ORLANDO, FLA.—A survey of 164 pharmacy stakeholders from across the country suggests that health-system pharmacists should brace themselves for mounting financial pressures and expanding clinical responsibilities, among other big changes.
The five-year Pharmacy Forecast, released today and slated for presentation at the American Society of Health-System Pharmacists (ASHP) 2013 Midyear Clinical Meeting, also indicated that experts believe hospital pharmacies will need to focus more on outpatient care and demonstrate their department’s influence on the hospital’s success.
David A. Zilz, MS, who is clinical professor emeritus and former director of pharmacy at the University of Wisconsin Hospital and Clinics in Iola, said health-system pharmacy leaders need to develop and implement a strategic plan now more than ever. “Hospitals are being integrated into multihospital systems and the model of care is changing from a siloed acute and community care approach to a longitudinal, continuum-of-care model,” said Mr. Zilz, who is slated to moderate the ASHP session where the Pharmacy Forecast will be presented and whose Leaders for the Future Fund partly paid for the report’s development.
In his personal communications with pharmacy leaders, Mr. Zilz said he has found a few who “have articulated a very clear vision and strategic plan, but … as a group, we’re all over the map in terms of how well pharmacists have positioned their departments to effectively influence optimum patient outcomes in this new environment.”
William Zellmer, BSPharm, MPH, president of Pharmacy Foresight Consulting in Baltimore, headed the creation of the Pharmacy Forecast, a project of the ASHP Foundation’s Center for Health-System Pharmacy Leadership. He and the other forecast creators, all of whom held positions on various ASHP executive committees, developed a 64-item questionnaire that covered eight topic areas, including fiscal issues, quality of care, health care analytics, the pharmaceutical marketplace, pharmacy practice models, ambulatory care, pharmacy department operations and pharmacy leadership. They mailed the questionnaire to a group of 164 geographically-representative health system pharmacists who they identified as “recognized experts” with “knowledge of trends and new developments [in health system pharmacy] and a demonstrated ability to think analytically about the future of pharmacy practice in hospitals and health systems.”
Thirty-one percent of the survey respondents held some type of health system practice management position, 22% were clinical health system pharmacists, 22% were academic faculty members, 11% were informatics and technology specialists and the remainder represented a variety of other pharmacy positions.
Many of the surveyed panelists anticipate that increasing financial demands on hospitals will, in turn, be passed on to hospital pharmacies, said Lee Vermeulen, BS Pharm, MS, director of the University of Wisconsin in Madison’s Health Center for Clinical Knowledge Management and clinical professor of pharmacy, at the university’s School of Pharmacy.
Many panelists anticipate more revenues being provided as bundled payments, intended to cover the continuum of patient care from short-term acute care to long-term post-acute care in the community. Nearly all of the survey respondents said they believed that more than half of all hospital revenues will be in some way contingent on how well organizations and pharmacies perform on pre-established, standardized quality indicators.
“Pharmacists will be developing programs that tie fixed reimbursement to high-quality outcomes, particularly outside the acute care environment,” said Mr. Vermeulen, suggesting that cutting 30-day readmission rates will be a significant goal and will force resources to be shifted to manage outpatient care.

Coaching Better Compliance
The focus of outpatient care will be in coaching patients to achieve high adherence rates and monitoring drug therapy outcomes, said Joel A. Hennenfent, PharmD, MBA, BCPS, system director of pharmacy for Truman Medical Centers, a not-for-profit health system based in Kansas City, Mo.
“One thing to consider is optimizing the use of emerging point-of-care diagnostics for patient selection in order to improve care and reduce costs,” Dr. Hennenfent said. Increasing use of such diagnostics, he noted, will allow pharmacists to fine-tune drug dosing and optimize a drug’s efficacy and safety. Of the survey respondents, 60% expect these types of tests to accompany at least one-fourth of all newly approved molecular entities.
Scrupulous patient monitoring will also be critical because, as 58% of the surveyed pharmacy experts believe, the number of drug shortages is unlikely to diminish any time soon, meaning agents with potentially less favorable safety profiles than the drugs in short supply will be used as alternatives or substitutes, Dr. Hennenfent said.
According to 91% of those surveyed, more than half of all hospital pharmacies are expected to assign at least one pharmacist to manage the increasing outpatient care load. Additionally, Dr. Hennenfent said nearly half the respondents believed the majority of hospital outpatient pharmacies will ultimately contract chain retail pharmacies to manage their operations.

Pay Contingent on Patient Care Outcomes
In order to thrive operationally and financially, hospital pharmacies will need to demonstrate their effect on patient outcomes, noted Pamela K. Phelps, PharmD, director of Clinical Pharmacy Services at Fairview Health Services, and adjunct associate professor at the University of Minnesota College of Pharmacy in Minneapolis. “To build a convincing business case to senior hospital leadership that will garner additional pharmacy resources, you should identify all medication-related quality-of-life measures within the health system and position your department to improve on these measures,” Dr. Phelps said.
Pharmacy leaders whose departments are not demonstrably helping to improve hospital outcomes will be held directly accountable for their department’s shortcomings, according to Joyce Tipton, RPh, MBA, director of pharmacy and respiratory care at Memorial Hermann in Houston.
“Rather than simply being evaluated on the pharmacy department’s success in routine operations, pharmacy leaders will be financially incentivized primarily on their department’s contribution to the organization’s long-term strategic goals,” Ms. Tipton said, citing survey results.
For more information on the Pharmacy Forecast, a project of the ASHP Foundation’s Center for Health-System Pharmacy Leadership headed by William Zellmer, BSPharm, MPH, president of Pharmacy Foresight Consulting in Baltimore, visit www.ashpfoundation.org/pharmacyforecast.

None of the sources reported any relevant financial conflicts of interest