Enhancing Patient Education and Medication Reconciliation Strategies to Reduce Readmission Rates

Abstract

To the Editor: With the rollout of the Hospital Readmissions Reduction Program (HRRP) in 2012, hospitals are facing steep financial fallout if they are unable to align readmission rates with heightened quality standards. It is part of a concerted effort by the Centers for Medicare & Medicaid Services (CMS) to improve the unacceptable rate of patients readmitted to hospitals; this currently equates to 1 in 5 Medicare patients within 1 month of discharge. In the program’s first year, 65.5% of the 3,400 hospitals falling under HRRP were hit with penalties, totaling $280 million in losses. The financial risks associated with the program are expected to escalate, as the percentage of affected reimbursement moves from 1% in the first year to 2% in the second and 3% in the third. Enhanced medication reconciliation and patient education strategies are critical ways for hospitals to reduce readmission rates. A growing body of research suggests that lack of attention to these two areas is a contributing factor to the revolving door effect of patients discharging from and re-entering hospitals.1,2 A recent report from the Institute of Medicine (IOM) points to an alarming rate of limited health literacy among American adults – nearly half (90 million people) – when it comes using and understanding written health information.3 The report also points to a higher rate of hospitalization and use of emergency services among these patients due to complications with medication use or adverse drug events (ADEs). An article by the American College of Clinical Pharmacy4 points to the critical role that ADEs play in readmission rates and how ineffective care transitions, especially as they relate to medication management, exacerbate the situation. The paper outlines the key role that pharmacists play in performing medication reconciliation and obtaining admission drug histories to avoid potential problems. Going forward, hospital pharmacy departments will need to take a greater role in developing programs that foster collaboration between clinicians providing care to an individual patient so that patient education and medication reconciliation are at the forefront of quality and safety strategies. If pharmacists are providing these services prior to discharge and engaging with patients after discharge to ensure a clear understanding of medication use and care, the potential for readmission should be greatly reduced.