Based in Nashville, Tennessee, Ardent Health Services operates 31 hospitals in seven states. While the hospital group has long partnered with HealthTrust to assist with managing its supply chain and supply expenses, leaders recognized a few years ago that the pharmacy also offered significant cost-savings opportunities.
In 2014, Ardent Health launched a number of new clinical and supply chain initiatives, including a pharmacy engagement with HealthTrust. The pharmacy partnership has decreased total pharmacy expense and increased total pharmacy revenue, saving the organization’s facilities more than $7 million, says Kara Fortune, PharmD, BCOP, corporate system director of pharmacy services at Ardent Health Services.
“We started out looking for savings by managing expenses for pharmacy supplies,” she says. “But as we examined every piece of the pharmacy role, we came to realize how much could really be done to cut costs and improve outcomes at the same time.”
Many of the cost-savings initiatives Ardent Health’s pharmacy group has undertaken have involved clinical changes based on data analytics and enhanced training. For instance, the system has increased its use of IV push antibiotics (the rapid injection of a one-time dose of intravenous medication) rather than administering antibiotics via IV piggyback, when possible.
With IV push antibiotics, there are fewer delayed doses, increased accuracy of doses, easier scheduling of multiple antibiotics and reduced time administering the medication, Fortune adds. This enables nurses to have more quality time with patients to discuss their antibiotics, treatment goals and possible side effects, which positively impacts the patient experience. Patients are no longer confined by the IV pole, yet they benefit from the same results at a lower price.
For example, a one-gram adult dose of Cefazolin, traditionally administered by an IV, costs hospitals about $4.32 for supplies, along with IV pumps and the labor services of a registered nurse, pharmacist and pharmacy tech. The same one-gram dose with IV push administration costs hospitals about $1.78 for supplies, along with a registered nurse.
In addition to boosting the use of IV push administration, Ardent Health’s pharmacy group implemented a number of other clinical initiatives, including moving team members out of operational roles “to grow a robust clinical program,” adds Travis Lawler, PharmD, director of pharmacy at BSA Health System in Amarillo, Texas, an affiliate of Ardent Health Services.
To illustrate, BSA has hired five new clinical pharmacists in the past four years. It has also created a pain team that has seen a 50 percent reduction in postoperative opioid use among patients in an Enhanced Recovery After Surgery (ERAS) program, and an antimicrobial stewardship program that has achieved a 24 percent reduction in antimicrobial spend. Other accomplishments include an emergency room pharmacist initiative, a penicillin skin allergy testing program and a new PGY-1 pharmacy practice residency.
Additionally, the pharmacy initiatives have contributed to improved patient outcomes and increased patient satisfaction. Ardent’s HCAHPS (the Hospital Consumer Assessment of Healthcare Providers and Systems) score in the “communicates about meds” category has risen after implementing an initiative to provide more extensive and specific medication education by pharmacists.
Operational & Distribution Improvements
Along with changes at the clinical level, Ardent Health has made extensive changes to its supply chain processes with HealthTrust’s assistance.
“We embedded a pharmacist at the corporate level to identify opportunities and develop implementation tools for facilities, such as communication templates, clinical evidence and talking points,” says Drew Preslar, assistant vice president of HealthTrust’s inSight Advisory Services. “This was originally a part-time resource, but it was expanded to full to broaden the scope.”
In addition, the HealthTrust team has helped Ardent with operational assessments and distribution conversions. The team is working to align Ardent Health facilities and the corporate pharmacy and therapeutics (P&T) committee to improve communication and execution. And HealthTrust has identified significant cost savings across a variety of these clinical and operational initiatives, Preslar says.
A new operational cornerstone is the installation of a perpetual inventory management system. Before implementing the system, Ardent facilities used a manual process, with staff spending a full weekend once a year to create a list of items in inventory.
“With a perpetual system, we know our inventory levels at any given time,” Lawler says. “The system knows what’s coming in because it automatically orders the supplies we need. When received items are scanned in, the system can also flag discrepancies between what was ordered and what was received.”
The new system has allowed Ardent Health to reduce inventory by almost 50 percent and reduce pharmacy spend by 20 percent, Lawler says.
Though implementing the changes has been a team effort, Ardent Health leaders applaud the role their HealthTrust partners have played in these successes. “Without a doubt, the partnership is successful because of the people,” Lawler says. “We consider the HealthTrust staff we work with—Tom Chickerella and Kara Fortune—our teammates. They are top-notch individuals, and we are fortunate to have their leadership.”
From HealthTrust’s perspective, a strong working relationship with Ardent Health leaders has been a powerful starting point for bottomline results. “We have a highly collaborative approach to our work with Ardent,” Preslar adds. “We focus on engaging the right stakeholders at the corporate and facility level and also make the effort to spend one-on-one time with leaders and staff at the hospitals.”