As noted in a 2018 study conducted by the National Institutes Of Health (NIH), one of the cornerstones of the 2010 Patient Protection and Affordable Care Act (ACA) is the Hospital Quality Initiative for enhancing patient safety, reducing hospital readmissions, improving quality, and minimizing healthcare costs.
The cost of patient readmissions to hospitals
According to the NIH study, the average cost of a patient readmission is $15,200. Moreover, it’s been estimated that the total cost of treating and caring for 30-day hospital readmissions in the United States is $52.4 billion annually — which equates to an additional cost to the average HVBP eligible hospital of more than $760,000.
To put that Total Cost amount in perspective, the Lown Institute (a nonpartisan think tank) has estimated that the combined deficits of all U.S. nonprofit hospitals totaled a comparatively puny $25.7 billion in 2020. Moreover, based on the Institute’s estimates, that $52.4 billion cost of readmissions is enough to relieve the combined medical debt of 41.3 million Americans, and is far more than enough to save every one of the nation’s at-risk rural hospitals from closing.
What is an HVBP eligible hospital?
The Centers for Medicare and Medicaid Services (CMS) created the Hospital Value-Based Purchasing Program to reward acute care hospitals with incentive payments for the quality of care (QC) they give to Medicare beneficiaries. Hospitals become eligible for the VBP program by meeting minimum QC requirements, and they receive bonus payments based on how well they perform on QC measures — and how much they improve their performance.
All that said, while the monetary cost of readmissions is staggering, the human cost of readmissions — particularly preventable readmissions — is incalculable.
The primary cause of preventable patient readmissions
According to a 2021 article published by the National Library of Medicine, “approximately 20% of hospital readmissions can be medication-related and close to 70% of these readmissions are possibly or definitely preventable.” What’s more, based on analytics generated by ProxsysRx’s proprietary software, readmissions from prescription non-compliance are often significantly more expensive than other readmissions. That said, we believe the most effective readmission reduction program is about much more than patient medication protocol. It’s about providing the necessary follow-up clinical support to ensure compliance while also addressing the social determinants of non-compliance.
Taking patient readmission reduction to the next level
For years, ProxsysRx has offered hospitals proactive support in reducing readmissions through the cooperative efforts of our on-campus pharmacies and our Meds To Beds (MTB) programs. In early 2024, we took those fundamental components and developed the 30-day readmission reduction program we call Impact®.
Using a clinical pharmacist in collaboration with a nursing team, the program emphasizes personal, one-on-one patient education and medication-compliance support. And while the program operates as a separate service from Meds To Beds prescription delivery, it can easily work in collaboration with MTB. All that’s needed to add Impact® to a Meds To Beds program is an onsite clinical pharmacist and a virtual team of nursing care coordinators.
The Impact® program was originally designed to serve patients living at home and/or using home health support. However, it’s flexible enough to work with patients in nursing homes — or any other kind of living arrangement. At the same time, while our pilot Impact® program (now in its 11th month at South Carolina’s Conway Medical Center) targets multi-visit patients (MVPs), there’s no reason it can’t be equally effective with high-risk single-visit patients.
We initially launched CMC’s program using a Diagnosis Related Group model, but we learned fairly quickly that the more effective model for them was to target MVPs. Now, any patient who’s had two or more previous encounters (admissions) is eligible to be enrolled in our program. That said, our MVP program was so successful for CMC that we’ve since added diabetics to our target group — offering post-discharge support to any patients with an A1C of 7 or higher and to new diabetic patients. The key reason we additionally focused on patients with diabetes is (no surprise) its inherent risk factor for impacting virtually all disease states.
Enrolling a patient in the readmission reduction program
ProxsysRx’s Impact® program starts with a bedside consultation, enrolling patients as soon as they’re identified as eligible. During the enrollment consultation, our clinical pharmacist also offers a patient the option of bedside medication delivery (an option of which most patients gladly take advantage). At the time of discharge, the patient’s medications are delivered, and the clinical pharmacist conducts a Comprehensive Medication review.
