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Improved Patient Discharge Practices Reduce Fines

November 10, 2020

Recent data released by the Centers for Medicare & Medicaid Services (CMS) indicates that despite increased pressures to lower rehospitalizations, the overall Skilled Nursing Facility (SNF) rehospitalization rate rose to 19.4 percent in 2017, up from 19 percent just two years earlier. In many cases these incidences can be avoided and the associated costs reduced through the implementation of discharge planning.

The Price of Underperformance

In 2014 the Protecting Access to Medicare Act established a value-based purchasing component for Skilled Nursing Facilities, including a tracking system for readmission to any hospital within 30 days of SNF discharge and incentives for high-performing facilities. The Act was intended to incentivize or penalize facilities based on their ability to prevent unnecessary hospital readmissions.

Under the program, Skilled Nursing Facilities are evaluated based on how often patients are discharged and subsequently readmitted, and receive a score based on their individual performance as well as one based on their comparison to other SNFs. From these results, facilities receive payment incentives with the highest scoring facilities receiving the highest amounts – up to a 1.6 percent bonus. The lowest performing centers, on the other hand, face penalties of up to a two percent maximum.

In the latest CMS data, 27 percent of the almost 15,000 facilities who take part in the program received a bonus with just three percent receiving the maximum amount. The remaining 73 percent of centers were penalized and about 20 percent were assessed the maximum penalty amount.

A Proven Process for Improving Future Numbers

With new measurement processes in place, skilled nursing facilities can now review patient readmission rates and develop discharge plans to improve them. While pressures continue to increase to reduce patient length of stay, better management of the discharge process can help ensure a safe and effective transition of care.

According to a study published in the Journal of the American Pharmacists Association, 26 percent of hospital readmissions are medication-related and thus potentially preventable. As such discharge planning and comprehensive medication management are central to improve adherence at home. Components of a strategic approach include:

  • Improved quality of medication reconciliation
  • Updated electronic health records (EHRs) at all critical points of care
  • Procurement of new medications
  • Post-discharge pharmacist interventions and surveillance

PharMerica’s DischargeRx program assists organizations in enhancing their patient discharge processes by providing residents with a supply of their medications upon leaving for continued compliance. Through DischargeRx, former residents also receive personalized follow-ups from the pharmacy to review drug side-effects, questions, concerns, and primary care physician facilitation for future medication needs.

Of the clients actively utilizing DischargeRx, 97 percent did not receive a penalty in the most recent October 2018 CMS audit.

In today’s competitive environment, facilities need to position themselves for the highest payment incentives. Enhancing the discharge process is a simple approach to reduce penalties. To learn more about DischargeRx and how it can help your performance under the Value-based Purchasing Program, contact us at [email protected] or 855-637-1755.