Hospital administrators today are stressed. Challenges come from all operational, consumer and governmental directions. The needed success plan: Balance workflow efficiencies with quality of care.
New overall patient care performance guidelines demand accountable care, EHR meaningful use, ICD-10 code implementation, 340B involvement and extensive patient care coordination. The result: Budgets are impacted as never before. Distributing available funds to improve efficient technology use is now perhaps the highest priority. With expanded IT infrastructure to ensure HIPAA compliance using advanced in-house data analytics, including security and utility of eMobility use through BYOD (bring your own device), these are high dollar activities. These now-demanded areas of expense have caused in many locations staff reductions, when a higher level of patient care coordination effort by existing staff is necessary. Also impacted…CEO’s. CEO turnover hit an all -time high in 2013 (20%), the highest since the American College of Healthcare Executives (ACHE began monitoring the rate in 1981. Alaska had the highest adjusted CEO turnover rate at 37%, followed by Oklahoma with 33% and Arkansas with 30%. Vermont and Rhode Island, both with 0%, tied for lowest turnover.
Outpatient hospital pharmacies are just one area within a hospital structure where the extra demanded patient care coordination is most impacted. Unlike previous patient hospital discharge approaches, pharmacists today are being challenged to provide considerable valuable…and time consuming…patient exit discussions about the illness (multi-chronic in many cases), medications, therapy adherence and life style adjustments. In many of the most advanced hospital systems, pharmacists now serve as members of a healthcare team approach (pharmacist, physician, nurse, nutritionist) who have responsibility for completing regular follow-up with patients to ensure no necessary hospital re-admittance returns for the same challenge just treated. As most may or may not know, hospitals cannot re-bill insurance for patient services who return to the hospital within 30 days for re-treatment of the same illness/issues. This healthcare service impactor, as part of the P4P (pay for performance) construct has become a major budget influencer. Public data available indicates these return visits can cost hospital budgets $10-15K per event at a minimum…with no payment by insurance although hospitals have “must accept” patient guidelines. In many cases, as a further challenge to hospital budgets, uninsured patients are oft times not able to cover this cost resulting in hospital budget revenue loss.
How is it outpatient hospital pharmacies with automated pharmacy dispensing systems are now seen as a profit-center rather than a cost-center? Perhaps a surprising thought to many (other than hospital administrators and pharmacy directors) is that hospital operations with automated pharmacy dispensing systems see workflow efficiencies that create pharmacist time to do the necessary new patient care activities that ensure no patient hospital return for service with no hospital service reimbursement. How is it that hospital pharmacies with automated pharmacy dispensing systems are so valued by those hospital administrators with these systems in place? The literature is replete with the time and cost-saving value of in-house and outpatient hospital pharmacy automated pharmacy dispensing systems… so much so that many hospitals are now considering the addition of outpatient hospital retail pharmacies which can be revenue-producers…while increasing patient care coordination presence. This is an interesting evolution supporting hospital budget considerations demanded by new healthcare hospital performance requirements and hospital administrator response to required patient/consumer healthcare quality deliverance.
Are hospitals, with their reduced or re-directed budgets, really improving patient care, healthcare quality, hospital operations and efficiency? Actually, in many locales, consumers are now the primary healthcare use (hospital revenue producing) decision-makers in this challenging market for hospital service. Hospital administrators are continually looking for new techniques to evaluate their operational strengths, weaknesses, opportunities and challenges. Many area hospital administrators now regularly evaluate for impact on their budgets…due to consumer awareness and assessment before hospital entrance…for the following:
Quality physician care and “bedside manner”
Management infrastructure and technology commitment
Linkage (including eMobility) between in-hospital groups (specialties and nursing staff) with area physicians and pharmacists
Patient care coordination
Clinical care considerate and rational approaches
Patient “portals” for individual and extended family effective communication
Interprofessional healthcare team (physician, nurse, pharmacist, care-givers) employment
Recruitment and retention of qualified clinicians
Outpatient hospital pharmacy existence with automated dispensing use
And most certainly…adequate budget resources
In this age of expectation for immediate access to all available patient information by clinicians, hospital administrators, nursing staff and pharmacists, technology has become the conduit through which all happens…automated pharmacy dispensing and pharmacy software linkage included. With the availability online of hospital service and quality rankings (including hospital readmissions) through internet, social media and government sites – see www.medicare.gov/hospitalcompare and http://data.medicare.gov - consumers are now the emerging driving force behind hospital administration budget management.