HHS' Office of Inspector General will allow some pharmacists access to discharge information in an effort to help them create care plans that help curb readmission.
The permission was outlined in an advisory opinion issued Monday by the agency. An unnamed drug manufacturer requested the agency responsible for investigating fraud would check whether the program violated any anti-kickback laws since the program could lead to pharmacists recommending the drug company's products.
Under the proposed pilot program, the drugmaker would team up with a trade association, a Medicare Advantage plan and a hospital system. Pharmacists employed by the Medicare Advantage plan would receive real-time electronic access to certain discharge information for that plan's beneficiaries.
Pharmacists involved in this experiment provide medication therapy management services. This involves a plan that addresses drug and non-drug therapy, as well as lifestyle modifications associated with a disease.
Researchers have found that patients may not be getting the medications they need post discharge due to the unreliability of patients medication histories. With the continued push to move healthcare's focus to quality of care over volume, access to live data ensures patients get the care they need at the right times.
The experiment would focus on patients admitted to the hospital with one of the five diagnoses that are tracked under the Hospital Readmission Reduction Program: pneumonia, congestive heart failure, acute myocardial infarction, chronic obstructive pulmonary disease, and elective total hip or knee arthroplasty.
The drugmaker would develop an interface that took clinical data directly from the hospital system's electronic medical record.
HHS' OIG said it was approving the program despite a small chance of it violating kickback laws.
"Based on the facts certified in your request for an advisory opinion and supplemental submissions, we conclude that, although the proposed arrangement could potentially generate prohibited remuneration under the anti-kickback statute … the OIG would not impose administrative sanctions," the agency said in the advisory opinion notice.
For now, the approval for the pilot is only for the unnamed parties outlined in this proposal. It's unclear if other parties looking to also implement the same experiment could get expedited approval from the HHS OIG to move forward.
Violation of kickback laws constitutes a felony punishable by a maximum fine of $25,000, imprisonment up to five years, or both. Conviction could also lead to automatic exclusion from the Medicare and Medicaid programs.
