A 2016 white paper assessing pharmacy market trends offered the following recommendation, “Hospitals should strongly consider investing in their own ambulatory (outpatient, retail) and specialty pharmacy infrastructure to meet the need for high-quality comprehensive pharmacy services in the outpatient setting.”
While the white paper detailed the ‘what’ and the ‘why’ behind this perspective, the ‘how’ wasn’t provided. And, there are a multitude of variables that must be factored into a decision of this magnitude.
Understanding the scope of the decision and size of the investment facing pharmacy leaders and CFOs considering this new patient offering, the Vizient Ambulatory Pharmacy Development (APD) Committee created a comprehensive toolkit outlining how to successfully plan, implement and maintain an in-house pharmacy.
Lisa Mascardo, PharmD, FASHP, director, ambulatory care pharmacy services at University of Iowa Health Care, chairs the APD Committee and said, “From a quality, safety and revenue standpoint, I think every health system should evaluate their opportunity to provide these services. The toolkit provides valuable insight, numerous checklists and key elements for consideration, such as determining the appropriate scope of pharmacy services for your facility as well as calculating project ROI.”
Improving transitions of care
According to research by Medscape, up to 30 percent of patient prescriptions are never filled. The patient may not be able to get to a pharmacy to pick up their prescription or they may not be able to afford the prescription. These reasons directly increase the patient’s risk for readmission and can be mitigated by offering dispensing pharmacy services.
“Many hospitals have medication assistance centers that will go out and look for copay assistance for patients so that they can afford their medications. Additionally they often work directly with social services that have funds that can help patients pay for medications. Those support services, combined with the ability to fill the prescription at the hospital, helps make sure that that transition of care is as smooth as possible for the patient,” said Mascardo.
An in-house pharmacy can also provide patient convenience. The hospital could create a ‘meds-to-beds’ service where medications are actually delivered to the bedside before the patient goes home. This service eliminates the potential for a necessary prescription going unfilled.
Other important benefits within transitions of care relate to patient safety. “Pharmacists associated with the hospital can access treatment and prescribing details in the patient’s electronic health record. This greatly increases the ability to catch potential prescribing errors. Additionally, the bidirectional interface between the health system’s electronic medical record and the in-house dispensing pharmacy enables last-minute changes to prescriptions at discharge to be immediately communicated so patients get the appropriate medications” said Mascardo.
Ask yourself these questions
While member organizations’ reasons for establishing or expanding their pharmacy services vary, the decision to move forward should be grounded in supporting the goals of the organization. Are there performance goals related to care transitions for the patients? Are they focusing on improving in the patient safety areas? Is there a need to identify new revenue sources?
If an outpatient or retail pharmacy aligns with the organization’s goals, resources will need to be considered. Opening an in-house pharmacy will require additional staff and possible build-out of additional space, which typically represents a significant capital expense. When considering the system’s resources, is this where they want to invest?
“Another critical element in the equation is having an understanding of the primary payers in the marketplace. Hospitals want to maintain a viable financial mix while still serving the needs of the patients in their communities,” said Mascardo.
As hospitals continue to improve the transition of care, in-house pharmacies are leading the way as a viable option. Addressing all the variables necessary to successfully establishing or expanding pharmacy services can be a challenge, but the practical information provided in this toolkit helps ensure a smoother path.