BETHESDA, MD 30 July 2012—When patients are ready to be discharged from St. John's Hospital in Springfield, Illinois, they have a new option—having take-home medications delivered to their bedside, where they receive discharge counseling from a pharmacist affiliated with a regional community pharmacy chain's specialty pharmacies.

"It really seemed like a no-brainer," said Ginger J. Ertel, the hospital's pharmacy director, about the arrangement between St. John's and Schnuck Markets Inc., a grocery-store-based pharmacy chain that also operates a handful of specialty pharmacies in Illinois and Missouri.

"This is a great opportunity for us to make sure the patients receive [and] get counseled on their medications so they have a have greater chance of them taking them when they leave the hospital," Ertel said.

The specialty pharmacy opened in May at St. John's on the site of an outside-operated community pharmacy that was shuttered several years ago. Ertel said St. John's had considered operating its own outpatient pharmacy but also contacted local pharmacies to see if they wanted to lease the space from the hospital.

A Schnucks pharmacist who works with "almost all the HIV patients in town," as well as transplant recipients and hepatitis C virus-infected patients, was interested in moving from her grocery store location to the St. John's campus, Ertel said.

Ertel hopes the revamped discharge process at the 431-bed hospital will reduce readmissions by improving postdischarge medication adherence.

"It is about the patient and patient care. The patients so far love it, and the nurses love it. And that's our main goal; we want to make it convenient for the patients," Ertel said.

Ertel said the bedside delivery and counseling services are available to all patients at St. John's, not just those with special medication needs.

She said it took almost a year to set up the new, 2000-square-foot pharmacy, including time spent remodeling the space and educating the nursing staff about the new services.

The St. John's facility is the first standalone specialty pharmacy operated by Schnucks in Illinois, according to the company. The pharmacy is open to the public, and anyone can have their prescriptions filled there.

Discharge counseling. Patients are told about the availability of the new pharmacy services on admission to the hospital. Those who choose to participate are counseled by a pharmacist at the bedside before leaving the hospital with their discharge medications.

"The majority of time, Schnucks will be doing the counseling, because they're going to be delivering the medications to the patients," Ertel said.

She said the specialty pharmacy's personnel take care of issues with insurers, like prior-authorization requirements, that patients would otherwise have to deal with themselves at their local pharmacy.

Ertel said the specialty pharmacy in May employed two full-time pharmacists and a pharmacy technician. Pharmacy students from Southern Illinois University School of Pharmacy in Edwardsville come to the pharmacy for experiential rotations, and two postgraduate year 1 residents were scheduled to start at the pharmacy in July.

The inpatient pharmacy staff consists of about 54 full-time-equivalent employees, plus five pharmacy residents, Ertel said.

The patient care model. The discharge process isn't the only pharmacy-related change at St. John's.

Ertel said a just-completed residency project compared how well pharmacists, pharmacy technicians, pharmacy students, and nurses performed the medication reconciliation process for newly admitted patients.

She said the technicians did an outstanding job, probably because they are motivated to get the reconciliation right and ask a pharmacist for help if they have any questions.

"So we're changing the technician model and putting the technicians at the front lines to do the medication reconciliation, with pharmacist support for questions," Ertel said. "We're going to help make sure that the patients are on the right medications and that we're getting a correct medication reconciliation coming in and a correct one going out."

St. John's also plans to have the Schnucks pharmacy handle prescriptions dispensed through the federal 340B Drug Pricing Program, which will be a new service for the hospital. Ertel said the hospital in May was finalizing its arrangements for 340B program participation.

The 340B program was created in 1992 to limit the cost of outpatient drugs purchased for low-income patients by hospitals and other eligible institutions.

Illinois Governor Pat Quinn on June 14 signed into law the Save Medicaid Access and Resources Together (SMART) Act. Among other things, the SMART Act requires all hospitals that qualify for the 340B program to enroll in it. The SMART Act also requires hospitals that participate in the 340B program to use it for the purchase of outpatient drugs for Medicaid patients.

A late June conference call convened by the Illinois Hospital Association underscored the confusion surrounding compliance with the SMART Act's 340B-related provisions.

Unsettled issues discussed during the call included whether contract pharmacies must comply with the new law and whether hospitals that don't meet current 340B requirements must make changes that would render them eligible for the program. In theory, such changes could include entering into state contracts for the care of indigent patients or severing relationships with group purchasing organizations.

An emergency proposed rule from the state health department requires 340B-eligible pharmacy providers to enroll in the program by October 1.