Making a significant (financial) footprint at OHSU

Q&A

• Q: What has been your area of focus in the recent past?

  A: For me, providing access is the most important thing pharmacy can do for our patients. In order for me to provide access, I need to create an infrastructure to expand to provide the pharmacy services needed.

  Over the past few years, we’ve focused on growing outpatient pharmacy, retail pharmacy, mail order pharmacy, specialty pharmacy, ambulatory infusion clinics, and home infusion therapy services. Last fiscal year, we achieved $1.1 billion in revenue.

  Recently, I’ve been working closely with our finance and contracts teams to negotiate better pricing with payors for prescription drugs. I’ve been working with finance a lot since pharmacy has become the number one financial contributor for the hospital. There are many eyes—and a lot of dependencies—on pharmacy finances.

• Q: How did you get senior leadership to view pharmacy as a revenue generator?

  A: It took me and my CEO, who was then my VP, a long time, maybe six years, to convince senior leadership to view outpatient pharmaceuticals not just as expense but as cost of goods sold. With cost of goods sold, there is a net margin associated with that, which is an important distinction.

  What finally convinced them was when one of our payors changed its policy with regards to infusion therapy. The payor directed members to use the lowest cost of care setting, which was home infusion therapy, versus our ambulatory infusion facilities. That really opened up some eyes and proved that what we were predicting was coming true.

• Q: What action did you take in response to the infusion therapy issue?

  A: We created our own home infusion service from scratch. It took us almost a year to get it up and running—the facility, hiring people, getting resources, negotiating payor contracts, and so on.

  Because our pharmacists and nurses are well trained within their scope of practice, they’re able to provide a very high quality of care with better outcomes than most.

  We are able to provide access, to promote better outcomes, and to decrease the overall cost of care for our patients and for our facility. It’s been more than a year now and the home infusion service has been performing well.

• Q: What is your financial focus when it comes to inpatient pharmacy?

  A: I have approximately 55 assistant directors, operation managers and clinical supervisors. I also co-chair our expanded Clinical Knowledge & Therapeutic Executive Committee. We’re constantly looking at our top 50 list of medications on the inpatient side. We’ll work with our providers to create guidance for the top 50 list to curve spending down where it makes sense.

  One example that happened a few years back was when the cost of IV acetaminophen virtually tripled overnight, with no warning or reason given. With my committee co-chair, who is the medical director, we issued guidelines to limit IV acetaminophen to only certain patient populations. And my team is on the front lines to enforce that type of guidance. That example enabled us to avoid $500,000 in unplanned costs.

• Q: How did you develop your business acumen?

  A: In pharmacy school, I was all about being a clinical pharmacist. I was intrigued about the biological mechanics of drugs and how they react in a body. After graduation, I worked as a retail pharmacist and then I moved into management. I hated it at first, but soon grew to like it.

  That’s where a lot of my financial experience came from, as a Rite Aid pharmacy district manager, responsible for all pharmacy operations for as many as 40 stores. I learned to always try to think 10 steps ahead. Whether it's regulatory, operations, finance or clinical, I ask myself, how does this situation or decision impact our pharmacy profession? Then I try to find ways to mitigate those challenges.

• Q: Your chapter in the book Letters from Women in Pharmacy is titled “Be Persistent and Leave a Footprint.” Does that describe your leadership style?

  A: Yes, I think it does. I'm not a micromanager at any point. I try to hone the strengths of each manager, to believe in them and to trust in their decisions. That leads them to trust in me and to have confidence in themselves.

  I encourage my managers to make the decisions that are right for their teams. It’s okay to make mistakes. Everyone will make mistakes along the road. No one is perfect. But when you learn from your mistakes, that, to me, is a part of growing and being successful.