The Value of Hospital Pharmacists

Author: James C. McAllister III, MS, FASHP, Pharmacy Times Editor, Health-Systems Pharmacy Section

A few months ago, I wrote a commentary about uncompensated care and the need to become facile at techniques of ethical decision making as pressures continue to increase to reduce costs. The need to do so is driven by demands for health care services that exceed the health care resources available. While the pressures to "ration"health care resources will initially be the greatest in safety-net hospitals, whose mission includes providing care to the underprivileged, it is a national issue that will affect all hospitals and providers.

In a recent article by Reed Abelson in the Wall Street Journal entitled "As an era of soaring prices appears to fade, health care analysts see a bleak outlook for hospitals,"my premise was validated. The article focused on for-profit hospital chains such as HCA and Tenet Healthcare and was targeted toward investors, and it advised, "?the outlook for the future is largely negative?and [investment is] a big risk."The author also mentioned specialty hospitals, which cater to the most profitable areas of medicine and compete with community hospitals that provide services to a much wider (and less profitable) range of patients.

The article caught my eye for several reasons. My impression is that for-profit hospitals aggressively manage expenses by minimizing staff, limiting formularies, and standardizing care whenever possible. It is frightening and bothersome that their financial well-being is tenuous. Does that indicate that community hospitals and academic medical centers are on the verge of even tougher economic pressures? Will the new Medicare Act and its provision for outpatient prescription coverage eventually result in reduced hospital payments to finance the new benefits? What does all this mean to hospital pharmacists and their future?

It seems to me that what we are experiencing is a wake-up call. We all need to focus on value—the value hospital pharmacists bring to the clinical enterprise. As hospital margins continue to erode, efforts will be made to reduce expenses, and 2 easy targets are pharmacist staff expense and drug expense. So what should we be doing to demonstrate our value? I suggest we consider the following strategies:

  1. Document pharmacist interventions and calculate savings.
  2. Determine the value of pharmacy services as patient safety is improved.
  3. Play key roles in improving patient satisfaction.
  4. Promote activities that shorten length of stay.
  5. Ensure accurate charge capture and billing.
  6. Reexamine pharmacist activities and debate their value to those we serve.
  7. Learn ethical decision-making skills so that we can participate in discussions regarding the use of limited resources.

We should engage hospital and medical staff leaders and be active participants in strategic planning initiatives, becoming recognized as part of the solution rather than part of the problem. Are we ready to substantiate our value?