At Cureatr, one of our areas of focus is medication reconciliation post-discharge (MRP). It's a topic that's getting increasing attention because of its importance in reducing hospital readmissions, adverse drug events (ADEs), and unnecessary costs. To help you gain a better understanding of this important issue, we wanted to answer some of the most common questions being asked about MRP.
Q: What is medication reconciliation post-discharge (MRP)?
A: In a Q&A with our Chief Executive Officer Richard Resnick, he essentially defined medication reconciliation post-discharge as follows: When a patient goes to a hospital and is discharged, that patient is expected to have the benefit of somebody reviewing all of their medications when they arrive home. This is to make sure the patient has all their expected medications, help the patient understand the purpose and appropriate frequency and method of administration, and address any questions or concerns shared by the patient.
Q: Why is medication reconciliation post-discharge an area requiring more attention?
A: In that same interview, Resnick notes that MRP is "… vital because the discharge from the hospital to the home is one of the most dangerous care transitions for all patients, but particularly for those with complex medication regimens."
Consider the following: As the Agency for Healthcare Research and Quality notes, "A classic study found that nearly 20% of patients experience adverse events within three weeks of discharge, nearly three-quarters of which could have been prevented or ameliorated. ADEs are the most common post-discharge complication…"
Furthermore, we know that the number of patients with complex medication regimens is increasing. Our blog on statistics about polypharmacy in older adults — a population that is at an elevated risk of ADEs and drug interactions — noted the following:
- A JAMA Internal Medicine study found that the number of older people taking five or more prescription drugs, over-the-counter medications, and supplements is about 67% and rising.
- A sample of Medicare beneficiaries discharged to skilled nursing facilities from an academic medical center found that the patients were prescribed an average of 14(!) medications.
- Use of herbal or dietary supplements by older adults increased from 14% percent in 1998 to 63% percent in 2010.
Data from the Centers for Disease Control and Prevention's National Health and Nutrition Examination Survey show that more than one in five U.S. adults aged 40–79 use five or more prescription drugs.
Despite understanding the risks associated with the discharge process and recognition that polypharmacy and other medication management challenges are increasing, medication reconciliation post-discharge is not performed on a regular basis. To best ensure patient safety, all patients should receive an MRP within 72 hours of discharge. However, research shows that only about 50% of all patients do. This is particularly problematic when you consider studies have demonstrated that around half of patients experience a medication error following hospital discharge.
Q: Who is monitoring the performance of medication reconciliation post-discharge?
A: Medication reconciliation post-discharge is a quality measurement included in a number of programs. It's considered a "high priority" measure (process) by the Centers for Medicare & Medicaid Services (CMS). Concerning the measure — quality ID #46 and NQF (National Quality Forum) #0097 — CMS describes it as follows: "The percentage of discharges from any inpatient facility (e.g., hospital, skilled nursing facility, or rehabilitation facility) for patients 18 years of age and older seen within 30 days following discharge in the office by the physician, prescribing practitioner, registered nurse, or clinical pharmacist providing ongoing care for whom the discharge medication list was reconciled with the current medication list in the outpatient medical record."
CMS expects that data on the MRP measure is to be organized by three age groups: 18-64 years of age, 65 years and older, and all patients 18 years of age and older.
Medication reconciliation post-discharge is currently (as of July 2021) an active measure for three programs: Medicare Part C Star Rating program, Physician Compare initiative, and Healthcare Effectiveness Data and Information Set (HEDIS). It's worth noting that more than 90% of health plans use HEDIS to measure performance, so MRP receives a fair amount of attention from managed care.
Q: Why is medication reconciliation post-discharge such a challenge?
A: Some of the challenges associated with performing MRP overlap with those associated with performing medication reconciliation at any patient intervention. This includes variability in the consistency and quality of the process, time constraints for those expected to perform the processes, uncertainty about who should be performing the processes, data gaps, and shortcomings associated with electronic health records.
Organizations further struggle with medication reconciliation post-discharge because getting real-time discharge information is difficult to come by, especially if the patient was discharged from an out-of-network facility; additional information, including patient discharge summaries, discharge medication non-adherence notifications, and other vital information, are often inefficient and ineffective, leading to errors and oversights; and organizations simply lack the time and resources necessary to perform MRP on all patients.
In his Q&A, Resnick notes that health plans, which can be financially penalized when MRP does not occur, are trying to take on more responsibility for performing the process by assembling a telehealth team tasked with ensuring medications are safe when patients are discharged. But even this has significant shortcomings, with plans typically lacking the real-time data needed to perform complete and proper MRP and a large enough team to effectively and consistently perform MRP.
Q: What solutions are available to improve medication reconciliation post-discharge?
A: As with the challenges, some of the ways to improve MRP performance are the same as those that can help improve medication reconciliation. You can learn five best practices to improve med reconciliation in this video.
But the reality is that even with the implementation of best practices, many organizations and health plans will continue struggle to perform medication reconciliation post-discharge on most discharged patients, let alone all patients, which should be considered the goal and gold standard. That's why Cureatr developed its MRP service, a tech-enabled clinical pharmacy service powered by Meds 360°. In short, the Meds 360° technology accesses real-time national discharge data and clinical, claims, and pharmacy retail data covering a large majority of U.S. patients. This data is provided to Cureatr's board-certified, clinical telepharmacy team so they can perform MRP within 48–72 hours following patients discharge.
The results: MRP is performed for more patients, leading to reductions in readmission rates and ADEs and improvement in outcomes, patient satisfaction, quality scores (e.g., HCAHPS, STAR Ratings, and HEDIS), and financial performance. Want to learn more about our solution? Schedule an MRP consultation today.