The aggregate cost of hospital admissions related to medication adherence has been estimated to be roughly $100 billion per year and over 50% of this is considered avoidable.
In addition, the estimates of the share of hospital admissions related to non-adherence are as high as 10 percent.
This means drug adherence related re-admittance costs are over one hundred million dollars a year.
Hospitals, Insurance Companies and Medicare/Medicaid.
With the recent introduction of the Readmissions Reduction Program (HRRP) by The Affordable Care Act, Hospitals are now being held accountable for readmissions within 30 days of discharge from both their facility as well as the subsection hospitals (ie. nursing homes or LTC facilities) that they refer patients to for rehabilitation. Hospitals facing a readmission (within 30 days) will now be required to pay for that patients care. This represents a massive financial risk for hospitals – up to 3% of their Medicare payments. An overwhelming amount of these patients are actually released to a subsection hospital which the hospital has little to no control over. 2014 – Over the course of the year, the (HRRP) fines will total about $428 million, Medicare estimates. In New Jersey, every hospital but one will lose money this year. So will a majority of hospitals in 28 other states, including California, Florida, Georgia, Illinois, Massachusetts, New York, Ohio, Pennsylvania, Tennessee and Texas, as well as the District of Columbia, according to a Kaiser Health News analysis of the penalties.
Subsection hospitals (nursing homes and long term care facilities) often do not have the resources to employee full time pharmacists. Instead, the medication protocol explanation is being executed by nurses who do not have the time, knowledge or expertise to explain the protocols for as many as 15-20 different medications that elderly patients are expected to take as part of their post release care. In addition, the medications that these patients take often is different in the primary care hospital, subsection hospitals and follow up in accordance with the patients needs. This confusing , ever changing regimen is a big part of the drug adherence issues post release.
Subsection hospitals only source of revenue comes from primary hospitals referrals. Given the new HRRP regulations, primary hospitals are looking very closely at re-admittance rates from the subsection hospitals they refer to.
A mobile virtual pharmacist application for use in subsection hospitals - nursing homes and long term care facilities (and eventually hospitals). This application allows a trained pharmacist direct access and communication with patients being discharged to coach them through the medication protocol. Not only will patients have this live consultation where they and their family can ask questions but they, and their loved ones will be able to access a recording of the consult and subsequent information at any time once they have been released from any digital device.
The EHR records and past patient history as well as the physicians script protocol is downloaded onto a portable device located in the subsection hospital. This information is accessed remotely by the pharmacist who will optimize medications and prepare a discharge consultation. The nurse who is discharging the patient will bring the device to the patients bedside at which point a live pharmacist consult will take place with the patient (and with their family/home caregiver). Then, the scripts will be sent to a pharmacy of choice and either delivered to the subsection hospital prior to discharge or be available for pick up at a location convenient for the patient. Once at home, the patient and their family or caregiver can access the protocol through a secure patient portal and direct any follow up questions on their medications to the virtual pharmacist.
Pharmacist counseling has been proven to reduce hospital readmission rates by 20% 4. Pharmacist counselling can also help improve patient satisfaction. The better the patient understands his/her medications and discharge instructions, the more comfortable he/she is going home. Pharmacist counseling may also decrease any anxiety when patients return to the hospital for another visit. With the RxConcile app in place we expect to see similar results.