Medicare says it spends more than $17 billion a year on hospital readmissions that could have been prevented if Medicare patients had gotten the right care. A leading problem is that patients don't take their medication properly after leaving the hospital.
Western Maryland Health System (WMHS) in Cumberland, Md., is on the cutting edge of the effort to reduce unnecessary hospital readmissions that result from patients failing to take medications properly after leaving the hospital.
The hospital is a leader in "bedside pharmacy" - a best practice technique that focuses on educating patients on discharge day about the importance medication adherence. The innovative practice also makes sure patients aren't thwarted by price, availability or complexity when trying to adhere to their post-hospital medication regimen.
"Bedside pharmacy" is a fascinating new best practice idea because it solves two problems at once - it improves patient health and reduces the potential of penalties under the Affordable Care Act for avoidable readmissions.
How can hospitals fix the financial risk and improve patient outcomes? Hospitals are trying new ways to better educate patients and caregivers about taking medications properly after discharge. Western Maryland Health System (WMHS) is one of true innovators on the issue, especially in its efforts to involve community pharmacists. The result is an informative case study about how the continuum of care improves when the hospital and community pharmacy coordinate the transition from hospital to home.
Take a look at one success story. WMHS had been partnering with a local retail pharmacy, PharmaCare to deliver pharmacy services to its nursing home and infusion and chemotherapy support services. In 2011, the hospital expanded its relationship with PharmaCare to include a new patient discharge process. The new program included in-depth medication plan reviews with patients, plus specific directions for post-discharge follow-up.
The primary goal? To reduce hospital readmissions by improving patients' understanding of their medications. Changing the hospital-retail pharmacy partnership created a win-win situation for everyone -- the hospital, the pharmacy and, more importantly, for patients. A great side effect - this practice reduces the burden on Medicare too due to lower re-admission rates.
Here's how it was done, and the key takeaways from this successful program:
The pharmacist visited patients in their rooms - thus, the new term "bedside pharmacy." The pharmacist checked each patient's chart to review key information, such as the patient's admitting diagnosis and any other diagnoses, as well as admitting medications and home medications. The pharmacist reviewed this information to ensure that no home medications were duplicated or missed. The pharmacist counseled each patient and walked him or her through the full medication regimen. Each medication was shown directly to the patient --- an opportunity for the pharmacist to explain the drug's purpose, schedule, directions and potential side effects. During this process, some patients would recognize medications that they were already on but hadn't listed on paperwork. This process increased the likelihood that the patient, along with family or caregivers in the room, understood the need for each medication, how to realistically maintain the treatment regimen and what side effects to expect.
Just as noteworthy, patients have provided positive feedback in the hospital's discharge surveys. Patients' positive ratings on medication education and discharge instructions improved from about 65 percent to more than 90 percent.
An additional benefit was that patients learned how much prescriptions would cost outside the hospital. If necessary, the hospital could shoulder some of the cost of extremely expensive drugs to promote adherence. The hospital also could tap into manufacturer-sponsored patient assistance programs to help ensure that patients were financially capable of filling those prescriptions after their initial discharge. These efforts reduced readmissions by minimizing cases in which patients don't fill any prescriptions or only filled the cheapest ones.
Good patient care doesn't have to cost the hospital more money. PharmaCare's business has improved, too. The pharmacy estimates that20 to 30 percent of the hospital's outpatients continue to fill their medications at PharmaCare. Some patients' family members have moved their business, too. This leads to additional revenue for the retail pharmacy and, more importantly, ensures patients have continuity of care after they leave the hospital.
Better care. Fewer readmissions. Lower costs. It's an example of how collaboration between community pharmacists and hospitals can achieve the goal of cost-effective healthcare.