Hospital pharmacies need pharmacy-specific numbers to improve metrics
Some national effort is needed
Work needs to be done at both the national level and the hospital level to improve hospital pharmacy metrics, experts say.
Medication therapies are more expensive and complicated now than a decade ago, and patient acuity levels are higher, so there is a definite need to find better ways to collect pharmacy data and to develop national standards for analyzing metrics, says Philip E. Johnson, MS, RPh, FASHP, director of pharmacy at H. Lee Moffitt Cancer Center in Tampa, FL.
"Most metrics show cost per patient day or cost per 100 beds," Johnson says. "But you need to know what kind of beds those are."
Developing such metrics will be challenging, says James A. Jorgenson, MS, RPh, executive director of pharmacy at Clarian Health Partners in Indianapolis, IN.
"It can be quite daunting," Jorgenson says. "If I focus on financial metrics, the first thing I'd look at are some of the basics, like total pharmacy expenditures, what percentage is personnel, drugs, and everything else."
For instance, if the beds are intensive care beds or orthopedic or long-term care beds, the metrics will have different meaning with regard to acuity, staffing needs, and costs.
When a hospital's metrics show the number of staff per 100 beds, there needs to be a modifier that shows what might be expected in staffing for a particular type of bed and its patients' typical acuity levels.
"One thing I'd suggest is that pharmacy directors take a hard look at what kind of metrics package their current C-Suite is looking at," Jorgenson says. "What are they looking at in terms of internal flex numbers, and what are they looking at in terms of benchmarking?"
Also, there might be national numbers that can be used, such as pharmacy supply expense as a percentage of net revenue. But organization leaders have to make sure they fully understand the impact of both the numerator and denominator in these types of comparative statistics, he adds.
Without good numbers, it will be difficult to provide hospital leadership with an accurate picture of a hospital's performance.
"You need to have more specific numbers in your database, so your metrics are more specific," Johnson says. "We have to start creating these numbers."
The numbers could be based on metrics already devised for nursing, he suggests.
"Nursing has a patient acuity level scale of 1 to 4, and it's based on how much nursing manpower it takes to take care of these patients," Johnson explains. "Can patients feed themselves, ambulate, wash themselves?"
The case mix index is of mixed value to hospital pharmacies, says David Kvancz, RPh, MS, FASHP, chief pharmacy officer at the Cleveland Clinic in Cleveland, OH.
"The pharmacy workload really is the admission and discharge and transfer processes that occur and the rapidity with which drug orders are changed during a hospital stay," Kvancz says. "A patient might have a very high acuity level because they had a surgical operation that was very complex and post-surgery care is very complex," Kvancz explains. "But they may be relatively limited or simplistic when it comes to drug therapy, and we can have the converse of that."
Unfortunately, there are no acuity level indexes for pharmacy, Kvancz and Johnson say.
"We have case-mix index, which looks at the average cost of one hospital for a given diagnostic code, but it doesn't break it down to what the cost is," Johnson says. "So we need to develop a better way and set some examples of how to come up with numbers that can specifically identify the kind of patient and institution we have."
Then hospitals with similar pharmacy acuity levels can be compared and benchmarked more accurately than can be done now.
For this to happen, pharmacy departments need specific numbers in their metrics, numbers based on the amount of pharmacy staffing, medication costs, and other particulars, he adds.
"We've started doing this in our infusion center," Johnson says. "We rank patients as high, low, or medium intensity for both pharmacy and nursing."
For example, a simple drug might require blood pressure testing every 15 minutes, which is high labor intensity for the nurse, but low intensity for pharmacy, he says.
"Or a more complex drug where we have to recalculate the dose and check labs might be simpler for nurses," Johnson adds. "We have to know if it will be difficult for the pharmacist or nurse or neither or some combination."
Once these different acuity levels are known and quantified, then pharmacists can measure the acuity and use those numbers to measure how many patients can be treated with existing resources, he says.
"Then we can track that and measure our average patient acuity and compare ourselves to other institutions," Johnson says.
"This is what we're trying to do," he adds. "We want to get the whole concept started through a grassroots effort where hospitals start measuring what they're doing, what acuity level their patients are, and this gives us better data."
There will need to be a national standard for these numbers before true benchmarking can take place, Johnson says.
"That's what I'm hoping that cancer hospitals can do because we're a small enough group and we communicate very well," he says. "Our diseases already are rated by stage of disease, and that could be related to patient acuity, so the cancer world has some advantages in developing this sort of patient acuity system."
Until national metrics are available for pharmacy departments, data analyses will be largely done on an organizational basis, and they'll continue to be somewhat labor intensive, the experts say.
"We extract data mostly by using data analysts located in the department of pharmacy, taking downloads of data from legacy systems, manipulating those in database software and maybe spreadsheet software, and working with managers of each area to make sure data are clean and exceptions are identified," Kvancz says. "We have monthly business reporting and a monthly quality report card we produce for our department."
It takes a considerable amount of work to collect data, especially since some information is pulled from paper sources, such as patient charts, or visual observation, he adds.
For example, the Cleveland Clinic benchmarks its medication order turnaround time by both physically and electronically obtaining the medication order entry time, collecting the time it takes to deliver medication to the floor, and the time it takes to get to pharmacy, Kvancz explains.
"You need a pharmacy technician who observes when the orders leave the pharmacy and tracks them, and you have to take data from legacy systems, download data, and spread them to spreadsheet software, manipulating them, and analyzing them, before reporting to a manager," he adds. "You use electronic data combined with manual observation to provide a complete picture."
Work needs to be done at both the national level and the hospital level to improve hospital pharmacy metrics, experts say.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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