Addressing Hospital Readmissions by Smarter Medication Management
Stakeholders in healthcare (e.g., payers, consumers, and providers) are ferociously pursuing value defined as the highest quality care at the lowest cost achievable. As a healthcare executive and a clinician who cares about controlling costs while ensuring the highest quality care, I remain focused on hospital readmissions.
A key to reducing the cost of care is to reduce utilization of expensive and unnecessary services. To accomplish this, one might recommend reducing the patient’s length of stay in the hospital. However, in doing so, one would risk discharging a patient before he or she is sufficiently healed or prepared for discharge, resulting in readmission. It is no wonder that 30-day readmission rates have become an important focus of stakeholders and ties to penalties from Medicare.
The Medicare Payment Advisory Commission found that readmission rates for Medicare-targeted conditions ranged from 15 to 20 percent. Of the 3,241 hospitals that were evaluated under the hospital readmissions reduction program in 2018, 80 percent of hospitals, 2573 in total, had penalties levied against them. This lowered reimbursement rates for these hospitals by a staggering $564 million.
According to a 2016 study, almost 27 percent of readmissions were preventable. One important preventable cause of readmission is the “inadequate monitoring for medication adverse effects or nonadherence.” When this happens, patients may not get a prescription filled, refilled or take as prescribed if filled. Such causes of medication complications might range from a patient’s simple lack of understanding to cognitive or mental health limitations to social factors. While hospitals have worked diligently to improve the discharge planning and coordination process, including filling prescriptions before discharge, gaps might still remain in promoting medication adherence.
There may be meaningful opportunities to fill the gaps, reducing the rate of preventable readmissions due to complications around medications. They include:
Improved models of transitional care that coordinate the link between discharged patients with community-based medical care and other supportive resources e.g., visiting home nurses, substance abuse and mental health providers.
Greater utilization of existing pharmacy-based and payer-based medication management programs.
Mitigating the impact of the patient’s prescription drug coverage limitations.
Improvements in the medication management of discharged patients may reduce readmission rates in a significant way. This small step will simultaneously decrease costs and increase quality of care, making value-based healthcare more in reach than ever.