The IT revolution in LTC pharmacy: it promises more control of one of the fastest-growing costs in long-term care. (Feature Article).

The long-term care (LTC) industry is facing a series of crises that threaten the operational and financial success of nursing facilities everywhere. Staffing shortages, reimbursement cuts and rising costs--especially for prescription drugs--have all providers striving for innovative solutions.

As has been often noted, LTC residents consume a disproportionately greater number of medications than the rest of the population. According to the National Center for Health Statistics' Health, United States, 2001, Americans residing in nursing facilities comprised only 0.6% of the nation's population but accounted for more than 5% of the $120 billion spent on medications last year. On top of this, Health, United States, 2001 found:

In 1999, prescription drug expenditures increased 17% compared with an average annual rate increase of 12% between 1995 and 1998. In 1999, prescription drugs posted one of the highest rates of price increase in the Consumer Price Index....

Moreover, according to the Office of the Actuary at the Centers for Medicare and Medicaid Services, by the year 2011, national healthcare costs will double to $2.8 trillion, while drug expenditures will more than triple to $413 billion.

To sustain any hope of maintaining financial viability, providers must better understand and manage their drug utilization and costs, starting now.

Meeting the Challenge

Quick to embrace information technology (IT), LTC pharmacies have offered their clients services such as medication formulary management systems, clinical utilization management programs, education and drug regimen review interventions. They have also begun to identify and develop IT solutions that involve nursing facility staff and prescribers. These solutions offer valuable tools for LTC providers struggling to improve operational efficiency while maintaining quality care. These software tools are now readily available from several sources, and should be a key consideration for any nursing home owner or administrator in choosing an LTC pharmacy. In making this decision, the provider should look for:

A well-developed preadmission screening program using specialized staff and computer software assists in the recognition of vital clinical, regulatory and financial issues related to medications before the resident enters the facility. Reports specifically designed for the nursing staff, the prescribers and the Minimum Data Set (MDS) coordinator can quickly direct the flow of information to the most appropriate individual in the most relevant format.

Consultant pharmacists using drug regimen review management software are able to track resident-specific anecdotal notations across extended periods of time, compared to the short-term records available with most medical records charts. Using a portable printer while visiting the nursing facility, the consultant pharmacist can quickly and easily develop professional communication records. The ability to append notations and outcomes from their documented interventions provides consultant pharmacists with a new dimension in clinical monitoring. Such ongoing drug reviews offer the facility continued opportunities for cost reductions and containment.

Meanwhile, the dispensing pharmacist has direct access to the largest repository of resident medication information yet available in resident- and facility-specific screening. Every active order and most discontinued orders can be screened by the pharmacist and computer software.

Aside from drug interaction and allergy alerts, this is a very powerful tool at the pharmacist's disposal. For example, the ability to receive automated reminders of past adverse drug events or special precautions has immeasurable value. Facility and pharmacy drug formulary initiatives can be supported by computer-generated warnings and automated substitutions, where permitted by state law.

Retrospective reports are available to assist a nursing home administrator in evaluating actual drug-use patterns and measuring their financial impact. The results provide a valuable road map to high-impact utilization issues and potential compliance problems. Some reports even project the potential cost savings if these drugs were to be converted to medically appropriate alternatives that are more cost-effective.

LTC Connectivity

The next trend in LTC pharmacy-related IT solutions will be nursing facility connectivity. Although the notion of connecting nursing facilities directly to their pharmacy's data resources is not a new idea, advances in technology have only recently made it a practical reality. Connectivity opens new capabilities to drive clinical, financial and regulatory compliance initiatives in a more timely and efficient fashion. Supporting the efficient use of nursing time for ordering and tracking medications, researching drug information and communicating with the pharmacy and prescribers are only the tip of the iceberg of advantages offered by connectivity.

For example, information access and exchange by business office personnel can increase the accuracy and reliability of resident billing. Electronic reconciliation of medication transactions has the potential to save hours of tedious work by nursing facility staff. Consultant pharmacists who are connected with each other and nursing staff throughout the country will have more convenient access than ever to the most up-to-date drug profiling, resident/patient demographic information, new developments in the field and other vital information.

Conclusion

Drug costs are rising and will continue to represent an increasing percentage of the costs associated with the daily operation of a nursing facility. Providers who are committed to winning the battle for financial viability and quality care should look to their LTC pharmacy provider for technologic solutions. Pharmacies today can offer innovative tools that assist providers in evaluating drug costs, decreasing adverse medical reactions and reducing utilization, while maintaining positive clinical outcomes. Providers that aggressively pursue and use these tools will quickly outpace their competitors.

Richard Mainzer, RPh, FASCP, is a director of marketing and product development with NeighborCare and a clinical pharmacist with 24 years of long-term care experience. NeighborCare, based in Baltimore, Maryland, operates pharmacies, medical supply centers, infusion services and home medical equipment facilities for more than 250,000 customers in long-term care settings and for more than one million covered lives in homecare settings in 41 states. For more information, contact Mainzer at [phone] or e-mail [e-mail].