Cost of providing pharmaceutical services to hospice patients

The cost to a hospital pharmacy department of providing pharmaceutical services for a hospice program was studied. Drug acquisition costs were tabulated for all prescriptions dispensed to patients in the hospice program from April 1, 1992, to March 31, 1993. Direct time studies were conducted to determine the average personnel time involved in dispensing a prescription for a hospice patient. To determine the personnel time associated with auxiliary activities, self-reporting and work-sampling techniques were used. Indirect and delivery costs were also calculated. Relevant resource inputs were identified, measured, and valued by using both observation and pharmacy records. A total of 5640 hospice prescriptions were dispensed by the outpatient pharmacy; these represented 30% of all prescriptions dispensed. The average cost of dispensing a hospice prescription was $14.91 (total annual costs less drug acquisition costs). The total annual cost of providing pharmaceutical services to the hospice's patients was $196,607, and the total annual reimbursement received from the hospice program and self-paying patients was $155,623; therefore, costs exceeded revenues by $40,984. The cost to a pharmacy department of providing pharmaceutical services to patients in a hospice program substantially exceeded revenues. Greater efficiencies, a change in the pricing structure, or both may be necessary.