Reducing Hospital and Nursing Home Readmissions

May 2016 - In the last blog, we began discussing GrandView Pharmacy’s uniquely designed IMPACT (Integrated Management for Post-Acute Care Transitions) program that is aimed at reducing hospital and nursing home readmissions. After a medication regimen review, optimized protocols and other evidenced-based best practices, we provide the resident access to a cutting-edge technological advancement in clinical pharmacy- pharmacogenomic testing.

Did you know that your DNA determines how your body metabolizes different drugs? From a simple cheek swab, a healthcare provider can see which medications your body is able to metabolize, eliminating the costly and dangerous trial and error process. This is a vital step, especially when dealing specifically with cardiac and pain medications. Results can be obtained in as quickly as 1 week, so you can be swiftly confident the resident is on the appropriate drug regimen for them, as an individual, leading to the best quality outcome. When results are received, the Certified Geriatric Pharmacist, who is also voluntarily certified in interpreting metabolic validation results, analyzes the genetic profile and compares the current medication regimen to the medications best metabolized by the resident’s unique body chemistry. Since the resident’s genetic material does not change over time, they are provided a copy of the results to use for the rest of their life to guide the decision-making related to medications they should and should not take. Many have found they have taken medications for chronic conditions, sometimes for decades, that their bodies cannot break down and use effectively, but often suffered with the side effects without any therapeutic benefit. It is still relatively unknown that not all people can metabolize all medications for a particular condition.

These two quality measure components continue to be monitored after the resident leaves the NF (if still within 30 days from hospital DC). Our GrandView Care Coordinators work with the facility to manage the various stages of transition. We will deliver a 30 day supply of the resident’s current medications and any required home health equipment, including oxygen, hospital beds, CPAP, BiPAP and home IV products, directly to the nurses’ station prior to discharge. Social Service Directors and Discharge Planners no longer have to track down prescriptions and find providers out in the community to source these solutions on their own. This continuity of care also reduces an additional opportunity for transcription errors in the medication profile as the dispensing pharmacy remains consistent through the process. If you were unaware, a major factor in drug-associated readmissions is related to the failure of the resident to fill their prescriptions after leaving the NF. Not only do we relieve them of that burden, but our staff makes phone calls to the resident at days 3, 14, and 28 to follow-up on medication adherence and address any questions or concerns they may have. Any concerns or abnormalities are reported back to the NF discharge staff, the prescriber and home health company, if applicable.

For residents who may need a little extra assistance, GrandView Pharmacy offers in-home patient monitoring devices. This could be as simple as a progressive medication reminder system, something more comprehensive like the Philips Telestation, a medication dispensing device, or Medacheck which (among other things) patients use wireless measurement devices, like scales and blood pressure cuffs, to take their own vitals which can be tracked and accessed remotely by a clinician or family member. The Medacheck device also functions as a medication reminder system, but its ability to track high risk data elements, like weight, blood pressure and blood glucose, by communicating directly with the device’s via Bluetooth technology, removes “patient bias” – the inclination to make your health numbers better than they actually are - and gives real-time feedback to caregivers through a secure online portal.

While many readmission efforts exhibit a common weakness in that they don’t naturally extend beyond the 30-day window, GrandView Pharmacy’s IMPACT program is truly personalized healthcare that not only benefits the resident throughout the course of their rehabilitation, it can help chronic disease patients avoid hospitalizations in the first place. Residents can choose to continue their relationship with GrandView while at home, after the 30-day initial dispensing, and can work directly with their Certified Geriatric Pharmacist while living in the community.

The bottom line is, effective transition management is possible and your Star Rating (and thereby, your reputation with the general consumer) depend on your ability to do it. Unfortunately, none of these new quality measures come with any sort of reimbursement increases, so to develop a program like IMPACT, on your own, will require a significant investment of time and appropriate human capital to make it work. Fortunately, GrandView has worked these processes for over a year in preparation for the new measures and have proven process and positive outcomes, all at no cost to you.

For more information or to enroll in IMPACT, please contact your GrandView Account Manager. If you are not currently a GrandView customer and would like to see if our process would be a good fit, please contact Mel Green at 317-417-5107 or by email at mel.green@grandrx.com.

References and Resources:
Learn Morehttp://www.medicareadvocacy.org/preventable-emergency-department-visits-by-nursing-home-residents/
Learn Morehttp://www.chqpr.org/readmissions.html
Learn Morehttps://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/CertificationandComplianc/Downloads/Improvements-NHC-April-2016.pdf
Learn Morehttp://www.grandrx.com/errors.php#metabolicvalidation
Learn Morehttp://grandrx.com/pharmacy.php#transitions

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