A few months ago, I wrote a commentary aboutuncompensated care and the need to become facileat techniques of ethical decision making as pressurescontinue to increase to reduce costs. The need to do so isdriven by demands for health care services that exceed thehealth care resources available. While the pressures to"ration"health care resources will initially be the greatest insafety-net hospitals, whose mission includes providing careto the underprivileged, it is a national issue that will affectall hospitals and providers.
In a recent article by Reed Abelson in the Wall StreetJournal entitled "As an era of soaring prices appears to fade,health care analysts see a bleak outlook for hospitals,"mypremise was validated. The article focused on for-profit hospitalchains such as HCA and Tenet Healthcare and was targetedtoward investors, and it advised, "?the outlook forthe future is largely negative?and [investment is] a bigrisk."The author also mentioned specialty hospitals, whichcater to the most profitable areas of medicine and competewith community hospitals that provide services to a muchwider (and less profitable) range of patients.
The article caught my eye for several reasons. My impressionis that for-profit hospitals aggressively manage expensesby minimizing staff, limiting formularies, and standardizingcare whenever possible. It is frightening and bothersomethat their financial well-being is tenuous. Does that indicatethat community hospitals and academic medical centers areon the verge of even tougher economic pressures? Will thenew Medicare Act and its provision for outpatient prescriptioncoverage eventually result in reduced hospital paymentsto finance the new benefits? What does all this mean to hospitalpharmacists and their future?
It seems to me that what we are experiencing is a wake-upcall. We all need to focus on value—the value hospital pharmacistsbring to the clinical enterprise. As hospital marginscontinue to erode, efforts will be made to reduce expenses,and 2 easy targets are pharmacist staff expense and drugexpense. So what should we be doing to demonstrate ourvalue? I suggest we consider the following strategies:
We should engage hospital and medical staff leaders andbe active participants in strategic planning initiatives,becoming recognized as part of the solution rather than partof the problem. Are we ready to substantiate our value?