With readmission rates on the line due to the ACA’s 2012 Hospital Readmission Reduction Program (HRRP)—which imposes penalties for higher-than-expected risk-standardized, 30-day unplanned readmission rates for six conditions—hospitals would be remiss if they didn’t establish an effective program to improve their measures.
The Medicare Payment Advisory Council (MedPac) estimates that 12% of readmissions are potentially avoidable. Preventing even 10% of them could save Medicare $1 billion.
As pharmacists move farther away from their traditional role of only dispensing medications and accept responsibility for medication therapy management, hospitals are leveraging their expertise and placing them at the forefront of readmission reduction programs.
Role of pharmacists in readmissions programs
Eric Maroyka, PharmD, director, Center for Pharmacy Practice Advancement, ASHP, believes that pharmacists could play many roles in readmissions programs:
- Conducting full medication reconciliation from hospital admission through discharge.
- Offering recommendations, such as eliminating unnecessary or harmful medications, optimizing dosing, and suggesting alternative therapies to a medical team.
- Making changes independently to medication therapy based on practice scope and collaborative practice agreements.
- Assisting with care coordination and patient navigation near the time of discharge, providing patient education, and scheduling follow-up visits for medication management services.
- Coordinating with pharmaceutical assistance programs, insurance carriers, and community or outpatient pharmacies to access and afford medications.
- Ensuring medication adherence.
“An interprofessional and complementary approach using the pharmacist as the medication expert will add a necessary dimension to ensure an experience every patient deserves to improve access, cost, quality, and overall interprofessional team resilience,” Maroyka says.
While he has pinpointed the extensive role of pharmacists in readmission reduction programs, Maroyka is well aware of the challenges of such endeavors.
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“Electronic health record interoperability remains a significant barrier across patient care settings,” he says. “This contributes to communication breakdowns and making less-informed decisions about patient care when accessing disparate data systems with incomplete or incorrect patient information.
“In addition, it is necessary to ensure staff competency enabling the pharmacy to have the capability and capacity to consistently support interprofessional care transition efforts across a continuum of care,” Maroyka says.
Pharmacists at BayCare
BayCare Health System, a not-for-profit healthcare system in Tampa, Florida, introduced its Pharmacy Transitions of Care Program (PTOC) as a pilot in 2014, with two pharmacists in one of its 15 hospitals. The program has since grown to 23 pharmacists and has expanded to all its hospitals. It targets Medicare A and B beneficiaries with primary diagnoses of a CMS core measure who are discharged from a hospital to home or an assisted living setting.
Timothy L’Hommedieu, PharmD, director of pharmaceutical services, East Region, BayCare Health System, credits the healthcare industry’s shift to value-based care for the initiation of PTOC.