Potential to Decrease Hospital Readmission Reduction Program Penalty Through Pharmacist Discharge Visits.

Abstract

SUMMARY Goal: We explored how investment in pharmacist services may be beneficial for health systems at risk for Hospital Readmission Reductions Program reimbursement penalties from the Centers for Medicare & Medicaid Services. Our aim was to determine to what extent reduction in readmission penalties justifies the increased operational cost of integrating a pharmacist in the delivery of transitions of care services in the outpatient setting. Methods: We created a mathematical model using incremental costs to evaluate the potential benefit from penalty reduction over a range of patient discharge volumes and excess readmission ratios (ERRs). The model estimates were based on the following assumptions: a national average of 13.45% of all Medicare discharges being measured by the program, an average of 40 minutes of pharmacist time per Medicare patient discharge, and a pharmacist hourly total payroll cost of $91.00 per hour. Principal Findings: Institutions in our model with discharge volumes ranging from 1,000 to 7,000 patients annually and an ERR of 1.1–1.3 benefited from pharmacist posthospital discharge visits, achieving a 15% reduction in early readmissions. Estimated annual net savings ranged from nearly $70,000 to just under $1,000,000. Net savings were greater for institutions with larger discharge volumes and higher initial ERRs. Applications to Practice: Healthcare managers overseeing transitions of care services need evidence-based strategies for reducing early readmission penalties. Our model shows that the additional cost of pharmacists providing outpatient transitions of care services could improve patient care and reduce early hospital readmission penalties. Institutions could target interventions to patients at high risk of readmission and further increase savings by limiting implementation costs.