You may be wondering, how vital is medication reconciliation to facilitating safe patient transitions of care?
Thankfully, the Institute for Healthcare Improvement provides some insight into this question. "Each time a patient moves from one setting to another where orders change or must be renewed, clinicians should review previous medication orders alongside new orders and plans for care, and reconcile any differences. If this process does not occur in a standardized manner that is designed to ensure complete reconciliation, medication errors may lead to adverse events and harm."
With this in mind, it should come as no surprise that medication reconciliation in transitions of care is an area of focus for the National Committee for Quality Assurance (NCQA) within its Healthcare Effectiveness Data and Information Set (HEDIS®) measures. In this article, we look closely at HEDIS® measures, specifically, the single measure that concerns medication reconciliation in transitions of care.
Medication Reconciliation in HEDIS® Measures 2022
What's critical to understand right off the bat is that medication reconciliation does not have its scale in the list of HEDIS® measures for 2022. Instead, medication reconciliation appears as one of the reported rates that fall under the HEDIS® Transitions of Care (TRC) measure.
In addition, it's not just medication reconciliation that's one of the reported rates. It's more specifically medication reconciliation post-discharge (MRP). NCQA describes HEDIS® MRP as "Documentation of medication reconciliation on the date of discharge through 30 days after discharge (31 total days)."
The HEDIS TRC measure also includes three additional reported rates:
- Notification of inpatient admission: "Documentation of receipt of notification of inpatient admission on the day of admission through 2 days after the admission (3 total days)."
- Receipt of discharge information: "Documentation of receipt of discharge information on the day of discharge through 2 days after the discharge (3 total days)."
- Patient engagement after inpatient discharge: "Documentation of patient engagement (e.g., office visits, visits to the home, telehealth) provided within 30 days after discharge."
Importance of Medication Reconciliation Post-Discharge for HEDIS® TRC Measure
The HEDIS® TRC measure was added by NCQA in 2018, with NCQA noting at the time that the addition of HEDIS® TRC was one of several new measures added in the hopes of helping to address emerging health needs and evolving processes in care delivery. More specifically, NCQA said the HEDIS® TRC measure intended to "… improve care coordination during care transitions for at-risk populations including older adults and other individuals with complex health needs."
Now that we've provided background on the MRP rate and how it pertains to the HEDIS® TRC measures, we should spend a little time examining why MRP is such an essential facet of transitions of care. This will help explain why NCQA has made MRP just one of four rates associated with its TRC measure.
Why MRP is Essential for Transitions of Care
First, let's take a moment to examine why MRP can be such an essential service to patients. The Centers for Medicare & Medicaid Services (CMS) provides a concise explanation in the description of its own MRP quality measure. CMS states, "Implementing routine medication reconciliation after discharge from an inpatient facility is an important step to ensure medication errors are addressed and patients understand their new medications. The process of resolving discrepancies in a patient's medication list reduces the risk of these adverse drug interactions being overlooked and helps physicians minimize the duplication and complexity of the patient's medication regimen. This in turn may increase patient adherence to the medication regimen and reduce hospital readmission rates."
Unfortunately, performing MRP can present a significant challenge for healthcare organizations. The following are just a few of the contributing factors:
- Variability in the consistency and quality of the MRP process
- Time constraints for those expected to perform MRP
- Lack of knowledge and experience to perform proper MRP
- Uncertainty about who should perform MRP
- Data gaps
- Shortcomings associated with electronic health records
The Obstacles Faced Trying to Improve HEDIS® MRP Performance
Organizations may struggle with medication reconciliation post-discharge because obtaining the real-time discharge information needed to complete a proper HEDIS MRP can be difficult to come by. This challenge is even more elevated if a patient is discharged from a facility outside the organization's network.
Health plans can be financially penalized if an MRP service is not provided to appropriate members. So, in turn, some plans are taking it upon themselves to develop a telehealth service to help ensure MRP occurs. However, this has significant potential for shortcomings.
Organizations increasingly lack the available personnel — or personnel with the right level of medication expertise and training — needed to perform MRP on all patients who would benefit from the process. This lack of available and qualified professionals, coupled with disparate patient data, is likely to continue restricting many organizations and health plans. This leads to missed or suboptimal MRP and increases the risk of patient harm, readmissions, and the financial penalties associated with poor performance.
While there are tactics that can help organizations increase the overall percentage of MRPs, these recommended practices are not likely to overcome the significant obstacles to medication reconciliation post-discharge success.
Cureatr's Clinical Pharmacists Will Improve Your MRPs
When it comes to HEDIS MRP, organizations and health plans face three significant barriers to success:
- Too many patients
- Too many errors
- Too little time