May 2, 2019 – Health systems are juggling a myriad of pharmacy-related challenges in 2019. Compliance with new regulations, declining reimbursement rates, rising medication costs and drug shortages are some of the many challenges that are top of mind. Now the real question is, how do they overcome them?
LogicStream Health and Becker’s Hospital Review convened a panel of experts for a widely attended webinar – WHAT’S TRENDING IN HOSPITAL PHARMACY – in March. I've gathered my thoughts and perspectives on some of the most interesting insights shared by the panel below. You can also listen to the webinar to hear the entire discussion.
Growth in the face of declining reimbursements
I was intrigued with how pharmacies are creatively balancing revenue streams to fund targeted growth. In the era of declining reimbursements, hospitals still need to put resources into expanding practices like antimicrobial stewardship and opioid stewardship. For example, health systems are achieving this balance by looking at ways to expand ambulatory services. This could bring in additional fee-for-service funding to help support inpatient services for which reimbursements are declining.
Challenges facing pharmacy leadership
Panelists agreed that management of prescription drug costs is the biggest challenge facing pharmacy leaders. With drug prices continuing to rise, so too is the need to care for a growing volume of patients. Many of these patients also have multiple, chronic diseases requiring complex medication regimens.
The panelists shared concerns about the rising impact of high-cost specialty pharmaceuticals. They consume an increasing amount of U.S. drug expenditures and are predicted to reach 50% of medication spending in 2019. Pharmacy executives must manage these medication expenditures while adhering to their formulary, minimizing the impact of drug shortages and focusing on team-based care. That’s no easy task. One panelist commented on how useful it would be to align the cost of pharmaceuticals with patient outcomes.
Factors driving drug shortages
Drug shortages are another major challenge, resulting in the absence of a critical supply of life-saving medications. The panelists discussed drivers of drug shortages, including manufacturing problems, intermittent lack of raw materials, industry consolidation, recalls, regulatory enforcement, product discontinuations and natural disasters. Spikes in demand caused by changes in therapeutic guidelines, new indications and rapid disease progression also drive spikes in drug utilization that can lead to shortages.
Panelists agreed that the way people respond to shortages often exacerbates the situation. Sometimes hospitals stockpile when they receive early notification of shortages but have no insight into their own usage or inventories. This results in unneeded overstock while others are running out. Early detection in addition to an understanding of their individual medication usage and the likely impact of the shortage would improve prioritization and efficiencies in the pharmacy. With no overview of available inventory at a national level or mechanism to share medication resources, individual health systems are left to manage on their own.
Effective drug shortage management strategies
Strategies for dealing with drug shortages range from longer-term approaches. Longer-term strategies include support for increased competition, expansion of manufacturing capabilities and legislative action. More immediate solutions could include coping via improved communication and vigilance. However, that vigilance requires a great deal of time and effort as hospital systems examine processes, monitor inventory and identify alternatives.
One hospital pharmacy leader described cross-functional meetings held three times a week to share information on both the demand and purchasing sides of a drug shortage. Panelists agreed that technology solutions for gathering data, tracking changes and disseminating information are a huge help so people can make the right decisions quickly.
One such solution to help mitigate the impact of shortages and manage them more efficiently when they can’t be avoided is The Drug Shortage App from LogicStream Health™. This software helps hospitals better manage drug shortages and minimize disruptions to patient care by providing early warning about potential shortages that matter to a specific health system. The Drug Shortage App provides hospital pharmacy teams visibility into ordering, prescribing and dispensing practices so they can take control of medications in short supply. You can learn more about what this solution can do to help your organization by downloading a free overview of The Drug Shortage App.
Technology innovations to change the status quo
Other innovations the panelists mentioned include robotics, smart medications, cell phone apps and artificial intelligence. Robotics can free staff time while improving the speed and accuracy of care delivery. Smart medications, or “digi-ceuticals”, can track when medications are consumed. Cell phone applications are available for use in tele-pharmacy support to patients. Artificial intelligence (AI) tools can examine big sets of data looking for correlations or causality. Nontraditional entrants into healthcare also are likely to bring new approaches to consumer health diagnostics in the home and other virtual care settings.
It’s a challenging and exciting time for those of us working in or with health system pharmacies. I hope I’ve piqued your interest in hearing directly from the panelists about what’s trending in hospital pharmacy in 2019. Be sure to listen to the webinar for the full discussion.
Brita Hansen, M.D., is Chief Medical Officer of LogicStream Health. She began her career as an internal medicine hospitalist physician after receiving her undergraduate degree at NYU and her Doctorate of Medicine from the University of Minnesota School of Medicine. She served as Chief Health Information Officer for the Hennepin County Medical Center before joining LogicStream Health.