Prescription Delivery: Improving Hospital Star Ratings by Reducing Readmission Rates

Imagine a patient – we’ll call her Edith – goes to the hospital to have a heart valve replaced with a mechanical valve. The surgery goes well. Before Edith is discharged, her doctor goes over her prescriptions with her. Now that she has a mechanical heart valve, she’ll need to take warfarin, a blood thinner, for the rest of her life. Edith understands the importance of this new drug, but in the midst of being discharged from the hospital, Edith forgets to pick up her new prescriptions. Her children take her home and make sure she has everything she needs, but they weren’t present for the conversation about warfarin. Edith doesn’t start her prescription. Within 30 days, Edith has suffered a minor stroke and is back in the hospital.

This may sound like an unusual scenario, but unfortunately it is not. Back in 2009, the Centers for Medicare & Medicaid Services (CMS) reported, “On average, 1 in 5 Medicare beneficiaries who are discharged from a hospital today will re-enter the hospital within a month… Research has shown that hospital readmissions are reducing the quality of health care while increasing hospital costs.” Now, over ten years later, hospital readmission rates are still a major concern. When a patient returns to the hospital less than 30 days after being discharged, the patient, the hospital, and American taxpayers have to pay the price.

Hospital Star Ratings

That’s why CMS began the star rating system for hospitals, which rates hospitals on a number of quality measures including their readmission rates. Based on how well the hospital performs, it is given a star rating from one to five. This is meant to help patients decide which hospital is best for them. That said, the way that the ratings are calculated is said to be deeply flawed. But the fact remains that the system still exists. A one-star rating can negatively impact an organization’s credibility.

Also, while star ratings aren’t always related to a facility’s funding, some of the values used to calculate star ratings are used in other CMS programs that do impact reimbursement. It’s important that health system administrators understand the rating system and pinpoint ways to improve their quality measures.

A hospital’s star rating is a summary of various measures across seven categories of quality. These categories include:

  • Mortality
  • Safety
  • Readmission
  • Patient experience
  • Effectiveness of care
  • Timeliness of care
  • Efficient use of medical imaging

The first four categories are the most heavily weighted. While there are many ways that a hospital could improve in these areas, one not-so-obvious option has experienced immense growth in the past year: prescription delivery.

How Delivery Helps Improve Star Ratings

Prescription delivery meets patients where they are. By ensuring that they have their medications in-hand, hospitals can help patients start therapy and remain adherent to their medications. This is important for patients with chronic illness, but it’s essential for patients who have recently been hospitalized or have had surgery. If they forget to pick up their prescriptions before going home, they may not start them at all.

As we saw in Edith’s example, not starting a prescription could lead to an unplanned readmission to the hospital, at the very least. CMS star ratings focus on the following statistics related to readmission:

  • Rate of unplanned readmission for coronary artery bypass graft (CABG) surgery patients, COPD patients, patients who had hip/knee surgery, or for any other reason hospital-wide
  • Days spent in the hospital after unplanned readmission for heart attack patients, heart failure patients, and pneumonia patients

But failing to start a prescription could also lead to death. In Edith’s case, the blood clot that caused her stroke could have been fatal. CMS star ratings measure the 30-day mortality rate for:

  • Heart attack patients
  • CABG surgery patients
  • COPD patients
  • Heart failure patients
  • Pneumonia patients
  • Stroke patients
  • Patients with serious treatable complications after surgery

While we may like to imagine that no patients will suffer readmission or death after discharge from the hospital, many problems can arise during the transition from hospital care to home care. It’s suggested that 49% of hospitalized patients experience at least one medical error after leaving the hospital. Most of the time, those errors involve medication use. Some predictors of medication use errors include:

  • Not picking up prescribed discharge medications
  • Not knowing if these medications had been picked up
  • Not taking discharge medications
  • Not understanding how to take the medications

There are many factors that go into the issues listed above. The cost of prescriptions could keep newly-discharged patients from picking up their medications. The patient may not understand the importance of some prescriptions, or there may have been a language barrier between patient and providers. The patient may be too fatigued, too stressed, or in too much pain to focus on anything other than getting home.

It’s clear that if the patient does experience an issue with their medication, they could end up back in the hospital. This causes a sort of snowball effect: if more patients are readmitted to the hospital, the higher the re-hospitalization rate climbs, and the worse the hospital will fare in that CMS quality measure. The hospital could end up with a lower star rating and could lose funding for the year. That will negatively impact the quality of the hospital’s care, and could contribute to even more readmissions. Now that snowball is an avalanche, and whole communities can suffer as a result. To avoid that avalanche, it is key for hospitals to focus on ways they can keep patients healthy after discharge.

It is possible. Let’s return to Edith, and imagine how her story could be different.

The hospital where Edith is about to receive her heart valve surgery had less-than-stellar readmission rates in the previous years. As a result, their CMS star rating was lower than they liked. The hospital administrators made a number of changes to improve their ratings, particularly in the area of readmission. They added prescription delivery to ensure patients were able to easily start their new medications and stay on therapy.

As a result, when Edith is discharged, it’s okay that she forgot about her warfarin. The hospital pharmacy sends her prescription directly to her home. Edith’s children hear a knock on the door and find the bag of her medications. Inside is a month’s supply of warfarin and the pharmacist’s notes on how to take it. Edith begins taking warfarin that very day, and she is no longer at risk of a blood clot. 30 days come and go, and Edith is well enough to see her grandkids – all thanks to the simple added service of prescription delivery.

Are you a hospital administrator or pharmacy manager for a health system? Consider partnering with ScriptDrop. Curious how we’ve helped one Federally Qualified Health Center improve medication access for their patients? Download our case study for free.