Examining correlations between pharmaceutical nonadherence and 30-day hospital readmissions

Heil

RightCare is a medical technology company located in Horsham, Pennsylvania, that provides hospitals and health systems a comprehensive, end-to-end software application comprised of 3 modules-RightCare Risk Assessment, RightCare Coordination Central, and RightCare Post Care Connect-designed to assess patient risk at the time of admission, ensure the appropriate care plan is offered, and seamlessly transition patient information to post-acute care providers. RightCare’s software, based on 10 years of academic and clinical research, has been proven to reduce readmission rates by as much as 35%.

Background

Hospital readmissions is a staggering issue currently placing significant financial strain on the healthcare system in the United States, contributing upward of $30 billion in annual costs. With nearly 1 in 5 Medicare patients returning to the hospital within 30 days, many institutions are seeking a solution. To address the severity of this issue, the 2010 Affordable Care Act established the Hospital Readmission Reduction Program in order to penalize hospitals with excessive readmission rates through reduced inpatient prospective payment system (IPPS) payments. This reduction in IPPS payments to such hospitals with excess readmissions was effective beginning October 1, 2012. In 2013, 2225 hospitals were penalized and lost up to 2% of their Medicare reimbursement.

A number of various factors contribute to patient readmissions; however, pharmaceutical nonadherence in particular plays a major role. Like hospital readmissions, nonadherence costs the US healthcare system billions in avoidable spending annually. This $300 billion issue results in lost business for pharmaceutical companies, increased emergency room visits, and now penalties for not achieving optimal patient outcomes.

Experience

According to the World Health Organization, more than 50% of patients do not take their medication as prescribed. Socioeconomic status and suboptimal health literacy are major factors, but these factors are more difficult to address promptly. In contrast, factors such as prescribing complex drug regimens and ineffectively communicating drug information are much simpler to address instantaneously. Physicians and case managers must be cognizant of each patient’s individual needs and consider a patient-centered approach to care, engaging the patient in the prescription referral process. By asking appropriate questions and assessing patterns related to medication consumption, medical personnel can better determine the most appropriate drug and regimen, tailored to meet the needs of patients based on individual adherence components.

Overcrowding in hospitals makes it difficult for physicians to provide a personalized level of care to patients; therefore it is crucial to risk-stratify patients at the time of initial admission. By identifying high-risk patients, case managers and physicians can allocate more time to personalizing care for patients who present a greater risk for readmission.

When prescribing new medication, physicians should provide the patient with all necessary information including: the name of the medication, its purpose, why that particular medication was selected, the frequency of doses, duration of the regimen, and potential adverse effects. Clear communication, paired with appropriate postdischarge follow-up can drastically help combat two of healthcare’s most crippling issues.

Creating a seamless connection across the continuum of care ensures that physicians, case managers, and post-acute care providers have accurate and detailed information for every patient, enabling improved patient outcomes as well as reduced rates of readmission due to nonadherence. 

Eric Heil, MBA, is cofounder, president, & CEO of RightCare in Horsham, Pa.