CMS measures fall short of solving readmissions puzzle

The federal report released by the CMS noted that medication discrepancies can be common in care transitions. For instance, it cited one analysis showing discrepancies occurred in up to 75% of admissions to skilled-nursing facilities.

As things are now, sharing information about a patient's medications is mostly a paper-based process, which means it must be manually transferred into a post-acute provider's system.

"With a manual process, there is always the possibility of transcription error," said Landa Stricklin, director of clinical reimbursement at Life Care Centers of America, a nursing home chain.

The goal of the CMS' effort is to make providers more accountable for transferring important medication information such as dose and frequency, according to the agency. When a resident is discharged home, the second measure would track the transfer of medication information from a provider to the patient, family or caregiver.

The stakes are high when there isn't an accurate exchange of information about medications, according to Kristen Smith, an executive vice president at Post-Acute Medical, an operator of long-term acute-care facilities.

"The negative impact of poor medication information or lack thereof are a potential risk of illness, readmissions or death from medication administration errors," she said.

A study that appeared in a 2013 edition of the International Journal of Family Medicine found that 33% to 69% of medication-related hospital admissions in the U.S. are due to medication non-adherence, resulting in $100 billion per year in healthcare costs.

There is agreement in the medical community that more needs to be done to ensure that there is an accurate transfer of medication information, but there also seems to be near universal skepticism that the new measures would offer much help with that process.

The measures just track whether or not information about medication is being provided to the patient or provider at time of discharge. They don't address the accuracy of the information provided or the ability of the patient or family member to understand the information, Smith said.

"Oftentimes, patients or family members may receive medication (information) but may be confused, overwhelmed from their recent injury or have cognitive deficits impacting their ability to manage medications," Smith said. "These are often the greater source of medication error post-discharge."

Also, they may not to have the ability to store such information once they are at home, according to Megan Verdoni, CEO of ER Liaison, a Florida-based company that provides home health visits.

"Our patient population has a significant difficulty in managing the paperwork load, let alone achieving electronic access to their records," Verdoni said. "Most of our patients have flip phones and limited internet experience."

In the cases where a patient is going to a post-acute care provider, there needs to be a greater push from the federal government to ensure that information can be easily shared among different EHR systems, according to Clint Graybill, senior executive director of post-acute care at Sanford Health, a Sioux Falls, S.D.-based system with 43 hospitals and 45 long-term-care facilities.

"If the government is really looking to make an impact in this area, it needs to mandate some sort of criteria for EHRs to communicate back and forth," Graybill said.

Without that, the introduction of new measures leaves post-acute care providers manually inputting medication patient information into their systems.

"The gap that remains is human error," Graybill said. "If there were a seamless transition, you take out the possibility of things like transposing a dose, moving a decimal on a dosage amount or misspelling a medication's name."

Dr. William Huffner, chief medical officer at University of Maryland Shore Regional Health, Baltimore, sees value in the new measures, calling the CMS' efforts "a great first step."

Hoping to make progress, though, in the absence of true interoperability, the hospital has found another way to reduce readmissions.

In 2016, UM Shore launched a post-acute care clinic under which a group of providers at the hospital maintain communication with the patient's healthcare team at a facility to which they've been discharged. This helps to ensure the transition plan developed at the hospital is followed and reduces the risk of readmission.

"These patients are still getting treatment from nurses who are known to them, who can assist in making sure patients are getting the correct medication no matter where they've gone for care," said Nancy Bedell, regional director of care coordination at UM Shore.

When the post-acute clinic first launched, its readmission rate for Medicare patients was 13.8%. Today, the rate for that same cohort is 10.5% according to data provided by UM Shore.

A year prior to the start of UM Shore's efforts, LifeBridge Health, another Baltimore-based health system, launched an effort known as Post-Acute Physician Partners, under which a group of its providers also keep tabs on patients discharged to post-acute care facilities.

In addition to tracking implementation of care plans for patients, clinicians also travel to post-acute facilities participating in the initiative to offer care on-site to lessen the chances a patient would need to return to the hospital.

LifeBridge's readmission costs dropped by up to $4 million last year as a result of the partner initiative.

That should indicate to the CMS that there could be promise in replicating the models of care being used in Maryland.

"We're saving payers money because we're managing patients better, so they don't need to go back into hospitals," said Brian White, executive vice president of LifeBridge Health and its post-acute services division. "We're better coordinating transitions; we're better managing changes in conditions."