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Study links medication management learning to decreased hospital readmissions, improved quality scores

Education is a key component to improved performance.

It's not uncommon for patients to be discharged from the hospital and need to return a few weeks later with similar or related medical problems. Practices struggle with readmission rates and other key CMS services, despite intensive and structured approaches to address these issues. This is a particular problem when chronically ill patients, such as Medicare patients, are involved. In fact, readmission rates for Medicare patients are as high as 26 percent, according to the HealthCare Cost and Utilization Project.

Our practice, Quality Independent Physicians, developed a study to determine whether enhanced medication management learning could decrease hospital readmissions as well as help us enhance quality scores for high risk ambulatory sensitive conditions. The study results gave us a deeper understanding of what we needed to implement to improve our quality measures .

A Large ACO Assesses Today's Emphasis on Quality

QIP is a large Accountable Care Organization, with more than 50 physicians treating approximately 12,000 patients in Southern Indiana and Kentucky. As participants in the Medicare Shared Savings Program, we report more extensive quality measures to CMS than most practices, and our Medicare reimbursements are based on the results.

QIP conducted this study both as part of our commitment to high quality patient care and because of the increasingly stringent demands of today's healthcare marketplace. These changes were launched with The Affordable Care Act which has transformed the traditional fee-for-service paradigm, replacing it with a pay-for-performance model. CMS places strong emphasis on patient readmission rates for any practice, and particularly for ACOs.

In addition, our physicians were aware of a recent government analysis finding that 134,000 Medicare beneficiaries suffer from adverse medication reactions every month, many of which were clearly or likely preventable. In fact, the Institute of Medicine at the National Academy of Sciences has reported that medication errors alone harm at least 1.5 million people every year in the U.S., costing the healthcare system over $2.1 billion annually. It was statistics like these, and our desire to deliver the best care to our patients, that motivated us to implement this medication management learning program.

Essential Tools for Success

Our study evaluated rates of patient hospitalization and readmission, using data from 2009 to 2013 as a baseline. We compared these with the 15-month period from January 2014 to March 2015.

QIP partnered with Prescriber's Letter medication management learning program to develop the study. As a first step, we incorporated Prescriber's Letter medication recommendations into discussions with our Evidence-Based Medicine Committee, and update our clinical guidelines on an ongoing basis. The study's main focus was on high-risk disease states for ambulatory-sensitive conditions – including chronic obstructive pulmonary disease, heart failure, bacterial pneumonia, hypertension, anticoagulation, diabetes and acute coronary syndrome. These conditions are prevalent among a substantial portion of the Medicare population, and therefore their care impacts hospital admissions and readmissions, other CMS quality measures, and reimbursement rates for the ACO.

Prescriber's Letter supported us with customized educational resources that communicated the best medication recommendations for target disease states. They partnered with QIP for seven months to deliver the latest drug information to the point-of-care, and measured the impact of the intervention for several months afterwards. QIP was given useful tools as unbiased articles on optimal medication use, coverage of disease-specific quality measures, drug comparison charts, patient education materials, and online searchable medication management recommendations. Detailed documents on particular topics were also available to those who wanted to drill down for more information.

All material was delivered in a straightforward, concise style that facilitated sharing across the ACO. This helped us align therapies across providers as well as streamlined transitions-of-care, supporting greater efficiency, lower costs and enhanced patient satisfaction. The program's objective, evidence-based framework was essential to encourage physicians to adjust their current practices, if appropriate.

Throughout the study, staff met monthly for meetings within their practice and across the ACO to review materials, modify medication guidelines as needed and incorporate them into standard treatment protocols and policies. This also was essential to the study's success.

Patient education materials were essential to the success of this program. Patient care coordinators served as communication liaisons, and met with high-risk patients to ensure adherence to treatment recommendations, access to medications, understanding of red flags for worsening of their condition, and address other concerns.

Significant Quality Improvements Realized

The results were clear, with our Medicare Shared Savings Program (MSSP) Utilization Reports showing a statistically significant improvement in multiple quality measures on the MSSP Utilization Report. Because CMS ranking and reimbursements are determined by comparing ACOs to one another, we achieved great results and improved our quality metrics.

Hospitalization rates across all disease states decreased by 13 percent per 1,000 person- years, and 30-day readmission rates fell from 170 to 160 per 1,000 person-years.
This translates into a savings of $130,000 per 1,000 patients based on the average area readmission cost of $13,000 per patient. Cost savings were realized for many different medically managed diseases.

The results illustrate the importance of medication management education as a part of standard practice-wide guidelines for care. Though our focus was on high-target disease states, the same methodology could possibly be applied to other conditions.

In conclusion, we believe strong medication management learning, with up-to-date guidelines and clinician buy-in across the ACO, has substantially reduced hospital readmission rates, increased CMS quality metrics and benefited our patients, physicians and practices for the future.

Dr. Greg Hood is a medical director for "Quality Independent Physicians", an ACO in the greater Lexington and Louisville, KY areas. He is an internist in private practice and a Master of the American College of Physicians, as well as a former Laureate and governor of the Kentucky ACP chapter. Dr. Hood has extensive experience in matters of health policy, quality improvement and advocacy for both patients and the medical profession. He is the principal investigator of ongoing studies regarding the enhancement of safe, effective chronic pain management.

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