Addressing Short-Stay Challenges With Effective Medication Management

November 10, 2020

About 40 percent of Medicare patients are admitted to a skilled nursing facility (SNF) or rehabilitation facility after being discharged from a hospital. Unfortunately, approximately 20 percent of those discharges ultimately result in readmissions. Effective management of residents’ medication is paramount to improving outcomes, particularly to preventing short-stay skilled nursing facility residents from being readmitted to a hospital within 30 days of arriving.

Medication management has taken on even greater importance for short-stay residents since The Center for Medicare & Medicaid Services (CMS) added new quality measures in 2016 to assess the rate of rehospitalizations from skilled nursing facilities as well as the percentage of short-stay residents with an outpatient emergency department visit.

Additionally, medication management is vital to containing costs, especially since patients discharged to short-stay SNF often have on average 14 medication orders and rarely utilize a full 30-day supply before leaving, per a column in Pharmaceutical Commerce.

Improving Outcomes Through Transitional Care

For residents whose stays are measured in days or weeks, the pharmacy plays a crucial role in the care outcomes. As with any resident, every stage of the treatment process, from prescribing through administration, can present problems. This is especially true among residents with a high number of medications and complex administration schedules. The most common issues these residents face are medication errors and adverse drug events, with one study finding that an estimated 22 percent of Medicare beneficiaries experience an adverse event during their SNF stay.

Providing proper medication regiment reviews (MRRs) is essential to demonstrate that a skilled nursing facility is properly assessing and caring for short-stay residents. That means that instead of just monthly reviews, pharmacists should conduct reviews as close to admission as possible, particularly for high-risk residents or those taking multiple prescriptions for a myriad of conditions.

Medication management is equally important when residents transition back into the community, since another new quality measure evaluates the percentage of short-stay residents who are successfully discharged. To address common problems like inadequate communication between care settings, pharmacists should perform medication reconciliation at discharge, reviewing previous orders alongside new ones and against physician orders. This step demonstrates that a facility is preparing residents for the transition back home. This is another critical step in the discharge process, since the following could have occurred during their transition process: medication changes or additions to regimens during a hospital or SNF stay; the resident may have gone for a period of time without being responsible for personal medication administration.

Lowering Costs with Innovation

Extensive medication management not only ensures appropriate drug use, but is also intended to lower medication costs. In 2019 alone, there was an average price increase of about six percent on more than 1,000 medications, according to CBS reports. One of the sectors most impacted by the escalations is the skilled nursing industry, since hospitals are discharging patients earlier, including patients with complex referrals that require costly treatments like chemotherapy. Subsequently, skilled nursing facilities centers need to stock supplies of medications to meet their residents’ needs, with the understanding that not all of the medication purchased will be used during a resident’s short-stay.

To address the increasing drug expenses for short-stay residents, especially those with medical complexities, medication management is more important than ever. Frequent reviews can help reduce prescription costs by identifying less expensive, medically equivalent drugs, unnecessary medications, excessive doses, or duplicate therapies. Skilled nursing facility pharmacists can further assist with efforts to address the cost challenges posed by residents with a shorter length of stay through innovative approaches, such as:

• Ordering smaller supplies of prescriptions, such as one week, rather than the standard 30-day supply, to reduce waste.
• Considering different strengths of medications, for instance, using a more expensive drug for a shorter period of time.
• Sending residents home with the balance of their medications, billed to the resident’s insurer or third party payor, that also serves to improve adherence.

The key to lowering medication-related costs is to make sure that residents receive the proper drugs at the proper dosage and schedule.

With increased pressures on skilled nursing operators to reduce lengths of stay to even shorter periods than the industry sees today, effective medication management is critical to optimizing outcomes and cost savings. To find out how PharMerica can help, contact us at [email protected] or 855-637-1755 to learn more.