Hospital readmission reduction program: A golden opportunity for pharmacists
By Kinjal Patel
Pharmacists across the United States have argued for expanding their role beyond dispensing. The Patient Protection and Affordable Care Act, which has put the current healthcare system in the midst of dramatic changes, provides opportunities long awaited by pharmacists.
Many healthcare professionals and healthcare institutions are pushed to employ newer models of healthcare delivery to provide cost-effective care as the ACA now advocates for a fee for performance model. The Centers for Medicare and Medicaid Services is currently focusing on hospital readmissions rate as a major indicator of performance. Almost 20 percent of the patients discharged from hospitals are readmitted within 30 days, costing CMS approximately $12 billion per year. Reducing readmissions can help CMS save billions each year while improving outcomes for patients as over 75 percent of the readmissions are deemed unnecessary.
A section of the law allows CMS to implement the Hospital Readmissions Reduction Program (HRRP), which reinforces the importance of medication reconciliation and counseling in reducing unnecessary hospital readmissions. If taken advantage of, this opportunity will allow pharmacists to improve patient care while saving millions of dollars for their employer hospitals and our healthcare system.
The main goal of healthcare reform is to provide cost-effective healthcare services for all Americans. Section 3025 of the Affordable Care Act added section 1886(q) to the Social Security Act, which requires CMS to initiate cost-effective measures to reduce payments to the Inpatient Prospective Payment System hospitals with high rates of readmission. In response to section 1886(q), CMS introduced the HRRP to identify and penalize the hospitals with excessive readmission rates.
Per HRRP, a hospital’s readmission rate is compared to the national readmission rates for similar hospitals using excess readmission ratio calculation. As of now, CMS has developed such calculation for acute myocardial infarction, heart failure and pneumonia, which are termed “index admissions.” If patients are readmitted for any cause within 30 days of the index admission — with some exceptions — the readmission is liable for the penalty which is incurred by the hospital where the index admission occurred.
The payment penalty as of Oct. 2012 is as much as 1 percent of all annual Medicare reimbursements, which will eventually increase to 3 percent by FYI 2014. In 2015 additional index admissions will be added to the current list and may include COPD, CABG and PTCA procedures among other vascular issues. Over 2,000 hospitals are on CMS’ list to incur this penalty, and the total estimated cost is about $243 million annually.
Poor transformation of information to patients and primary caregivers is one of the most common reasons leading to hospital readmissions. In addition, about 19 percent of readmissions are related to an adverse drug reaction. Most patients do not understand how to use their medications upon discharge or how to recognize emergent situations. Many sources blame inadequate disclosure of drug therapy and expected side effects as well as inadequate medication reconciliation leading to duplication of therapies, among other reasons.
Pharmacists are well positioned to reduce hospital readmission by performing medication reconciliation at admission and upon discharge. In addition, pharmacists are well trained in the area of patient counseling. Pharmacists can also act as a link between the primary care provider and the patient as they are the most accessible healthcare professionals in the community.
Many community and institutional programs have been developed to help reduce hospital readmission rates and the importance of medication reconciliation and discharge medication counseling is stressed in all of these models. Pharmacists have been proven to be a valuable addition to healthcare teams in clinical studies, however, their role has been limited to specific conditions such as hypertension and diabetes. Pharmacists have also helped with medication adherence that resulted in improved outcomes for patients with heart failure and patients taking anticoagulants.
The new rule allows pharmacists to reduce readmissions for all causes of hospitalization following an index admission. Few hospitals, such the Piedmont Hospital in Atlanta, have found great success with reducing their readmission after employing pharmacists to do all medication reconciliation and counseling. Walgreens, a giant retail pharmacy, has also recognized the need of transition care and has implemented its “Well Transition” program where the role of a community pharmacist is found to be critical.
The penalties for readmissions are already being enforced, but many hospitals are not using the most valuable resource available to them. In that case, it is up to the individual pharmacists to reach out to their administrators and ask for opportunities. Although HRRP does not dictate that only pharmacists must perform medication reconciliation and discharge counseling, pharmacists are most able to perform them as they have the most appropriate training in the area.
If pharmacists do not take charge of their role in healthcare, other healthcare professionals with less drug expertise will have to step in and take their place. Although a nightmare for hospital administrators, the HRRP allows many opportunities for pharmacists to prove their role in healthcare. Most of all, it gives them the opportunity to enhance patient care.