Financial pressures from healthcare reform drive change in hospital pharmacy

ASHP's “Pharmacy Forecast 2014-2018,” presented during the Midyear Clinical 2013 Meeting and available at the ASHP website, revealed that health-system pharmacists will be greatly impacted by healthcare reform and particularly by the Accountable Care Act.

Financial pressures, expanded clinical responsibilities, and an advanced pharmacy practice model that puts greater emphasis on ambulatory care are some of the trends to consider over the next five years.

This five-year forecast is based on a survey of 164 pharmacy experts, nominated by leaders of five ASHP sections, who were queried about fiscal issues, healthcare analytics, quality of care, pharmacy practice models, ambulatory care, the pharmaceutical marketplace, pharmacy department operations, and leadership. The survey completion rate was 91%, said William Zellmer, BS Pharm, MPH, the project director of the forecast, which is an initiative of the ASHP Foundation's Center for Health-System Pharmacy Leadership.

Eleven pharmacy experts interpreted the survey results and reported their recommendations for pharmacy practice leaders.

Fiscal issues

The majority of those surveyed (90%) agreed that by 2018, at least half of hospital revenue would come from payment systems that incentivize high-quality care, such as pay-for-performance. In addition, 86% agreed that 50% of hospitals will have agreements with payors for bundled payments encompassing short-term acute care, physician services, and long-term post-acute care for at least one medical condition.

"Pharmacists need to participate in programs that tie fixed reimbursement to high-quality outcomes, particularly outside the acute-care environment," said Lee C. Vermeulen, BS Pharm, MS, FCCP, director of the Center for Clinical Knowledge Management, UW Health, and clinical professor, University of Wisconsin-Madison School of Pharmacy, Madison, Wis.

Vermeulen believes that the fee-for-service reimbursement model will no longer be viable and that provider organizations may choose to pursue an accountable care organization (ACO) model, bundled payment offerings, or a combination of both.

"Learning to live with lower reimbursement rates will position those organizations well for the future, when most care is not reimbursed in a piecemeal fashion," Vermeulen noted in the forecast report.

Healthcare analytics

Almost 75% of the pharmacy experts surveyed believe that in at least 50% of the hospitals, analytics will be used to automatically detect adverse events and notify healthcare team members of the need for a clinical intervention. In addition, 77% believe that pharmacists in at least half the hospitals will use a validated automated method for identifying patients likely to benefit from pharmacy-based patient-care services, including drug-therapy monitoring.

"Pharmacists need to lead interdisciplinary efforts to identify high-priority medication-use information needed within the organization," Vermeulen said.

Quality of care

Pharmacy departments will also be expected to be accountable for measurable contributions to improvement of performance on core indicators of quality and safety, said Pamela K. Phelps, PharmD, FASHP, system director for clinical pharmacy services, Fairview Health Services, and clinical associate professor, University of Minnesota College of Pharmacy, Minneapolis, Minn.

In addition, there will be a "major shift in hospital pharmacy practice models ... with hospitals being held accountable for patient outcomes after discharge," she said.

In fact, more than half of those surveyed believe that at least 25% of hospitals will contract with a corporate entity (such as a retail pharmacy chain) to ensure medication adherence of discharged patients.

"Patients may be better served through the continuity and consistency of care that can be achieved when a health system is directly responsible for both inpatient and outpatient pharmacy services," she concluded in the forecast report.

Pharmacy practice model

Approximately 60% of the survey respondents believe that at least 75% of hospital pharmacists will spend essentially all their time as members of patient-care teams handling complex medication-use issues, instead of spending their time on product preparation, distribution, or order- verification-related tasks.

Also, 58% of those surveyed believe that in at least half of hospitals, pharmacy students will provide essential patient-care services.

"The use of pharmacy students in appropriate patient-care activities can enable pharmacists to allocate their time to patients with complex medication-use needs," wrote Daniel J. Cobaugh, PharmD, and David Chen, BS Pharm, MBA, in the forecast report.

This shift in duties will also require the need for credentialed pharmacy technicians and the need for advanced roles of technicians, such as “tech- check-tech,” in the future, they wrote.

To read or download a PDF of the new pharmacy forecast report, go to ASHP pharmacy forecast.