Tip of the Week: Maximize Your Employees’ Contribution to Collaborate with Home Health Agencies
Community pharmacy teams can help reduce hospitalizations through the provision of medication reconciliation, which adjudicates discrepancies such as therapeutic omissions, duplications, dosing errors, drug interactions, and unintentional therapeutic changes.
Home health care encompasses a variety of services offered to ill or injured patients with the intent of them to remain at home and receive a similar level of care provided by continuous skilled nursing, but at a lower cost. One factor that plays a large role in home health agencies’ reimbursement is hospital readmission rates.
Thirty-day readmissions are weighted heavily by the referring facilities such as Accountable Care Organizations and hospitals, and 60-day rates affect the value-based purchasing of the home health agency. Both 30- and 60-day readmission rates are available for patients to review when choosing a home health agency.
One way in which community pharmacy teams can help reduce hospitalizations is through the provision of medication reconciliation, which adjudicates discrepancies such as therapeutic omissions, duplications, dosing errors, drug interactions, and unintentional therapeutic changes. For even greater efficiency, pharmacies might employ the use of technicians in certain aspects of a medication reconciliation program.1
In this program described by Baird et al, a pharmacy technician contacts the patient to obtain an accurate medication list, and to complete a falls risk assessment and a depression screening. The technician updates the medication list, allergies, and vaccine status in the electronic health record (EHR). The pharmacist reviews the medication list for completeness, assesses for falls risk, depression, and medication interactions, and generates communication to the provider for clarifications or recommendations, if needed. Additional counseling points that need to be conveyed to the patient by the home health nurse are documented in the EHR.
In the study, 30- and 60-day hospitalizations for enrolled patients were manually pulled from 66 documented transfers in the EHR and compared against data from a third-party administrator. Medication therapy problems were categorized by the pharmacist and documented. At 30 days from the start of care, 13.4% of 695 patients who received pharmacy services were hospitalized compared to 26.8% who did not receive pharmacy services. At 60 days from the start of care, 20.9% of 695 patients who received pharmacy services were hospitalized compared to 33.3%of those who did not receive pharmacy services. These differences were all statistically significant.
The researchers concluded that a technician-driven medication reconciliation process led to a reduction in hospitalizations and identified medication therapy problems in home health patients. Of course, this was only part of the picture. The pharmacists’ professional judgment and clinical acumen were essential, as was the ability to delegate and effectively design an efficient and effective patient service.
It is unfortunate that in some workplaces, there seems to be almost a competition between pharmacists and technicians. This is another of many examples where pharmacists deployed technicians effectively so that the pharmacist could spend more time using their clinical judgment. Managers should be aware of this and of the opportunities that avail themselves to form profitable and satisfying partnerships with other types of providers. This will become increasingly salient as the health care system moves toward home health care and other more cost-effective modes of care delivery.
Additional information about Pharmacy Technicians and Implementing Value-Added Services can be foundin Pharmacy Management: Essentials for All Practice Settings, 5e.
Shane P. Desselle, RPh, PhD, FAPhA, Professor of Social/Behavioral Pharmacy at Touro University California in Vallejo.
Baird AB. Abode AM, Holland CR, Rhodes LA, et al. Utilizing pharmacy technicians to maximize pharmacist intervention with home health service patients. J Am Pharm Assoc. 2020;60(3):S103-S107.