Helping Patients Reach the Highest Level of Recovery

Q1. ARE THERE ANY PARTICULAR OVERVIEWS OF CURRENT TRENDS IN THE MARKET THAT YOU HAVE OVERSEEN?

One thing we are focusing on is drug diversion. Throughout the U.S., skilled nurses in rehab centers or hospitals tend to be easier targets for staff who might be looking to divert drugs, or may have substance abuse issues themselves. A lot of that is because of a smaller budget in rehab. The larger care centers have larger budgets for different kind of technologies and systems where they can keep better track and monitor the nurses and staff. So, one of the things that we are working on is a system that allows us to perform thorough lifetime audits that gives us all kinds of data analytics. With this analysis, we look at early pulls, late administrations, and medication wastes, which gives us our standard deviation. It automatically looks at nurses that could be high risk and allow leaders to look into it a bit more. We see if it is truly a drug aversion or more of a practice to have a better understanding of how to pull back medications, when to pull back or give them, and the time constraints around those medications. We have a pharmacist working with us who helps us set the machines up, runs reports, and sends them out to all nursing administration leaders throughout Brooks rehab. Another topic which is very important in this day and age is antibiotic stewardship. Throughout the U.S. and the world, we are starting to see a lot more resistance to antibiotics and different pathogens that build up to this resistance. So, we are starting to see more of these nasty bugs out there that are harder to treat and patients are getting sicker, getting septic shock, and all types of different acute care settings and rehab settings. So, our team works on antibiotic stewardship and making sure that the patients are on the right antibiotic and getting the full dose. We also make sure that when we are doing different tests, like a urine collection, we follow the proper procedure and practices to do it. We know that sometimes people test and retest and it’s not always the best method to determine if someone is over a certain illness or infection. As we are working on antibiotic stewardship with our system, we are continuing to expand and opening our third hospital. Our second hospital, which is an inpatient rehab hospital, is further south of our first one. So, we're continuing to expand upon antibiotic stewardship to both locations as we serve a greater population of patients.

Q2. ARE THERE ANY TRENDS THAT YOU FEEL ARE NOT POSITIVELY INFLUENCING MEDICATION MANAGEMENT?

One of the biggest things that we face in this market is medication costs. There are generic medicines being made but they are not always as good as the original drugs. As costs of medicines continue to increase, patients are finding it more and more difficult to be able to afford the original drugs. When they come to the rehab settings, they are expensive for us to administer as well. We are always trying to make sure that we have the best and financially sustainable medication. Also, when a patient goes back home, we want to make sure that they have the relevant drugs. So, making sure that the patients are getting the best drug that's affordable for them upon discharge continues to be one of the biggest struggles in this industry. When it comes to acute care setting, we have one formulary. We have to see if it is accessible to us and what it costs us, and then when a patient goes home, it's going to cost them so we don't want to continue switching different medications back and forth. It could be insulin, antibiotics, or prophylactic drugs, but we take care of transplant patients by giving them certain medications that their surgeons and providers want them to take because they are more effective in the long run.

Q3. DO YOU HAVE ANY PARTICULAR APPROACH WHEN IT COMES IDENTIFYING THE RIGHT PARTNERSHIPS OR SOLUTION PROVIDERS TO ENABLE YOUR INNOVATION IN THE PHARMACEUTICAL INDUSTRY?

Erin Miller is our dedicated pharmacist and she is a wealth of knowledge when it comes to the pharmaceuticals industry and the best formularies. We’re constantly evaluating and revaluating and continuing to reach out to the buying power of the larger companies in the US. 

Since we are a smaller company, we don't have as much buying power. So, if we were one of these other larger corporations, then we could have gotten our costs down just because of the pure power behind it. If we had about 100 hospitals across the nation, and we tell them that a drug is not affordable, then rather than going to somebody else, they're more willing to negotiate and drop their prices. To partner with larger corporations, we have associated with HCA, and we purchase a lot of medications through them because they have a lot of buying power. They work really well with us, and they see the value in the services we provide to all patients. So, they are willing to continue to partner with us and help us out with our overhead costs.

Q4. BASED ON YOUR OBSERVATIONS OF TRENDS, WHAT EVOLUTIONS DO YOU SEE HAPPENING WITHIN THE MEDICATION MANAGEMENT MARKET IN TERMS OF DISRUPTIONS AND TRANSFORMATIONS IN THE ARENA?

Just like everything else, the ongoing pandemic has caused some supply chain issues in the medication market. We've been methodical on how we plan out the ordering of our medications. For instance, we're opening a new hospital next week and we wanted to make sure that we had enough lead time on obtaining these medications. So, our pharmacists are working really closely with our partners and HCA to determine how long it's going to take them to get the medications for the current locations. They are also making sure that we have all medications in place well before opening our new hospital, so most of our medications are already loaded in our Pyxis machines. We held off on loading any of our controlled substances in the machines because there are a lot of people near the building, and construction is still wrapping things up. Also, we ordered medications a couple of days before to give us enough time to get them all loaded. We did that so when our patients start arriving next week, we have everything we need to provide high-quality care for our patients from the start.

"If We Had About 100 Hospitals Across The Nation, And We Tell Them That A Drug Is Not Affordable, Then Rather Than Going To Somebody Else, They're More Willing To Negotiate And Drop Their Prices"

Q5. DO YOU HAVE ANY PIECE OF ADVICE THAT YOU WOULD LIKE TO IMPART TO A PROFESSIONAL WHO LOOKS TO EMBARK ON A SIMILAR JOURNEY ALONG THE LINES OF YOUR EXPERIENCE AND BACKGROUND?

A piece of advice I would like to give is to find the right partnership. Acute care settings, which are different from rehab settings, are usually expanding, have vast amounts of experience opening new centers, and buying out other hospitals. In the rehab world, not many are opening additional freestanding hospitals, and if they do, they don't have their own dedicated pharmacy. By opening a freestanding hospital, they have partnerships with different pharmacy companies that send them pre-packaged medications. So, our pharmacist, Erin, was able to find someone well versed up north in the pharmaceuticals industry. We partnered with an external vendor to make sure that our sterile compounding is done, we don't have any liabilities that would put us at risk, and we pass our life and safety inspections. The vendors also help us make sure that all our policies are in place and we can open up on time. Some of the biggest things in finding the correct partner is doing a very diligent search for someone who fits into your culture, is detail oriented, and well versed in pharmaceutical ordering. During the pandemic, we took a chance and ordered all of our Pyxis medication machines well in advance to opening up the hospital. We knew that by doing this, we are possibly setting ourselves up for something being lost, stolen, or damaged, and once we took possession of that, it would be our responsibility and liability. Luckily, we made that decision, because now we are opening and we're hearing about other local hospitals who did not order those machines early, having problems opening their hospitals.