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V-A UNIT-DOSE DRUG DISPENSING WOULD BE EXPANDED MORE QUICKLY BY CLINTON

Executive Summary

V-A UNIT-DOSE DRUG DISPENSING WOULD BE EXPANDED MORE QUICKLY BY CLINTON economic stimulus package issued in February. In the "public investment" chapter of his economic stimulus/deficit reduction plan, "A Vision of Change for America," President Clinton included a Veterans Affairs Department quality-of-care initiative that calls for "automating drug dispensing at V-A hospitals." The initiative proposes to spend a total of $2.5 bil. over FY 1994-1997 for three activities: accelerating drug dispensing improvements; hiring more staff to comply with new limits on the working hours of medical residents; and enabling both existing and newly activated V-A facilities to meet quality-of-care standards, including revised accreditation requirements and addition of specialized and high technology services. The allocation of funds among these three areas has not been set. "Lack of accountability in V-A's inpatient drug distribution system has been identified as a material weakness," a department summary of the proposal states. "Conversion from a ward-stock system of distribution for inpatient medications to the unit-dose distribution system enhances accountability." In V-A's FY 1993 appropriations, the department received full funding of its request to spend nearly $7 mil. this year to expand unit-dose dispensing using automated dispensing technologies. The request was estimated to allow conversion of 4,320 beds with the net result that 87% of V-A hospital beds would have access to unit-dose dispensing by the end of 1993. About 75% of beds are converted at this time. The V-A serves almost 970,000 hospital inpatients annually with an average daily census exceeding 42,000. Another V-A proposal contained in the Clinton Administration plan would make permanent the $2 copayment for each 30-day supply of an outpatient prescription drug used for treating a condition that is not a military service-related disability. Legislative authority for the current copayment policy extends into 1997. Making the copay permanent would yield estimated savings of $42 mil. in 1998. The administration also proposes to institute a prospective payment system -- "similar in concept" to Medicare's diagnosis- related group (DRG) system -- for allotting funds between V-A hospitals. "In general, the current allocation system simply retains the past year's allocation among medical centers and then adds funds for inflation and special projects," the Clinton document explains. "Little or no changes are made...to reflect potential improvements or efficiencies in current operations." Potential savings are placed at $400 mil. in 1997 and $1 bil. over four years.
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