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Hospital clinics and outpatient departments that bill Medicare for unused portions of certain medications recently gained six additional months to meet newly mandated documentation and billing requirements. In a June 10 communication, the Centers for Medicare and Medicaid Services (CMS) announced

Implementation of a syringe pump system for delivery of intermittent i.v. drug doses in a 452-bed teaching hospital is described; the system was evaluated for cost effectiveness one year after implementation. Drugs to be administered by syringe pump were diluted to concentrations recommended for i.v. push administration and then administered over 22-30 minutes. For batch preparation of more than 100 syringe doses, an automated dispensing pump was used. Before the syringe pump system was implemented hospitalwide, costs were predicted on the basis of data from the pharmacy's computerized i.v. administration records. In the first year after hospitalwide implementation of the system, 4687 patients received 113,898 doses of intermittent i.v. medications by syringe pump; this represented approximately 73% of all intermittent i.v. doses. The remaining doses were dispensed in minibags, and no substantial problems resulted from concurrent use of both systems. Based on current contract prices, use of the syringe pump system resulted in savings of more than +79,000 during the first year. Implementation of a syringe pump system for administration of most intermittent i.v. medications resulted in substantial cost savings.

Pharmacy department costs for preparing and administering intermittent i.v. drug doses using a piggyback bottle system and a syringe pump system were predicted and compared. Centralized i.v. admixture service personnel time for preparation of small-volume injections in piggyback bottles was recorded for 14 days. After a four-week orientation of personnel to the syringe pump system, personnel time for preparation of doses in this system was recorded for 14 days. Material costs were itemized for each system and annual costs were predicted. Costs were calculated on the basis of the previous year's purchasing data, assuming that 80% of intermittent i.v. drug doses could be given by the syringe pump system. Syringe pump system costs were calculated for administration of one to eight drug doses through each secondary infusion set; 5-mL and 10-mL syringes were used. Preparation time was slightly longer for the syringe pump system than for the piggyback bottle system; the annualized personnel cost difference was $0.012 per dose. Based on one dose per secondary infusion set, material costs were higher for the syringe pump system. Based on administration of four doses through each secondary infusion set, overall costs were lower for the syringe pump system. Lower material acquisition costs for the syringe pump system could result in pharmacy department cost savings if at least four intermittent i.v. drug doses were administered through each secondary administration set.

The cost impact of converting from a hospital-mixed (HM) system for preparing antineoplastic-drug doses to a manufacturer-mixed bulk package (MMBP) system in a 565-bed comprehensive cancer center is analyzed. The cost per dose for nine antineoplastic agents--bleomycin, cisplatin, cyclophosphamide, doxorubicin, fluorouracil, methotrexate, mitomycin, vinblastine, and vincristine--was assessed for each system. The average dose for each drug was determined by reviewing nearly 2200 physician orders collected over nine days. Cost per dose was calculated by allocating the costs associated with the production of multiple-dose containers and withdrawal of a single dose. A time-and-motion study using standard industrial engineering methodology measured labor times for all tasks associated with the production of drug doses. Calculated costs included direct labor, drug expense, supply expense, drug waste, waste removal, overhead, management labor, and inventory reduction. Operating costs (labor, supplies, overhead, and waste and waste removal) were reduced by an average of 26% per dose for all drugs, using the MMBP system. This institution produces a high volume of antineoplastic admixtures; thus, the impact on operating costs is likely to be different in other institutions. The total measured operating and drug acquisition costs decreased for three drugs, marginally increased for five drugs, and increased substantially for one drug. Based on this institution's use of the nine antineoplastic agents, the total first-year savings from conversion from the HM system to the MMBP system would be $31,219, including a one-time inventory reduction of $94,621. However, in subsequent years, use of the MMBP system would result in increased costs of $63,402.(ABSTRACT TRUNCATED AT 250 WORDS)