Hospital administrators face ever-shifting and increasing demands as they work to ensure that patients receive high-quality care, while also reigning in costs. Many hospitals today look to mergers and acquisitions as a strategy to help tackle these demands. In fact, 90 hospital mergers and acquisitions were announced last year, according to a KaufmanHall article.
However, many acquisitions don't perform as expected. A 2017 Deloitte study found that two years after an acquisition, acquired hospitals see a decline in operating margins and revenue. "So, what makes for a successful integration strategy?" asked Michael D. Brown, vice president of managed services at Cardinal Health, during an Oct. 24 webinar sponsored by Cardinal Health and hosted by Becker's Hospital Review. "It really boils down to spending time on integration planning and collaboration. It's all about execution."
Mr. Brown said that a successful integration plan should establish a clear strategy, value culture as a driver of change, leverage project management expertise and standardize system-wide best practices for new organizations.
An often overlooked area for standardization is medication management, noted Mr. Brown. An efficient, best practice-driven medication management system can help a facility achieve its aims of improving outcomes and quality, while also reducing costs.
"Medication management should be important for a system because medications span across all service lines," said Mr. Brown. "There rarely is a patient that comes into the facility — inpatient or outpatient — who isn't on a medication or prescribed a medication. That's one reason why pharmacy can make an organization-wide impact."
Growth strategy best practices from a 40-facility system
Post Acute Medical, a for-profit health system comprising 40 long-term acute care hospitals, acute rehabilitation hospitals and outpatient centers, has a great deal of experience in acquiring and integrating new facilities. It acquires an average of five facilities a year and recently the organization completed the acquisition of nine long-term acute care specialty hospitals, said Adam Burick, DO, executive vice president and CMO of Post Acute Medical.
Post Acute Medical recognized early on the role of culture in supporting its growth strategy. "Our culture can be summed up in one word: teamwork," said Dr. Burick. "We focus on collaboration and partnerships; removing layers of bureaucracy so teams are engaged, included in decision-making and empowered." This culture is the foundation for how we approach acquisition and integration planning, he added.
While standardization is also a key component of Post Acute Medical's integration planning, the role of medication management best practices is a more recent insight. Post Acute Medical began working with its pharmaceutical services partner, Cardinal Health, to focus on operational priorities, yet it quickly became apparent how medication management is a key aspect of a successful acquisition, Dr. Burick said.
Now, with each acquisition, Post Acute Medical ensures that strategies are in place for admissions, clinical collaboration and standardized best practices for medication management across the newly acquired entity. Here are some of the organization's medication management best practices:
1. Successful integration takes planning and preparation prior to Day One. Due diligence and documentation set the stage for smooth transitions. Before the acquired facility begins operating as a member of the larger organization, Post Acute Medical and Cardinal Health standardize pharmacy protocols, conduct compliance and regulatory oversight, optimize automated dispensing cabinets, and ensure clinical support to enable nursing and pharmacy staff collaboration on medication review and consultation. "This helps Day One to feel like Day 90," said Dr. Burick.
2. Effective clinical collaboration and support. Post Acute Medical monitors utilization and addresses variation through a physician-and clinician-led Stewardship Committee, said Dr. Burick. The committee focuses on appropriate therapy, proactive management of high-cost medications, reducing resistance patterns and improving patient care. By leveraging engagement and participation from physicians — plus evidence-based literature, clinical analyses and standardized order sets — Post Acute Medical has achieved 100 percent compliance with clinical initiatives, he said.
For example, the committee identified a list of restricted antimicrobials. Whenever there is a question about the use of a restricted antimicrobial, Dr. Burick, Cardinal Health and the prescribing physician review the case as a team to determine a new therapeutic plan for that patient.
"We found this process does several things for us," said Dr. Burick. "It assures the latest evidence-based medicine and care for our patients, while decreasing the incidence of multidrug resistant organisms and ultimately, the cost of care for our patients."
3. Foster a culture of collaboration. Involving the pharmacy in point-of-care decisions with admissions, field navigators, nursing and other teams is key to help streamline clinical operations and ensure optimal patient care. The pharmacy can also help long-term care facilities prepare effectively for each patient's arrival and divert patients who may be better served at a different type of facility, according to Dr. Burick.
The patients that come to inpatient rehab or long-term care facilities are expected, as they are not emergency or urgent care cases, he said. Pharmacists can help ensure that admissions are never delayed or denied for medication-related reasons or even during significant drug shortages.
On the flip side, when taking note of incoming patients' medications, pharmacists can also identify complexities or comorbidities that indicate a patient would receive more appropriate care in a different healthcare setting.
Conclusion
Establishing a culture of teamwork and collaboration, and standardizing medication management best practices, are two foundational elements to integrate new facilities into a hospital organization. Lastly, leveraging the expertise of an experienced pharmaceutical services partner can be incredibly helpful. Providers should look for a true partner and not just a vendor, said Dr. Burick, one that is committed to collaboration, availability and accountability—and shares your mission and culture of patient care.
"Both partners must have the same mission… It's a two-way street," he said. "It allows me to sleep better at night, that's for sure, knowing I have a lot of assistance and back up in the pharmaceutical realm."
To watch the webinar, click here.
To learn more about Cardinal Health, click here.