In a new environment stacked with seemingly competing goals, hospital leaders are facing more pressure to simultaneously cut costs, expand services and lead new clinical initiatives.
This pressure is forcing hospital administrators to find ways to do more with less, including reducing labor costs from budgets — one of their top expenses.
While this situation affects many departments across the hospital, it is especially challenging for the pharmacy, as pharmacists continue to assume a greater role in hospitals' strategic initiatives and take on more responsibilities, such as computerized physician order entry [CPOE] implementations, patient discharge counseling, medication reconciliation and facilitating transitions of care programs, explained Kelly Morrison, director of remote and retail pharmacy services for Dublin, Ohio-based Cardinal Health.
Ms. Morrison spoke with Becker's Hospital Review about the changing role of hospital pharmacy and how leveraging a remote pharmacy model can help hospitals manage labor costs to satisfy competing goals.
Note: Responses have been lightly edited for length and clarity.
Question: What healthcare trends are driving hospital and health system pharmacists and executives to consider remote pharmacy models?
Kelly Morrison: The most relevant trend driving pharmacy leaders and executives to consider remote pharmacy services is reimbursement reform, and related financial pressures which are forcing many hospitals to reduce budgets while trying to expand services. For the pharmacy, the top expenses are drugs and labor. Until recent years, hospitals focused primarily on reducing drug-related expenses. However, many pharmacies are now forced to look beyond drug budgets and focus on labor expenses as well. As a result, the pharmacy is challenged to expand services amid budget reductions and labor constraints. Leveraging remote models can often be a solution to enable expanding pharmacy services under these constraints.
Q: How do remote pharmacy models help optimize staffing resources and control labor costs?
KM: One example is overall productivity. Remote pharmacists are often more productive than on-site pharmacy staff due to lack of interruptions and distractions that the on-site pharmacy team experiences as they work directly with patients and providers. In a remote environment, pharmacists can focus strictly on medication order reviews and processing. As a result, by supplementing your on-site team with remote teams, you're managing labor expenses [realizing cost savings], while increasing the pharmacy services provided.
Another example is the impact of healthcare consolidation. Larger hospitals are acquiring smaller, rural facilities because the smaller hospitals can't provide services on their own in this new, challenging healthcare environment. With that said, it is often difficult to recruit and retain pharmacy talent in some of those rural areas. As a result, labor rates are often much higher in rural areas than in urban areas. Because the remote pharmacist does not have to be located in rural areas, those salary implications don't apply and that helps hospitals extend services to its rural facilities at a cost savings.
Q: What is the biggest misconception of remote pharmacy models?
KM: The biggest misconception, particularly with large, academic medical institutions, is that remote pharmacists are "generalists," meaning that they don't have the experience or expertise to handle the unique needs of academic medical centers. Because of this misconception, some hospitals initially limit the type and scope of medication orders that the remote pharmacy team processes. However, many remote pharmacists have prior experience as pharmacy leaders for large, academic health centers. Once these larger facilities experience first-hand how a remote model can provide clinical expertise, they expand the remote team’s responsibilities to include medication orders from critical care, with complicated dosing and clinical interventions. After spending time with us, they see that remote teams can handle complex cases just as seamlessly as on-site teams.
Q: Is it possible to leverage a remote pharmacy despite having a fully staffed in-house pharmacy?
KM: Absolutely. One example is the need to support computerized physician order entry (CPOE), which many hospitals are increasingly adopting. What hospitals don't realize is that, after they implement CPOE, the order volume for pharmacy increases on average by 30 percent. This increase is due to two reasons: first, pharmacies must take on processing orders for other parts of the hospital they did not prior to CPOE, such as the emergency room and procedural units and second, PRN, sliding scale and range orders can create more steps for the pharmacists. Once that order volume increases, the pharmacy department often realizes it doesn't have enough staff.
Another reason for a hospital to leverage a remote pharmacy team, despite having a 24/7, fully staffed pharmacy, is because the pharmacy is being asked to lead more strategic initiatives than ever before. For example, hospital executives are asking how pharmacy can help reduce readmission rates. Medication adherence is the single-most effective method for reducing unnecessary 30-day readmissions – and pharmacist-led medication discharge counseling is proven effective at increasing adherence. To effectively manage discharge counseling, the pharmacy must find ways to free up on-site pharmacists to enable face-to-face interaction with patients.
Finally, many hospitals are looking to open on-site outpatient retail pharmacies or provide pharmacy services to affiliated clinics in the community. As they look into these additional services and as pharmacy leads more initiatives, hospitals must provide adequate pharmacist labor. Leveraging remote models can help provide additional services and fulfill these labor requirements at a much lower cost.
Q: How are hospitals keeping up with technology and innovative solutions?
KM: Honestly, they are struggling to do so. Recently, two large systems reported huge declines in operating income after implementing CPOE or a new electronic health record system. It is a great example of hospitals trying to implement technologies to seek greater reimbursement dollars.
Unfortunately, as hospitals implement these new technologies, they often overlook the need to prepare and properly staff their facilities for the changes. There's no way to add these additional services or implement these new technologies without adjusting labor and staffing. By bringing on a remote pharmacist(s), they can increase on-site staff productivity, which reduces expenses and, in some cases, that remote pharmacist can also provide coverage across multiple, affiliated hospitals.
Many health systems increasingly try to establish an in-house remote service for affiliated hospitals. These systems often try to leverage one of their larger hospitals that has a 24/7 pharmacy and have that team provide services to smaller member hospitals. However, often the larger hospital misinterprets and underestimates the amount of labor needed to effectively implement this service expansion to its smaller, affiliated sites.