Ambulatory Pharmacy, A Strategic Asset – Part 2 of 3

Discharge Medication Management

 Gregory K. Shaeffer MBA RPh FASHP

This is the second post in a series following my initial blog on Ambulatory Pharmacy and the strategic asset the service can represent to the pharmacy enterprise and the organization.

In this writing I will explore the opportunity and impact of providing a discharge medication program.  It is well documented, particularly in the specific Diagnosis Related Group’s(DRG’s) identified by Medicare, that hospital readmissions are related to a myriad of medication related issues.  These medication related issues can range from patients not having transportation or a means togo to the pharmacy to obtain their medications to patients being unable to afford their medications. IMS reported that approximately 50% of prescriptions written are never filled.  We also know that many of these patients, even after obtaining the mediation(s), have many adherence challenges taking complicated regiments properly for optimal therapeutic management.

The Medicare patient, particularly the chronic disease DRG’s that have been targeted by CMS, are an at-risk patient population for therapeutic failure.  For Pharmacy, these patients are in dire need of active therapeutic management that traverses acute to ambulatory care.  It is essential that patient education and management begin as an inpatient and continue through discharge and post discharge to ensure effective and successful outcomes.

It is a given and assumed the therapeutic management is the “right thing” to do for the patient, but there is also an economic value to the pharmacy and the organization to effectively manage these patients and mitigate 30-day hospital readmissions.  The Medicare population generally have third party prescription coverage predominately Medicare Part D and/or Medicaid. These patients, having third party coverage, provide the Ambulatory Pharmacy a revenue opportunity to prepare and dispense discharge medications and can virtually eliminate the patient challenges of obtaining their discharge medications.

As I mentioned previously, many of these patients have complicated poly-pharmacy therapeutic regiments and, based upon the Medication Therapy Management(MTM) criteria, can provide an additional revenue stream for pharmacy with the assessment and implementation of an MTM program.

Lastly, the most important form of economic value to the organization is the mitigation of therapeutic failures requiring hospital readmission within 30 days of discharge for those specific targeted CMS DRG’s that requires the hospital to provide care for the readmission without additional reimbursement.

In summary, I have explored the opportunities for an integrated pharmacy strategy that traverses inpatient, outpatient and post hospital care that provides an opportunity to improve patient care and provide additional pharmacy revenue and organizational cost savings.  These opportunities clearly need to be explored and assessed within each organization to determine the programmatic success.