According to a 2018 study conducted by the National Institutes Of Health (NIH), the average cost of a patient readmission is $15,200. It’s been estimated that the total cost of treating and caring for 30-day hospital readmissions in the United States is $52.4 billion annually — which equates to an additional cost to the average Hospital Value-Based Purchasing Program (HVBP) eligible hospital of more than $760,000.
That said, while the monetary cost of readmissions is staggering, the human cost of readmissions — particularly preventable readmissions — is incalculable.
The primary cause of preventable patient readmissions
According to several online estimates, close to 70% of preventable readmissions are medication- related. What's more, based on analytics generated by ProxsysRx’s proprietary software, readmissions from prescription non-compliance are often significantly more expensive than other readmissions.
We believe the most effective readmission reduction program is about much more than patient medication protocol. It’s about providing the necessary follow-up clinical support to ensure compliance while also addressing the social determinants of non-compliance.
Taking patient readmission reduction to the next level
For years, ProxsysRx has offered hospitals support in reducing readmissions through the cooperative efforts of our on-campus pharmacies and our Meds To Beds (MTB) programs. In early 2024, we took those fundamental components and developed the 30-day readmission reduction program we call Impact®.
Using a clinical pharmacist in collaboration with a nursing team, the program emphasizes personal, one-on-one patient education and medication-compliance support. Our pilot Impact® program (now in its 11th month at South Carolina’s Conway Medical Center) initially targeted multi-visit patients (MVPs). It was so successful that we’ve since added diabetics to our target group — offering post-discharge support to any patients with an A1C of 7 or higher, and to new diabetic patients.
Enrolling a patient in the readmission reduction program
During the bedside enrollment consultation, our clinical pharmacist offers a patient the option of bedside medication delivery. At the time of discharge, the patient’s medications are delivered, and the clinical pharmacist conducts a Comprehensive Medication review. By virtue of this encounter, patients leave with both the medication and the knowledge they — and their caregivers — need to ensure the likelihood of a successful transition from hospital to home.
Our medication review consists of three key elements: Patient Education, Medication Optimization and Validation Of Accuracy. The clinical pharmacist begins by validating discharge prescription orders, ensuring that they’re compatible with a patient’s home medications.
In addition to this validation, the pharmacist draws-on their knowledge of current treatment guidelines to ensure that the patient’s medication therapy meets all current treatment standards. Finally, the pharmacist provides in-depth counseling to ensure that the patient knows the importance, and proper use, of their medications. Once completed, the patient is provided with a written copy of their medication review — so that they can refer to it whenever needed, and take it with them to any follow-up doctor’s appointments.
Post-discharge patient support
Once patients are at home, an Impact® Care Coordinator / nurse will reach out to them at least four times over the course of their first month, post-discharge; even more, if their situation warrants additional contact.
Typical questions asked during a first call include: Do you have all of your medications? Have you been following your prescription protocols? Have you scheduled an appointment scheduled with your doctor? We’ll also ask questions specific to a patient’s disease state — helping them ensure they’re taking all necessary steps for a successful recovery. Subsequent calls are even more focused on disease states. For instance, if a patient has COPD, we’ll ask if they’re using their maintenance inhaler — and if they have a rescue inhaler when they need it.
Investigating social determinants of readmission
We always ask patients if they have transportation. It will come as no surprise to non-profit hospitals just how important that question is. Transportation access is a huge contributor to a health system’s readmissions — many of which occur simply because patients can't get to their doctor's appointments. Of the 192 patients enrolled in CMC’s pilot program, in fact, nearly one in six did not have transportation access. For those patients, we’ve provided rides using Uber Health — which typically costs $12 - $30 per patient.
Many other patients are readmitted to the hospital because they simply cannot afford their prescriptions. ProxsysRx also offers a variety of Prescription Payment Assistance options.
Integrating readmission reduction into the health system
Using ProxsysRx’s Impact® data platform, all patient communications, and the all data we collect, are uploaded into our secure database — then passed-along to our clinical pharmacist for any necessary follow-ups. When issues are pharmacy related, the clinical pharmacist addresses them. When issues are case-management related, we forward that information to the hospital’s team — then follow alongside them through each patient’s completion of their 30-day program.
Readmission reduction results: By the numbers
When our program launched in November, 2023, CMC’s health system had a baseline 35% readmission rate among its MVP patient population. After 10 months our program had enrolled and served 192 participants — and achieved a readmission rate of just 13.5%.
The savings CMC achieved in readmission avoidance costs, as a result of the program, was $486,400 (based on the $15,200 readmission cost per patient cited above). What’s more, patient satisfaction ratings with the program (63 respondents) was 9.77 out of 10 — a significant improvement over the national average of 6.6 for health system HCAHPS scores.
Given the success of our pilot program, ProxsysRx has already been contracted to implement the Impact® program at a second health system.
ProxsysRx is here to help, if you have questions.
There are so many ways to unlock pharmacy’s potential for better outcomes, and better incomes.
For more information on our Impact® program, or any of our services, contact:
HOWARD HALL C: 214.808.2700 | howard.hall@proxsysrx.com
ProxsysRx offers hospital systems proven solutions for optimizing pharmacy services’ positive impact on the continuum of care; solutions ranging from management of their 340B prescription-savings programs, Retail and Specialty Pharmacy operations, to Prescription Benefits program management, and patient financial assistance.
