1. Preventing Avoidable Hospital Readmissions by Utilizing Proper Medication Reconciliation Process and Community Collaboration
Christine Lewandowski
Siena Heights University-LDR 650 Medical Law
March 1, 2016
Professor Shanna Reed

2. Affordable Care Act’s (ACA) Hospital Readmissions Reduction Program (HRRP)
As of October 2015, 2,592 hospitals will lose a combined total of $420 million in reimbursements, penalized for failing to meet readmissions targets set by the Centers for Medicare and Medicaid Services (CMS) under the ACA’s HRRP (Lackman and Loos, 2015, para. 1)
The estimated annual cost of this problem for Medicare is $26 billion annually and $17 billion is considered avoidable (Reardon, 2015, p. 1).

3. Impact of Readmissions
Patient harm
Loss of patient trust in healthcare provider
Mortality
High costs for avoidable care
Complications associated with hospitalization (falls, adverse drug events, and infection)

4. Adverse Drug Events (ADEs)
Over 66% of emergency readmissions for patients over 65 years old are due to adverse medication events
19% of Medicare discharges are followed by an adverse medical event within 30 days
2/3 of these are preventable
Source: Lackman & Loos, 2015, para. 1

5. Seven Foundations to Assure Safe Transitions
Leadership support
Multidisciplinary collaboration
Early identification of patients at risk
Transitional planning
Medication management
Patient and family action/engagement
Transfer of information

6. Care Continuum
The transitions a patient makes in an episode of care can be numerous
It is important that effective communication not allow patients to fall through communication gaps
Critical information related to caring for patients is lost when communication is not standardized

7. Duty of Care Hospitals owe a direct duty to provide quality care
Avoidable readmissions are a result of the abandonment of care and negligence in meeting the duty to provide the quality of care expected
Hospitals owe a duty of care to ensure the right information is communicated with the next provider and to the patient

8. Standard of Care
The Joint Commission establishes the standard of care of performing a medication reconciliation process to ensure errors are not present
Provide an updated list for the next care provider in transitions of care, including a list provided to the patient (The Joint Commission, 2006).

9. Breach of Standard of Care
The breach in the standard of care is present when providers do not effectively communicate necessary information to care for the patient in the next setting
Incomplete communication forms
Lack of information
Inaccurate medication lists
Delay in discharge summary
Delay in test and lab results

10. Negligence and Malpractice
Negligence is defined as the failure to do something that another provider would do based on ordinary standards of care
When patients return to the hospital for an adverse drug event, it is because of the hospital’s negligence to ensure an accurate medication reconciliation
Malpractice can also be present if it was due to prescribing or dispensing the wrong medication, duplicate medications, or wrong dosages
Challenging Defective Service. MCR 2.116(I)(3) does not require a jury trial to determine whether service of process was sufficient
Res Ipsa Loquitur. “The thing speaks for itself.” The doctrine allows an inference of negligence where a plaintiff may be unable to prove the actual occurrence of a negligent act
The harm justifies the negligence claim without proving how the incident occurred

11. Medicare’s Call to Action
Reduce hospital readmission rates for Medicare Fee For Service patients by 20 percent by 2019.
Increase community tenure (number of nights spent at home) by 10 percent.
Improve medication safety to prevent adverse drug events (ADEs) that contribute to significant patient harm.
Build and sustain community coalitions focused on improving coordination of care between settings.

12. Why Medication Therapy Management (MTM)?
Most post-discharge adverse drug events (ADEs) are related to medications.
The odds of being hospitalized for ADEs is four to seven times higher in older adults than in the younger population.
MTM is an evidence-based, proven strategy to improve medication safety. 7x
1. Greenwald JL, Denham CR, Jack BW. The hospital discharge: a review of a high risk care transition with highlights of a reengineered discharge process. J Patient Saf. 2007;3:
2. Salvi F, Marchetti A, D’Angelo F, et al. Adverse drug events as a cause of hospitalization in older adults. Drug Saf. 2012; 35(Suppl 1):29-45.
3. Ramalho de Oliveira D, Brummel AR, Miller DB. Medication therapy management: 10 years of experience in a large integrated health care system. J Manag Care Pharm. 2010;16(3):
MTM

13. Conduct Medication Therapy Management
Reduce Hospital Readmissions
Medication Therapy Management
(Matt 11/25/2014) Does this describe where MTM fits in? It should describe where MTM fits into the broader goal of improved healthcare for communities.
Reduce and Prevent ADEs
Increase Medication Adherence
Improve Medication Reconciliation
Coordinate Communication Across Care Settings
Reduce Hospital Readmissions

14. Opposition to the Hospital Readmission Reduction Program (HRRP) Risk Adjustment
Opposition of the HRRP has stated that the calculation of readmissions should be adjusted to account for socioeconomic demographics
CMS has refused to account for socioeconomic status in the risk adjustment of patient acuity in fear that it would further reinforce the existing disparities in care for minorities
The logic behind this is that every patient should be receiving the same standard of care (Tobel, 2014)

15. Improving Quality will Reduce Costs Improving Quality will Reduce Costs
To improve a process, you must have the data to understand your specific problem
With interventions, you must measure the effectiveness by tracking the data
Measurement allows you to adjust the process proportionally in order to control and achieve desired outcomes
Improvements in quality will drive down costs in reducing the error rates

16. The Building Blocks of a Community Coalition
The term “Building blocks” represents the process of forming a community coalition. To build anything you need a solid foundation. Each community meeting builds upon the last where we share and listen to effectively identify members, set goals, and create and implement strategies. By meeting regularly as a community, the foundation of trust and rapport are established and members can effectively collaborate to address cross setting barriers and interventions.

17. Join A Community Coalition
Nursing Home
Home Health
Pharmacy
Clinic
Long-Term Services and Support Provider
Advocacy and Service Organization
Hospice
State and Local Government
Hospital
Healthcare Plan
Identify a common understanding of the readmission and ADE issues in the community.
Establish a collaborative partnership with local providers to improve coordination of care.
Share best practices and evidence-based interventions with community partners.
Comments from 8/28/2014:
What is a community coalition
Who are participants
9/4/2014 New Slide from Mimi

18. References
Amy Boutwell, Snow, J, Maxwell, J, Bourgoin, A, Genetti, G. (2014). Hospital Guide to Reducing Medicaid Readmissions. Rockville, MD: Agency for Healthcare Research and Quality; August AHRQ Publication No EF. Retrieved from
Kucukarslan, S. N., Peters, M., Mlynarek, M., & Nafziger, D. A. (2003). Pharmacists on Rounding Teams Reduce Preventable Adverse Drug Events in Hospital General Medicine Units. Arch Intern Med Archives of Internal Medicine, 163(17), Retrieved from joins-general-medicine-rounds
Lackman, J., & Loos, J. (2015, August 12). Reducing unnecessary hospital readmissions: Time to think inside the box. Retrieved from box.html Becker's Hospital Review
Readmissions Reduction Program (HRRP). (n.d.). Retrieved from payment/acuteinpatientpps/readmissions-reduction-program.html
Reardon, S. (2015, January 13). Preventable Readmissions Cost CMS $17 Billion. Retrieved from
Simpson, I. (2011, December 15). Handbook of Michigan Medical Malpractice Law. Retrieved from
The Joint Commission. (2006). Using medication reconciliation to prevent errors. Retrieved from
Tobel, A. (2014). Admitting the Problem with the Hospital Readmissions Reduction Program. Law School Student Scholarship. Paper 640. Retrieved from