In the past year, more than 2200 hospitals have been penalized $280 million for "excessive" readmission rates under the Centers for Medicare & Medicaid Services' Readmissions Reduction Program, and the penalties will become more severe as the maximum penalty rises to 3% by 2014.
In the past year, more than 2200 hospitals have been penalized $280 million for “excessive” readmission rates under the Centers for Medicare & Medicaid Services’ (CMS) Readmissions Reduction Program, and the penalties will become more severe as the maximum penalty rises to 3% by 2014.
As most health care leaders are aware, CMS is focused on readmissions because nearly 20% of hospitalized beneficiaries are readmitted within 30 days of discharge, representing almost 2 million hospitalizations per year. The cost is more than $9700 per readmission, at a total cost to Medicare of $17.5 billion. According to many estimates, up to 75% of these readmissions may be preventable.
So why are there so many preventable readmissions? Not surprisingly, medication misadventures can play a major role. These issues include unfilled prescriptions, poor patient knowledge, lack of medication reconciliation, and adverse events.
Ambulatory Pharmacy’s Role in Reducing Readmissions
Extensive evidence shows that ambulatory pharmacy can play a key role in helping to reduce readmissions in 4 specific ways:
Through these varied interventions, hospital-based ambulatory pharmacies are making a significant difference in reducing readmissions.
Reducing Readmissions: Case Studies
Hospitals and health systems are now considering their options when it comes to starting or expanding their ambulatory pharmacy operation—to own and operate their own ambulatory pharmacy or to outsource to a third-party retailer. There are certainly pros and cons to both scenarios.
By outsourcing to a third-party retailer, the hospital is delivered a fully operational pharmacy on their property with minimal work required from the hospital. There are many financial models for an outsourced pharmacy, including an attractive lease rate back to the hospital, a percentage of the pharmacy’s total revenue, or a combination of both. However, potential benefits of hospital-run programs extend far beyond financials. They also include control and design of programs to reduce readmissions, prescribing errors, drug-related discrepancies, drug administration errors, and morbidity and mortality for certain conditions. Additionally, studies document how hospital-owned and -operated programs have improved patient satisfaction and health outcomes.
Hospital-based ambulatory pharmacies have taken hold and are gaining momentum. A recent survey found that 34% of hospitals already operate an ambulatory pharmacy and 48% of larger urban hospitals do so. More than half of hospitals with an ambulatory pharmacy (58%) plan to expand their ambulatory pharmacy offerings.
Ambulatory pharmacies can help improve outcomes and patient satisfaction, increase revenue, and decrease readmissions. They extend the hospital’s reach into the community and extend the continuum of care.
Robert Scholz, RPh, MS, MBA, is the vice president, pharmacy practice consulting for McKesson Pharmacy Optimization. He leads a team of pharmacy professionals providing health care/ hospital consulting service in areas such as revenue enhancement, supply chain improvement, packaging, barcode readiness, Lean Six Sigma process improvement, 340B optimization, and ambulatory pharmacy.