When Curtis Gainer was an inpatient at Einstein Medical Center Philadelphia five months ago after a severe asthma attack, he was pleasantly surprised to see a pharmacist at his bedside, along with specialists and others.
“It was a meeting of the minds there,” Gainer, 58, recalled. “They wanted to know what kind of medication I’m taking, what new medication was coming in. They explained how to use it, when to use it. They asked me to do it myself. If I had to get a prescription, they would fill it downstairs. They were instrumental.”
That pharmacist was one of three at Einstein tasked with getting involved early with inpatients in a bid to reduce the chance that patients will end up back in the hospital 30 days after they are discharged.
Research published this month based on pharmacist intervention at Einstein found that it cut the readmission rate by more than half for traditional Medicare patients to 9.8 percent compared to 20.4 percent for a group that did not receive the interventions.
The Einstein researchers tested their quality-improvement initiative on 1,059 admissions of 667 Medicare patients to Einstein Medical Center Philadelphia from July 2012 through June 2013. The results were published in the American Journal of Health-System Pharmacy on May 1.
Thirty of the 305 patients that received the full intervention had unplanned readmissions, compared with 110 readmissions for the 518 patients who received the usual standard of care at discharge.
The pharmacist in the study reviewed medications, adjusted dosages, provided education and counseling, ensured the patient had access to medications, and arranged for follow-ups at home, when appropriate.
Deborah Hauser, Einstein’s network pharmacy director, designed the study’s program for the nonprofit Philadelphia health system and was one of the authors. After the study, Hauser has been working on incorporating the pharmacist interventions into Einstein’s standard care.
“We now have three pharmacists who do this in their day-to-day work,” said Hauser, who first started thinking about how pharmacists could use their skills to make inroads against readmissions in 2010.
That was two years before the Centers for Medicare and Medicaid Services started penalizing hospitals for exceeding permitted readmission thresholds by withholding up to 3 percent of Medicare reimbursement.
Einstein’s penalty last year was 0.45 percent, well below the maximum. The North Philadelphia hospital’s overall readmission rate was 17.6 percent, about the national average, according to the Pennsylvania Health Care Quality Alliance.
The Medicare Payment Advisory Commission estimated in 2010 that avoidable readmissions cost the government’s elderly insurance program $17 billion annually. Efforts to reduce that annual cost trimmed it by $2 billion in 2016, commission researchers said in January.
Commercial insurers are also focused on the problem. The University of Pennsylvania Health System’s year-old contract with Independence Blue Cross makes Penn financially responsible for hospital readmissions within 30 days of discharge, and pharmacists have a role at Penn as well.
“Pharmacists who work on inpatient units and in outpatient clinics, for example, conduct medication teaching for patients with diseases such as cancer, multiple sclerosis, and rheumatoid arthritis, and a concierge service at several hospitals delivers patients new prescriptions prior to discharge,” said Richard Demers, chief administrative officer for Penn’s ambulatory pharmacy services.