The Centers for Medicare & Medicaid Services have placed increased emphasis on avoiding hospital readmissions over the past few years—for good reason. According to the Center for Health Information and Analysis, hospital readmissions cost Medicare $26 million annually. Of that amount, $17 million is avoidable. What role does nursing home pharmacy services play in avoiding readmissions?
First, let’s consider the consequences of a high readmission rate. Three of the six new measures added to the Five-Star Quality Ratings System in July specifically relate to hospital readmissions. Beginning in 2018, Skilled Nursing Facilities will have their Medicare reimbursement rate partially based on those measures.
The senior population as a whole is more likely to be admitted to the hospital. In fact, adults 65 years and older make up more than 40 percent of annual hospital admissions. To avoid rehospitalization, use a multidisciplinary team effort to help long term care residents. Long term care pharmacy providers play a significant role. Pneumonia, asthma, congestive heart failure, pressure ulcers, dehydration and urinary tract infections represent the leading causes of hospital readmission for the elderly population. The CMS reports that up to 80 percent of cases are avoidable if managed proactively. Here’s how LTC pharmacy services can help.
Nursing Home Pharmacy Services Key 1: Clinical Consulting
There are a number of factors that contribute to hospital readmissions, and many are particularly prevalent among seniors. Clinical factors that can contribute to readmission include:
- Certain conditions, such as COPD, diabetes or heart failure
- Having more than six chronic conditions
- Polypharmacy
- The use of certain medications, such as anticoagulants, antipsychotics and opioids
Other factors pertinent to SNF residents may include previous hospital admissions. Particular emphasis on hospitalizations within the last year and low health literacy are important to note. Because medications are often a contributing factor to senior hospital readmissions, Grane Rx utilizes regular clinical consultations in long term care pharmacy.
As part of these consultations, our team of PharmDs performs comprehensive medication regimen reviews. These occur at admission and at regular intervals thereafter. In addition, pharmacists also conduct clinical change of status reviews, targeted medication class and disease state management reviews, and medication utilization optimization reviews. Keeping a keen eye on issues via these thorough and regular reviews could contribute to rehospitalization.
Nursing Home Pharmacy Services Key 2: Emphasis on Certain Contributing Factors
In addition to conducting general medication reviews, long term care pharmacy providers pay particular attention to medications that could contribute to the leading causes of rehospitalization. For example, certain classes of medications, including antihistamines, antihypertensives, diuretics and chemotherapy agents, cause increased urination, which can lead to dehydration. When residents are prescribed medications in these classes, pharmacists work with the rest of the multidisciplinary team to regularly observe them and ensure they remain properly hydrated. In addition, pharmacists may suggest alternative medications and recommend that residents be prescribed only the lowest possible dose for the shortest possible duration needed. [Tweet “Medication reviews play a role in limiting hospital admissions among #skillednursing residents”]
Key 3: Observation & Communication
In many cases, signs of medical conditions present themselves early enough that a condition can be stopped in its tracks. In fact, symptoms of pneumonia, asthma, congestive heart failure, pressure ulcers, dehydration and urinary tract infections can be treated effectively with early intervention.
How can you ensure early intervention in these cases? It requires a multidisciplinary team approach. In regular interactions with residents, medical providers can carefully observe residents for emerging symptoms, such as shortness of breath and unusual fatigue in the case of pneumonia and fever or chills and reports of pain or pressure in the abdomen in the case of urinary tract infections.
After meeting with residents, nursing home pharmacy services providers can communicate and corroborate their observations with other members of the medical team. This approach makes prompt intervention and treatment more likely.
When you partner with Grane Rx for LTC pharmacy services, we work alongside your Skilled Nursing Facility’s team. Discover the Grane Rx difference today.]]>
