. Hospital-owned retail pharmacies also allow hospitals to capture revenue that otherwise would be lost to pharmacy chains.

Lifespan hired a consultant to conduct a business analysis before entering into the retail pharmacy business. Retail pharmacy has many fixed costs, including space, phones, computers, pharmacists, and technicians, so the organization had to determine the baseline number of discharges and specialty services necessary to cover those expenses. The business analysis showed that the threshold was achievable at Lifespan’s two largest hospitals. The organization opened its first retail pharmacy in May 2013 at Rhode Island Hospital and its second in October 2014 at the Miriam Hospital.

Lifespan was able to open its pharmacies with existing pharmacists, many of whom had previous retail experience. Each facility has a pharmacist in charge who works only in that location, but other pharmacists alternate between retail and inpatient pharmacy.

The explosion of specialty drugs is prompting some hospital systems to create their own specialty pharmacies. In 2013, Lifespan launched a specialty drug service at its Rhode Island Hospital retail pharmacy after concluding that it made no sense for the organization to hand off those patients to outside pharmacies.

Lifespan’s retail pharmacy enterprise, including the specialty drug service, is nonprofit. Any revenue gained goes back into the system to pay for new programs.

A number of major trends, from rising drug prices to value-based payment, will affect hospital pharmacy departments in the coming years. These trends include the following:

  • Pharmacy departments can help their organizations to succeed by standardizing processes, implementing best practices that improve patient health, managing the formulary properly, and applying business acumen throughout the medication-use process.
  • Because of growth in the use of expensive specialty drugs, health systems should conduct an assessment to determine the best approach to these medications. Options include creating a hospital-owned specialty pharmacy service, establishing such a service with a business partner, completely outsourcing the service, or not providing a specialty drug service while ensuring safe and appropriate care of patients on specialty drugs.
  • The push for quality improvement and payment for value will extend into pharmacy departments. They should design and implement medication therapy-related quality measures and performance metrics that focus on enhancing quality, efficiency, and cost management.
  • The consolidation of generic drug manufacturers is posing challenges. The switch from multisource to single-source generics will lead to at least a 25% increase in health system expenditures for generics by 2020.
  • In the face of pressure to deal with the continual escalation of drug prices, a pharmacy should ensure that the driving force behind its work is patients’ best interests complemented by compliance with evidence-based medication use and waste minimization.

Source: H&HN; March 10, 2016.