Reducing unnecessary hospital readmissions: Time to think inside the box

As of October 2015, 2,592 hospitals will lose a combined total of $420 million in reimbursements, penalized for failing to meet readmissions targets set by the Centers for Medicare and Medicaid Services (CMS) under the Affordable Care Act's Hospital Readmissions Reduction Program.

With the maximum CMS penalties as high as 3%, the financial consequences of missing this performance target weighs heavy on the minds of hospital c-suite executives. This year's penalties represent an increase of 85% from $227 million in penalties imposed in 2014. It's no surprise that in a recent article in Becker's Hospital Review, CEOs cited financial challenges, including reimbursements from Medicare and Medicaid, as the most pressing issue facing their organizations.

As hospitals continue to grapple with the most effective steps to take to keep patients recovering safely at home, the answer might come from a resource often overlooked by hospital leadership – the hospital pharmacy.

Pilot programs conducted by Comprehensive Pharmacy Services (CPS) at three hospitals produced significant reductions in unnecessary readmissions – of up to 40%, through pharmacist-driven medication management initiatives.

The Challenge
Statistics paint a bleak picture of the challenges confronting hospitals as they work to stem the tide of unnecessary readmissions:

  • Nationally, almost 20% of Medicare patients will be re-admitted to the hospital within 30 days of discharge;1
  • Over 66% of emergency readmissions for patients over 65 years old are due to adverse medication events;2
  • Nineteen percent of Medicare discharges are followed by an adverse medical event within 30 days, and 2/3 of these are preventable;3
  • Twenty percent of patients do not fill their prescriptions.4

That medication management issues are among the primary drivers of unnecessary hospital readmissions makes the role of the pharmacist critically important in care transitions. The hospital pharmacist has the clinical skills, expertise and pharmaceutical knowledge to ensure an effective medication management program. When working directly with a patient, a pharmacist can help improve medication adherence, eliminate duplicate medication therapies and preempt possible side-effects that lead to a patient reducing their medication compliance or discontinuing their medication therapies altogether.

Research shows that engaging patients with credible information delivered by a pharmacist delivers results. Having a pharmacist involved in care transitions reduced medication-related emergency department visits and drove down hospital readmissions within 30 days after hospital discharge from 8 percent to 1 percent.5 Post-discharge phone calls by pharmacists to patients reduced 30-day readmission rates from 21.4 percent to 10.6 percent.6 A University of California study indicated that when a clinical pharmacist participated in the discharge process and provided follow-up calls with the patient, the readmission rate dropped by more than 50%.7

Stemming the Tide of Unnecessary Readmissions: Three Success Stories
Unlike other healthcare professionals, a pharmacist doesn't need to be on-site to have an impact. The widespread prevalence of technology, from handheld devices to the near ubiquity of Wifi and internet access, make telepharmacy both a viable and cost-effective option for delivering personalized medication management.

CPS partnered with each of the three hospitals to customize a pilot program specific to the hospital's needs and delivered by CPS' telepharmacy remote group. The CPS telepharmacy team had access to the hospital's EHR, the ability to document patient interactions within the hospital's system and provide customized reporting to the primary care physician or case manager.

All programs were scalable by disease, population, and payer, so if the results proved to be positive the hospital was well positioned to move to full implementation.

Hospital #1, a rural, non-profit acute care hospital, piloted a post-discharge program delivered to 552 patients. A CPS remote pharmacist conducted an abbreviated post-discharge medication reconciliation and at-home follow-up call. Pharmacists assessed the patient's understanding of their drug therapies, screened for clinically significant side effects, as well as checked that discharge orders were filled and patients knew about follow-up labs and physician appointments. When necessary, patients were referred to their physician or emergency services or the site's outpatient pharmacy if assistance was needed in obtaining discharge medications.

Hospital #2, a rural mid-size non-profit hospital, piloted a disease state specific discharge program. The 438 patients enrolled in the pilot had one of the CMS targeted penalty groups; chronic heart failure, COPD, pneumonia or heart attack.
The pharmacist conducted discharge medication reconciliation and performed drug counseling at discharge, and patients received a post-discharge follow-up call with clinical interventions.

Hospital #3, a large urban hospital, piloted a discharge medication reconciliation program targeting its heart failure unit. The CPS telepharmacist provided medication reconciliation, identified discrepancies and contacted the provider for any needed changes, updating the patient's discharge medication list in the hospital's EHR.

The Results
According to CMS, during the calendar year 2012, the readmissions rate average was 18.4 percent.8 Each of the three hospitals posted significant reductions to unnecessary readmissions, reaching levels far below the national average:

Hospital 1 16.4% to 9.9% (39.6% improvement)
Hospital 2 18.6% to 14.0% (24.5% improvement)
Hospital 3 16.1% to 13.0% (19.0% improvement)


1- Medicare hospital readmissions: Issues, Policy options and PPACA
2- Budnitz DS, Lovegrove MC, Shehab N, Richards, CL. Emergency hospitalizations for adverse drug events in older Americans. N Engl J Med. 2011;365:2002-2012.
3- Medicare hospital readmissions. Issues. Policy options and PPACA
4- Ibid
5- The role of pharmacist counseling in preventing adverse drug events after hospitalization. Arch Intern Med. 2006
6- ASHP-APhA Medication Management in Care Transitions Best Practices. 2013.
7- The Impact of Follow-up Telephone Calls to Patients After Hospitalization, Dudas, Bookwalter, Kerr, Pantilat; Am J Med. 2001; 111(9B):26S-30S.
8- Data shows reduction in Medicare hospital readmissions rates during 2012. Medicare & Medicaid Research Review. 2013: Volume 3, Number 2.

Jeff Lackman has over 30 years of pharmacy management experience in retail, hospital and hospital systems. He joined CPS 13 years ago. In 2012, he was promoted to Division Vice President over CPS' telepharmacy resources, Rx Remote Solutions. The group continues to expand and develop innovative products for clients and patients.

Bonnie Loos has been engaged in a broad range of pharmacy services for over 35 years including hospital, retail, LTC and insurance. A graduate of Butler University school of Pharmacy, she joined CPS as a Corporate Director of Pharmacy and currently is the Project Manager responsible for the development and implementation of the company's Transitions for Care services.

The views, opinions and positions expressed within these guest posts are those of the author alone and do not represent those of Becker's Hospital Review/Becker's Healthcare. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them.

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