One of the topics most frequently discussed at Cureatr is medication reconciliation post-discharge, also known as MRP.
There are many reasons why we focus so much on MRP, but one of the most significant is we know — and have seen firsthand — that when healthcare organizations improve the frequency and effectiveness of medication reconciliation post-discharge, patient safety and outcomes greatly improve. How is such a substantial improvement possible? Check out these alarming discharge statistics:
- More than half of all adults discharged leave with at least one medical error.
- About one in four patients have an adverse drug reaction post-discharge.
- One in five patients are readmitted due to adverse drug reactions.
Considering the importance of medication reconciliation post-discharge in overcoming such risks and harms, it's not surprising to see that MRP has been a part of the National Committee for Quality Assurance (NCQA)'s HEDIS® measures.
What to Know About MRP and HEDIS® Medication Reconciliation Post-Discharge
Let's take a closer look at medication reconciliation post-discharge and how HEDIS approaches MRP.
Meaning of medication reconciliation post-discharge
Before we dive into the key things to know about HEDIS MRP, it's helpful to first understand what is meant by medication reconciliation post-discharge. For that, we refer to this MRP FAQs resource we put together. It begins by defining MRP using the words of our chief executive officer, Richard Resnick.
He defined medication reconciliation post-discharge and its importance this way: 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.
Description of MRP HEDIS measure
NCQA describes the MRP HEDIS® measure as follows: "Assesses whether adults 18 years and older who were discharged from an inpatient facility had their medications reconciled within 30 days."
Where MRP is included in HEDIS measures for 2022
While the MRP HEDIS measure used to be a standalone measure, that's no longer the case. For 2018, medication reconciliation post-discharge became one of the four reported rates for the Transitions of Care HEDIS® measure. You can see this in the NCQA document outlining the HEDIS measures in 2022. NCQA describes the MRP indicator as "Documentation of medication reconciliation on the date of discharge through 30 days after discharge (31 total days)."
Along with MRP, the reported rates for the TRC HEDIS® measure are notification of inpatient admission, receipt of discharge information, and patient engagement after inpatient discharge.
While HEDIS has removed the MRP measure, but that does not suggest a decreased prioritization of this crucial intervention. With MRP now included in the expanded HEDIS® TRC measure, we believe this illustrates that medication management, and medication reconciliation in general, has a much greater role to play in care coordination and the overall health of patients.
Changes affecting HEDIS MRP in 2022
The NCQA announced several changes to the Transitions of Care HEDIS® measure for measurement year 2022. Two of these revisions affected the MRP indicator:
- "Added physician assistant as an appropriate provider type to perform a medication reconciliation for the medication reconciliation post-discharge indicator."
- "Clarified in the notes that documentation of 'post-op/surgery follow-up' without a reference to 'hospitalization,' 'admission,' or 'inpatient stay' does not meet criteria for the fifth bullet of the medication reconciliation post-discharge indicator."
Documenting the HEDIS® MRP indicator
To properly report the medication reconciliation post-discharge TRC measure indicator, organizations must document MRP correctly. BlueCross BlueShield of Illinois describes the documentation that's required, noting the following: "Documentation in the outpatient medical record must include evidence that medication reconciliation occurred between the discharge medications and the medications the member was prior to admission. The medication reconciliation may be conducted by a prescribing practitioner, clinical pharmacist, or a registered nurse. The member does not have to be present to perform the medication reconciliation."
BCBS of IL goes on to state that medication reconciliation may occur on the date of discharge through 30 days after discharge — i.e., 31 total days. This must be notated in the member's outpatient medical record with a range of supporting evidence, which the payer lists.
Measuring MRP beyond HEDIS®
In addition to its inclusion as an indicator for the Transitions of Care HEDIS® measure, medication reconciliation post-discharge is monitored under the Medicare Part C Star Rating program and Physician Compare initiative.
In this blog post, we examined medication reconciliation-related CMS quality measures, including medication reconciliation post-discharge. MRP is included under quality ID #46 and NQF (National Quality Forum) #0097.
CMS describes the MRP measures as "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 notes that the data for this measure should be organized by three age groups: 18-64 years of age, 65 years and older, and all patients 18 years of age and older.
How Cureatr Improves Medication Reconciliation Post-Discharge Performance
Healthcare organizations nationwide are partnering with Cureatr to help ensure medication reconciliation post-discharge is performed on all discharged patients. Cureatr combines clinical pharmacist-led MRP and other medication management services with innovative technology and robust data to fill the medication information and transition of care gaps that lead to adverse events and readmissions. Learn more about our MRP service by downloading this brochure and then schedule a consultation with a member of our team.