A change in perception
Mark L. Eastham, B.S., R.Ph, Sr. Vice President and GM of McKesson Pharmacy Optimization®
The role of the clinical pharmacist is rapidly expanding to stay ahead of the changing dynamics brought by health reform. At the heart of this is a change in perception.
Hospital leaders are recognizing the critical need for pharmacy to play a prominent role in their overall strategies to expand care and improve outcomes in today’s challenging reimbursement environment.
In the past, pharmacy cost and charges were focused primarily on drug spend and not total costs, which includes drugs plus vital distribution and clinical services. However, as the clinical aspect of pharmacy continues to expand, there is far more accountability for medication therapy and improved outcomes. Pharmacists are positioned now more than ever to impact revenue by improving quality rather than constantly seeking to simply decrease cost.
Forward-thinking hospital leaders are recognizing the critical role of pharmacy in three core financial areas:
- Indigent care and recurring emergency room (ER) visits
- Hospital Performance Scores
Beginning in fiscal year 2014, hospital performance scores will be based on three domains, two of which have significant pharmaceutical implications.
- Clinical process of care. This domain score accounts for 45% of a hospital’s total performance score and is based on 13 measures, 9 of which have pharmaceutical implications.
- Patient experience of care. This domain score accounts for 30% of a hospital’s total performance score and is based on eight Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) measures. Of these, four measures have pharmaceutical implications.
- Outcomes. This domain score accounts for 25% of a hospital’s total performance score and is based on three mortality measures.
Medication issues are a major factor in preventable readmissions.
- Unfilled prescriptions. Discharged patients often do not get their prescriptions filled. One study found that discharge medications are often absent from discharge reports.
- Patient understanding. In citing five reasons for unnecessary readmissions, a Dartmouth Atlas publication stated that “patients may be confused about what medicines they should take and when they should take them, and they may not take the right medication at the right time.”
- Lack of medication reconciliation. Data from the Health Research and Educational Trust regarding readmission showed that poor patient understanding and non-disclosure of current drug therapy, and/or inadequate medication reconciliation, can yield drug therapy duplication or interaction.
- Adverse events. Research shows that 19% of Medicare discharges are followed by an adverse event within 30 days; two-thirds of these are drug events, which are often preventable.
Regardless of the sweeping changes brought by reform, managing an uninsured population is still an issue for hospital consideration. Pharmaceutical manufacturers offer patient assistance programs for those unable to afford their medications. These enable organizations to stretch scarce resources as far as possible when providing charity care, reaching more eligible patients and providing more comprehensive services.
The addition of indigent medication management in clinic settings also helps to stem the tide of potentially avoidable ER visits. Not only does the convenience and availability of clinics offer uninsured patients an alternative to the ER; they can also afford the opportunity for better adherence to medications.
As hospital and pharmacy leaders work together on healthcare transformation for their organization, careful planning is advisable. A recommended course of action is for pharmacists to be an integral part of a care team.
 Medicare Hospital Readmissions: Issues, Policy Options and PPACA, Congressional Research Service Report for Congress, September 21, 2010, http://assets.opencrs.com/rpts/R40972_20100921.pdf
 Care About Your Care: Tips for Patients When They Leave the Hospital, The Dartmouth Atlas Project, 2011, http://www.dartmouthatlas.org/downloads/reports/Atlas_CAYC_092811.pdf
 “Reducing Avoidable Hospital Readmissions,” Health Research and Educational Trust presentation at the June 4, 2010 Florida Hospital Association Meeting; presentation posted on AHRQ website at