When John Feucht started working in hospital pharmacies in the 1990s, paper-based orders still ruled and data-driven decision-making was scarce. Now, he thinks there is sometimes too much data to make sense of, but that data also allows him find more answers to his hospital’s problems – like how to rein in high-cost anesthetics.
Feucht, the pharmacy director at Mercy Medical Center, a 476-bed hospital in Canton, Ohio, and a part of the four-hospital Sisters of Charity Health System, talked with Healthcare Finance News about the evolving roles of hospital pharmacies in clinical improvement and cost savings and how he’s using data analytics to guide decision-making and find new opportunities.
Q: Since you started in the field in the mid-1990s, how has the hospital pharmacy changed?
A: One change would be a focus not only on being clinicians and being members of the healthcare team along with the nurses and the physicians, but a huge shift to becoming very nimble supply chain managers. Being able to maintain a formulary and maintain inventory have become just as important as having policies and procedures in place for high-risk medications. Another thing we’ve seen has been a change in the workforce. When I got out of pharmacy school, we had staff pharmacists and then we had pharmacists that were your clinical coordinators. We had maybe 11 staff pharmacists with bachelor’s degrees on staff and then we had one clinical coordinator for the entire facility. Here were are in 2014 and I’ve seen a shift to where, through the use of technology, we have only seven or eight people working in the centralized pharmacy and I have five clinical coordinators, and would love to hire a couple more. We’re becoming more high-touch with patients, but as far as management is concerned, we’re becoming more supply chain managers – quality-metric driven. You really have to be an expert and understand the dollars as much as the medications.
Q: Now that you’ve had automated pharmacy tools and hospital-wide databases for a few years, what have been some of your biggest challenges in terms of crafting medication guidelines?
A: Some of the more difficult areas to create protocols for would be critical care. In critical care, patients really differ in condition and what they’re going to require. And, unfortunately, they often have long lengths of stays, very high acuity and they use a lot of product, anything from blood to derivatives and factors to your highest-cost antibiotics to your highest-cost pain control agents. So reining that in and trying to put it into a cookie cutter mold is very difficult, as opposed to a labor delivery unit – everybody essentially gets the same thing – or our orthopedic units. Those critical care areas and those surgical care areas, where there’s surgeon preference and high-dollar items, that’s probably been our biggest challenge.
Q: What have been some of the more insightful findings and did they change any of your decisions or clinical approaches?
A: There have been a few a-ha moments. You know anesthesiologists sometimes can be challenging because they have patients’ lives in their hands when they’re putting people to sleep and you really don’t want to micromanage that process by making them use something that they’re not comfortable with. So we went in with a proposal, and we weren’t sure how well it would be received. We were going to take our highest-cost anesthesia gas off the formulary. And when we were in there, through the use of some of these analytical projection tools, we found that if we just let them have all three gases still in the formulary but really just flipped their utilization to where in the non-complicated cases they would agree to use the least expensive agent, we were able to arrive at the exact same savings amount that we would have if we would have not changed any practice patterns and just deleted the drug, which would have resulted in probably disgruntled physicians and then maybe depriving some of those patients who really needed that agent because of specific anomalies.
It’s one of those no news is good news scenarios. There were some skeptics in the group, and they began tracking their own patients: ‘Did they have more nausea and vomiting? Did they have more blood pressure fluctuations?’ And there were no differences. Being able to really show them the data and have a part in the buy-in – we’re seeing the savings; they’re seeing that product they’re using isn’t any worse and now they’re not going to have to worry.
Q: Are there analysis projects you have in the pipeline or future ideas?
A: Last year the hospital had an engagement of performance improvement and optimization consultants, so we started looking at more data than I ever thought was possible. We are using data metrics looking at purchases and dispenses and then of course the ever fluctuating cost of agents chosen within classes to track our clinical initiatives and really project savings. For example, we have one in place where we flipped the mix of our anesthesia gases, so we track the utilization of those on a monthly basis. Also some tools for our group purchasing organization gives us ideas and opportunities and benchmarks us against some of our peers and sister hospitals within the system.
As far as things that I’d like to track in the future, we have a pharmacist now that we have working on our cardiac step-down unit, which is where all of our heart failure patients are housed. We’re tracking some things around those patients in regards to: What kind of interaction do they have with our pharmacist for discharge and planning? What kind of score does a person who actually sits down and meets with the pharmacist have? What kind of rating do they give the hospital versus those who don’t? The telltale one is what does that do to our readmission rate?
But even with all of this data, some data you sift through and does it really tell you anything? There are things that get mined, I think, that when you really look – well, is that significant or not? – making those decisions sometimes can be really challenging.