By virtue of this encounter, patients leave with both the medication and the knowledge they — and their caregivers — need to ensure the likelihood of a successful transition from hospital to home.
About the Comprehensive Medication Review
Our medication review consists of three key elements: Patient Education, Medication Optimization and Validation Of Accuracy. The clinical pharmacist begins by validating discharge prescription orders, ensuring that they’re compatible with a patient’s home medications.
In addition to this validation, the pharmacist draws-on their knowledge of current treatment guidelines to ensure that the patient’s medication therapy meets all current treatment standards. Finally, the pharmacist provides in-depth counseling to ensure that the patient knows the importance, and proper use, of their medications. Once completed, the patient is provided with a written copy of their medication review — so that they can refer to it whenever needed, and take it with them to any follow-up doctor’s appointments.
Post-discharge patient support
Once patients are at home, an Impact Care Coordinator / nurse will reach out to them at least four times over the course of their first month, post-discharge; even more, if their situation warrants additional contact. The first call involves the most in-depth review, focusing on critical post-discharge obstacles patients face that can lead to negative outcomes.
Typical questions include: Do you have all of your medications? Have you been following your prescription protocols? Have you scheduled an appointment scheduled with your doctor?
Our first call will also include follow-up questions specific to each patient’s disease state — helping them ensure they’re taking all necessary steps for a successful recovery. Subsequent calls are even more focused on their disease states. For instance, if a patient has COPD, we’ll ask if they’re using their maintenance inhaler — and if they have a rescue inhaler when they need it.
Investigating social determinants of readmission
We always ask patients if they have transportation. It will come as no surprise to non-profit hospitals just how important that question is. Transportation access is a huge contributor to a health system’s readmissions — many of which occur simply because patients can’t get to their doctor’s appointments. Of the 192 patients enrolled in CMC’s pilot program, in fact, nearly one in six did not have transportation access. For those patients, we’ve provided rides using Uber Health — which typically costs $12 – $30 per patient. (NOTE: ProxsysRx can also provide transportation using a health system’s insurance coverage, if available.)
Many other patients are readmitted to the hospital because they simply cannot afford their prescriptions. ProxsysRx also offers a variety of Prescription Payment Assistance options.
Integrating readmission reduction into the health system
Using ProxsysRx’s Impact® data platform, all patient communications, and the all data we collect, are uploaded into our secure database — then passed-along to our clinical pharmacist for any necessary follow-ups. When issues are pharmacy related, the clinical pharmacist addresses them. When issues are case-management related, we forward that information to the hospital’s team — then follow alongside them through each patient’s completion of their 30-day program.
Readmission reduction results: By the numbers
When our program launched in November, 2023, CMC’s health system had a baseline 35% readmission rate among its MVP patient population. After 12 months our program had enrolled and served 295 participants — and achieved a readmission rate of just 12.2%. Of those patients, past the 30 day mark, 216 patients “graduated” without readmission — and there were only 36 readmits, for an 85.4% graduation rate. Not to mention a 58.3% reduction in the readmission rate. Based on the health system’s historical MVP readmission rate, without the Impact® program CMC would have expected 103 readmissions.
The savings CMC achieved in readmission avoidance costs, as a result of the program, was $790,400 (based on the $15,200 readmission cost per patient cited above). What’s more, patient satisfaction ratings with the program (92 respondents) was 9.77 out of 10 — a significant improvement over the national average of 6.6 for health system Hospital Consumer Assessment of Healthcare Providers and Systems Survey (HCAHPS) scores.
Given the success of our pilot program, ProxsysRx has already been contracted to implement the Impact® program at a second health system.
ProxsysRx is here to help, if you have questions.
There are so many ways to unlock pharmacy’s potential for better outcomes, and better incomes. For more information on our Impact® program, or any of our services, contact:
HOWARD HALL 214.808.2700 | howard.hall@proxsysrx.com
