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    Why hospitals should set up chief pharmacy officers

    With greater responsibility for the pharmacy profession ought to come greater recognition. That was the message at the 10th annual ASHP Conference for Leaders in Health-System Pharmacy held recently in Chicago.

    "Last summer, at my inaugural address, I expressed my hope that pharmacy wouldn't crumble like coal but become a diamond profession," said ASHP president Jill E. Martin, Pharm.D., FASHP. "At the time, we did not know the pressure of hurricanes Katrina and Rita."

    Competing pressures over cost and safety, as well as other factors, have combined to create the "perfect storm" in pharmacy, according to speaker Marianne F. Ivey, Pharm.D., MPH, FASHP, corporate director of pharmacy services for the Health Alliance of Greater Cincinnati and vice-chair and associate professor of pharmacy practice at the University of Cincinnati.

    Ivey said that such factors necessitated the emergence of chief pharmacy officers (CPOs) in healthcare systems. Trends that made it necessary for pharmacists to have access to senior management at a higher level include "the pressure on the revenue cycle and the complexity of the billing side in pharmaceuticals," Ivey said. Other factors include the current attention on medication safety and the emergence of the Medicare Part D benefit.

    In addition, pharmacists' traditional activities make a senior role appropriate, Ivey said. For instance, pharmacists have also played a role in clinical trials as well as serving on P&T committees. "Pharmacists control drugs that do not have Food & Drug Administration approval. They provide the placebos and do the blinding so the doctors and nurses don't know which arm of a trial a patient is in," she said.

    Ivey listed other functions traditionally and more recently fulfilled by pharmacists, which made their participation in senior-level decision-making necessary, such as rolling out computerized physician order entry programs. "Pharmacists are often the only ones in medical centers who know how to set up relationships" with pharmaceutical distribution centers and group purchasing organizations, Ivey said.

    Finally, Ivey cited statistics that show the increasing financial importance of the pharmaceutical side to a healthcare system. Pharmacy departments often produce 25% of an organization's gross operating revenue and contribute 30% of total supply expense, she pointed out. She estimated that 15% of an organization's technology costs are in pharmacy and that pharmacists save $16 for every dollar spent on pharmacists, she said, citing an article by Lee Vermeulen and colleagues, which quantify the benefit of pharmacists' services to an organization.

    Ivey went on to note that the salary structure of pharmacists has been driven by shortages for the past seven years. "For my staff, from the late '90s to now, starting salaries have doubled. Post-docs get an increment more," Ivey said, adding that salaries for some CPOs are in the six figures. "One thing in pharmacy that is a bit of problem is that while our salaries start out quite high, they plateau."

    Ivey also noted that even though she is virtually performing the functions of a CPO, she has not managed to obtain such a title for herself yet. "I spoke to my boss, and he said, 'We don't have to change your title for you to be doing what you're talking about,'" she said.

    One pharmacist who has been elevated to the rank of CPO is David A. Kvancz, M.S., R.Ph., FASHP, chief pharmacy officer for the Cleveland Clinic in Ohio, and adjunct professor at Ohio State University and Western College of Pharmacy in Glendale, Ariz.

    "I'm familiar with one other individual who has the title," Kvancz said. "I'm sure there are more, but Ron Small at Wake Forest Baptist University Medical Center in North Carolina, who has moved up to a VP of quality outcomes, was one of the first people I knew of who had this title."

    What do you think?

    Should hospitals initiate the roleof chief pharmacy officer? Let us know what you think. Send an email with your comments to

    THE AUTHOR is a writer based in Chicago.

    John Otrompke
    John Otrompke, The author is a writer based in Chicago.