Pharmacists part of innovative programs to reduce hospital readmissions

Doing everything possible to ensure patients aren’t readmitted in the hospital shortly after discharge is not only in the best interest of patients, but it is in the financial best interests of hospitals. 

Since October 1, 2012, the Centers for Medicare and Medicaid Services (CMS) has reduced reimbursement for its patients who are readmitted within 30 days for diagnoses of acute myocardial infarction (AMI), heart failure (HF), or pneumonia. As a result, hospitals across the country have initiated programs to decrease hospital readmissions, including ones that are pharmacist-led.

The role of the pharmacist in preventing hospital readmissions

A commentary in the February 1, 2015 issue of the American Journal of Health-System Pharmacy (“Hospital Readmissions Reduction Program: Implications for pharmacy”) highlights some programs that have been successful in reducing the rate of readmissions in AMI, HF, and pneumonia patients.

“Preventing hospital readmissions is a complex issue and must be targeted from all sides of the healthcare system,” the commentary’s authors wrote. “It is critical that pharmacists become practice leaders by actively participating and engaging in these new healthcare delivery models to deliver improved patient outcomes and lower costs.”

According to CMS, nearly 20% of Medicare patients released from hospitals cost $26 billion annually due to readmissions. The most common diagnoses of those readmitted are HF, pneumonia, and cardiac stent placement, and the average stay for the readmitted patients was 0.6 days longer than patients who had not been hospitalized within the previous six months.

Some of the pharmacist-led programs that have successfully reduced readmission rates are:

· Barnes-Jewish Hospital in St. Louis. Pharmacy facilitates bedside prescription transactions so patients can leave the hospital with medications in hand. “This enabled 34% of [internal] medicine patients, 25% of cardiology patients, and 67% of orthopedic patients to leave the hospital with their medications,” the authors wrote.

· Cleveland Clinic targeted HF program. Patients are counseled prior to discharge, and pharmacists call patients 48 hours after discharge to discuss medications. According to the commentary, the program has reduced the readmission rate by 2.2% and will eventually be expanded to pneumonia and AMI patients.

· Einstein Medical Center in Philadelphia. The hospital’s program includes medication reconciliation, patient education while in the hospital, sending patients home with their medications, and a pharmacist telephone consultation within three days of discharge. The program has cut readmissions within 30 days by 50% in heart patients.

· Boston University Medical Center. Clinical pharmacist does telephone consultation with patients within four days following discharge. Program has reduced readmission rate by 30%.

“Many pharmacy departments will likely have to implement programs centered on medication-related issues,” the commentary’s authors wrote. “Pharmacy departments will have to prioritize which patients will benefit from interventions the most to maximize pharmacist time.”

See also:

The pharmacist’s role in transitions of care

Greatest impact of pharmacist transition care seen in elderly