Transcript File

Subrata Behera
Chris Beuning
Jim Grubel
Steve McDonald
Medical Informatics: Health Care Operations 404
August 10, 2011
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Rural Midwestern town
Population 50,000
Licensed for 250 beds but operations 150
Not for profit
Medical staff of more than 50 active physicians
Specialties include orthopedic surgery,
gastroenterology, gynecology, urology,
ophthalmology, general surgery, podiatry,
nephrology, otolaryngology and general
medicine
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30% Medicare
20% Medicaid
40% Commercial
10% Self pay (uninsured)
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$1.5 M deficit fiscal year 2009
Near $2.5 M deficit in year 2010
Reduction in Federal grants spending which
reduces recovered money and strains cost for
facilities and administration
Uncompensated care hurts profit margin
Performance Management team created
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A pharmacy is an essential component in the
operations of the healthcare organization. The
pharmacies of today are being challenged by
the changes in the structure and financing of
the healthcare industry in order to reduce costs
and improve performance. It is getting tougher
on the part of the healthcare organization to
maintain a fully fledged pharmacy and many
of them are using pharmacy outsourcing in one
way or the other.
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It is easy to consolidate pharmacy services in large
integrated health systems.
• Helps reducing the operational issues by improving the
medication distribution system, designing new pharmacy
workspaces, reducing medication dispensing and
administration errors and improving information systems
• Enable the organization to acquire additional resources
and expertise to carry out other changes
• Provide educational programs for patients and their
families and for health care staff
• Help the organization to staff hard-to-fill pharmacy
positions
• Allow the organization to reach optimal staffing levels for
achieving productivity targets
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Helps in reducing the operational cost for the organization.
• Control and reduce labor rated costs by shifting the cost of
employees, benefits, and liabilities to a contractor.
• Enable the healthcare organization to share the risks associated
with the operation of the pharmaceutical services.
• Avoid the cost of purchasing and maintaining costly pharmacy
equipment. It will help the healthcare organization focus on
activities that is more critical than operation of the pharmacy.
• Avoid the cost of physical remodeling of the office space and
the cost associated.
• Increase the organization’s financial operating margin by
allowing the organization to purchase drugs in bulk quantities,
use group purchasing contracts, decrease lost charges, improve
billing accuracy, decrease drug diversion and pilferage, improve
drug formularies, and transfer drug inventory, equipment, and
supply activities to a contractor.
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• Enable the organization to maintain or improve the quality of
patient care by expanding clinical services and pharmaceutical
care, establishing new services, and obtaining specialized
expertise in pharmaceutical care.
• Provide support for the medical and nursing staffs and improve
physician–nursing–pharmacy collaboration.
• Correct regulatory and accreditation problems relating to
pharmaceutical services
• Ensure continuing compliance with accreditation and
certification standards
• Allow the organization to gain an edge on competitors through
improvements in service, quality, or price.
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All Pharmacy Services
Pharmacy Third Shift
Pharmacy Management
Pharmacy Medication Procurement &
Inventory Management
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Current State
Personnel
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Responsibilities
Order Management
Sterile Products
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Inventory Management
Drug Locations
Number of Turns
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N.P.M. Proposal
Personnel
Become N.P.M Employees
Impact on Salaries
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N.P.M. Proposal, continued
No New Equipment Needed
Cost Savings
Inventory Management
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Current State
Staffing
Responsibilities
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N.P.M. Proposal
Shift Coverage
Cost Benefits
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N.P.M. Proposal, continued
Medication
Required Equipment
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Maintain current management positions
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New team to fill those positions
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Utilize N.P.M. personnel to fill these positions
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Cost Savings Initiatives
Utilize Lean methodology
Previously Identified Opportunities
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Switch to generic anti-emetics
Implement IV to PO conversion
Implement shorter acting erythropoietic agent
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Cost Savings Initiatives – Additional
Opportunities
Formulary limitation by more aggressive therapeutic
interchange process
 Antibiotic Stewardship
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 Minimize adverse events
 Optimize antimicrobial agents
 De-escalate antibiotic to oral therapy when appropriate
 Discontinue therapy when complete
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Cost Savings Initiatives
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N.P.M. Management team reporting
 Community Hospital Board of Directors
 N.P.M. Management and administration to track
progress and offer resources and guidance
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Potential areas of benefit
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Enrolling in 340b pricing program
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Inventory management – just in time
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340b Pricing Program
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Determine if any subset of Community Hospital
patients meet criteria for 340b pricing
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Tracking required
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Rigorous record keeping
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Inventory Management
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Lower inventory levels
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Increase number of inventory turns
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Establishment of minimum and maximum levels
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Technology options
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Automated system for inventory tracking (i.e.,
Talyst)
 Real time inventory tracking
 Refill of automated dispensing cabinets (i.e., Pyxis)
 Electronic purchase request submitted to vendor
 Fill floor stock medication requests
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Sterile compounded product outsourcing
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N.P.M. Compounding facility
 Labor and time intensive to prepare on site
 N.P.M. facility meets criteria to allow longer dating
than on site
 Reduced wastage
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Parenteral nutrition orders (TPN)
 Automated download from pharmacy system
 Remote preparation and deliver
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Technology options – implications
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Free up technician time with automated functions
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Technicians could be deployed to some of the
current, non-clinical pharmacists functions
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Pharmacist time could be moved to focus on cost
savings initiatives
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Point of care antibiotic assembly
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Antibiotic vial-bag-pin assembly
Lest wastage
N.P.M. Support
Expert support personnel for training and trouble
shooting
 Established policies and procedures for validation
and adoption
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The Pharmacy Review Group has brought
forth a recommendation for a combination of
two outsourcing options as a recommendation
for major cost savings initiatives. The proposal
includes a combination of outsourcing
pharmacy management and pharmacy
medication procurement and inventory
management.
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Demand
Present Economy
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Cost
Salaries
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Human Resources
Reorganization
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Output and Productivity
More Inventory Turns
Staff Engagement
Sterile Products
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Quality Outcomes
Clinical Initiatives
Formulary Review
Med Accessibility
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Processing Quality
Patient Satisfaction
Physician Satisfaction
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Community Hospital Mission – provide quality
patient care and patient satisfaction while
delivering exceptional medical care
Any solution must support this mission
Each of the solutions presented will be
measured against this mission
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A Health Care Organization becomes a part of
the community it serves
Challenges faced by the HCO impact or reflect
on the community
Community Involvement on the Board of
Directors is important
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Financial instability can impact the
organization’s competitive position
This needs to be considered with any changes
implemented
Rural setting limits competition
Viability still at risk