Hospitals are complex health care institutions. Patients wandering around the halls and floors of a typical hospital can feel a bit overwhelmed. Even hospital employees are sometimes confused and perplexed by the numerous departments and business units that exist within the walls of a single hospital. You have an OR and an ED. You have an ICU and a PACU. You have many different professions and departments operating simultaneously and often caring for the very same patient. With all that complexity, one might think the LAST thing you need is to add 1 more medical service to a hospital. But if that 1 more medical service is an outpatient pharmacy, you would be wrong.
Hospitals need outpatient pharmacy services. If you are a Director of Pharmacy, or a member of the hospital C-suite, you should seriously consider the importance of quickly making room for an outpatient pharmacy within your institution.
Here is why:
1) Readmissions. Patients being discharged from the hospital are often still at a very fragile stage of their recovery and at risk for readmission. One very significant reason for hospital readmissions is a failure with respect to obtaining and properly taking their discharge medications. Studies confirm this. Upwards of 20% of hospitalized Medicare patients are readmitted within 30 days, and more than half of these could be avoided.
Think about it. A patient is discharged with the expectation that they will continue with their prescribed antibiotic for another 10 days. The patient goes home, and simply due to the challenge of getting some help, does not attempt to get the prescription filled until the next day. They miss a critical dose or two. Then, when they do try to fill it, they could run into any number of problems: the pharmacy is out of stock, the insurance doesn’t cover it, the patient can’t afford it, transportation issues exist, etc.
Before long, their transition to home fails, their condition worsens, and they are back in the hospital.
These readmissions are not only detrimental to the patient, but financially devastating to the hospital through readmission penalties imposed by Medicare. As many as half of all US hospitals are facing these penalties.
2) Patient satisfaction. Hospitals understand that patient satisfaction is extremely important to their success. One very obvious way to help improve patient satisfaction is to help patients by having all their medications prepared and ready for them at the point of discharge. Having to leave the hospital and go to their pharmacy is just one more difficulty being imposed on them at a time when they probably already have enough challenges. Just getting home and starting the recovery process is hard enough. Also, since the hospital pharmacy is likely to be the last stop in their stay, it offers the opportunity to create a really great last impression.
3) Revenue. Today especially, the issue of revenue cannot be overlooked. Hospitals, like many other health care businesses, are struggling financially. An effectively managed and efficiently operated outpatient pharmacy can be a source of significant revenue for the hospital. Buying groups and 340B contract pricing helps hospital outpatient pharmacies leverage their purchasing power to generate stronger margin performance. Not offering an outpatient pharmacy is simply allowing hundreds of millions of dollars in revenue to literally walk out the door and into the pockets of competitors. It makes no sense. It would be the equivalent of a nice restaurant that refuses to offer dessert. And with the costs associated with many of the newest medications continuing to rise, the revenue potential continues to rise with it.
4) Cost avoidance. Hospital employees need to fill their prescriptions somewhere. For self-insured hospitals, they are exposed to much greater costs when employees choose to fill their prescriptions at a non-hospital operated pharmacy. By strategically developing a plan design to protect employees from rising copays by utilizing their own outpatient pharmacy, the hospital can accumulate significant savings in their drug spend. These savings can be appreciated by the Human Resource department as the total spend for employee medications will be reduced and controlled more effectively from the on-site pharmacy.
And while cost avoidance may help improve the bottom line, the pharmacy can also be a source of convenience and savings for many hospital employees who appreciate being able to get their medications and go straight home after work.
5) Collaboration. There is an enormous value to having the resources of an outpatient pharmacy at the disposal of the medical staff and personnel of the hospital. Opportunities for collaboration on a variety of initiatives to help patients can be explored once a hospital begins to operate an integrated and effectively managed outpatient pharmacy. The pharmacy can collaborate with discharge planning personnel, nurses and nurse managers, physical therapy, department leads, physicians and hospitalists, etc. I have seen great opportunities open up in collaboration around wound therapy, orthopedic supplies, specialty pharmacy and admission planning. Our outpatient pharmacies get numerous calls throughout the day for advice and suggestions that are related more toward outpatient medications than inpatient meds. Having the outpatient pharmacy as a resource is tremendously useful.
Yes, an improperly run and poorly managed outpatient pharmacy may lead to disappointment and frustration for hospitals who attempt this without sufficient experience to make it work. However, the right plan and the right people can make operating an outpatient pharmacy the smartest addition to your hospital in years.
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