Hospital and health system pharmacy leaders are tasked with overcoming complex challenges in today's increasingly dynamic reimbursement environment, including managing the skyrocketing costs of medications and mitigating the effects of drug shortages.
While there are many challenges — equipped with the right technology, information and personnel — pharmacy leaders can overcome these issues to improve efficiencies and help health systems meet their strategic initiatives.
During a March 27 webinar hosted by Becker's Hospital Review and sponsored by LogicStream Health, which developed The Drug Shortage App, four industry experts discussed the main challenges facing hospital pharmacies and offered tips to succeed under today's challenging conditions.
Panelists included:
- Seth Hartman, PharmD, director of pharmacy informatics at the University of Chicago Medicine
- Carina Dolan, PharmD, director for clinical oncology and pharmaceutical outcomes at Vizient
- Marvin Finnefrock, PharmD, divisional president of clinical purchasing services at Comprehensive Pharmacy Services
- Tara Pierce, RPh, vice president of strategic alliances and commercial drug information at Elsevier
Priorities + challenges for hospital pharmacies in 2019
To be successful in today's healthcare environment, health system pharmacies must prioritize efforts to address several issues simultaneously, the panelists explained.
Top-of-mind for many pharmacies is ensuring compliance of new regulations, including the hazardous materials chapter USP 800, explained Dr. Dolan and Dr. Finnefrock.
"Chapter 800 … will be implemented for the first time this year and it will require many changes across the entire institution. It begins with the receipt of a hazardous drug and ends with the disposal of that drug. It's not limited to only pharmacy, which makes it so cumbersome … It requires a clear containment strategy," Dr. Dolan said.
Dr. Finnefrock described pharmacies as being increasingly burdened by regulation. "You can't be a director of a pharmacy now without being an expert in regulation," he said.
In 2019, beyond ensuring compliance on regulations, University of Chicago Medicine is focusing on expanding its outpatient pharmacy strategy to support its inpatient services and successfully navigate the era of declining reimbursement, Dr. Hartman explained.
As reimbursement changes, health systems can focus on starting new revenue streams from the outpatient sector, to bring in additional dollars to support the more-limited inpatient side, Dr. Hartman explained.
The outpatient side is run on a fee-for-service basis, so health system pharmacies can use it to drive revenue for the inpatient side, which is no longer generating as much money.
"You can grow parts of the business so you can offset the cost of service lines on the inpatient side," Dr. Hartman explained. "We want to be able to compete with the Amazon's of the world that are buying up companies like PillPack … there are a lot of things we want to do to maximize that part of our business so we can grow our inpatient programs as well."
Another key challenge is managing expenditures, especially with the dramatic growth of drug costs, the rise of high-cost specialty pharmaceuticals and the growing incidence of complex, chronic diseases, explained Dr. Dolan and Dr. Pierce.
"In 2019, [specialty pharmaceuticals] are expected to comprise 50 percent of U.S. drug expenditures ... Pharmacy executives must manage medication expenditures while adhering to their formularies, minimizing drug shortages and focusing on team-based care," Dr. Pierce said.
The worsening drug shortage crisis
One of the top concerns for health systems is the drug shortage crisis, the panelists said.
"The drug shortage crisis results in an ongoing absence of a stable supply of essential and frequently critical lifesaving drugs … [and is] one of the critical demands placed on hospital leadership," Dr. Dolan said.
Shortages occur for a multitude of reasons, including manufacturing problems, product discontinuation, a spike in demand or even drug profitability. While many of these reasons are difficult to control, hospital pharmacy leaders have found several hacks to proactively manage the shortages. Below is a breakdown of five of the tips to mitigate shortages:
1. Go back to the basics. Before solving some of the more complex issues like drug shortages, ensure that the basics like time management, delegation of duties and good hiring practices are met, Dr. Finnefrock explained. "They all seem like simple things but … if some of these processes were better, it helps us do better on the bigger items that are really hitting [pharmacies] hard," he said.
2. Use innovative technologies. One example of a new technology is The Drug Shortage App from LogicStream Health™, which was developed to help hospital and health system pharmacies lessen the effects of drug shortages on patient care. The app helps tackle drug shortages by alerting providers to potential shortages and their impact on the hospital or health system, suggesting medication alternatives and helping providers determine if they should change EHR workflows to help control the demand of the drug.
3. Educate and inform legislators. To lessen the effects of drug shortages, providers should ensure they stay informed and support various regulations that will have positive effects for healthcare. "I think there's a role all of us can play in terms of educating our legislators … they could be partners and assist … [especially given] the attention and focus on managing drug costs," Dr. Pierce said.
4. Don't hoard products. Dr. Finnefrock, whose organization provides pharmacy management services to more than 700 hospitals and healthcare facilities, suggests that no matter what hospitals and health system pharmacies shouldn't hoard products or purchase them in abundance since it can worsen shortages. "I've walked into a pharmacy that has an overabundance of products in shortage … it's important to make sure we are good stewards of these products."
5. Be vigilant when working with key stakeholders. One of the best strategies hospital pharmacies can deploy to protect the system from feeling the effects of a drug shortage is vigilance when working with key stakeholders, Dr. Hartman explained. For example, University of Chicago Medicine has a committee that meets three times a week to mitigate drug shortages. On Monday the team reviews anything from the manufacturer that may be in short supply, on Wednesday the committee meets with clinician stakeholders to develop a plan for any potential shortages and on Friday the committee works to ensure that allocations are met. Hospital pharmacies should also work with their purchasers, Dr. Hartman explained. "It's a heavy lift and it takes a lot of work but it's giving us the opportunity to avoid being drastically affected by drug shortages … We have the ability to get the right people in the room to make the right decisions quickly and that's been a huge game changer for us."
Overall, pharmacy leaders have many issues to address to remain successful, including mitigating drug shortages. However, by accessing information, deploying technology and working with key stakeholders, hospital leaders can identify and proactively manage drug shortages.
To learn more about the challenges for hospital pharmacies and tips to overcome them, listen to the webinar here.
To learn more about LogicStream Health, click here.