• Calculating the Value of Meds-to-Beds

  • By Mike Coughlin
    September 6, 2017

    On a Saturday morning two weeks ago, I got a call at home from Gary Johnson, Senior Hospital Administrator and Chief Pharmacy Officer at University of Kentucky (UK). I could sense excitement in his voice. He had just digested the results of a year-long study reporting effects of the UK Meds-to-Beds (M2B) program.

    A year-long study reporting effects of the UK Meds-to-Beds program show an approximate 50% reduction in the probability of readmission (p<0.001).

    Gary had commissioned an independent study by an external entity to quantify the impact of M2B on UK’s all-cause unplanned readmission rate. The results showed an approximate 50% reduction in the probability of readmission (p<0.001). This is truly something to get excited about.

    The study population included 40,000 discharged patients across UK HealthCare during 2016. UK Pharmacy has a well-organized M2B program delivering medications to the bedside seven days per week. In this study, 10,000 of the 40,000 discharged patients were enrolled in the M2B program. The graph below tells the story.

    Powerful Financial Impact of Reducing Readmissions

    I suggested that the next step would be to calculate the financial implications. UK provided additional information and Gary has allowed me to release these calculations to the industry. Here’s the approach I took:

    1. Patient discharges per year: 40,000 (UK data)
    2. Reduction in readmissions: 1,776 (study results extrapolated across the UK system)
    3. Average readmission cost: $13,800 (industry averages from CMS data)
    4. Loss of gross profit from non-productive bed: $8,000 (UK metrics)
    5. Financial effect of avoided readmission: $21,800 ($13,800 + $8,000)
    6. Annual financial impact projected across UK HealthCare: $38.7M (1,776 X $21,800)

     

    The process begins by enrolling patients in the M2B program upon admission. They also enroll ED patients, which represent 45% of admissions. Medication reconciliation is completed for admitted patients as well as ED patients.

    The next step is to capture the discharge prescriptions in the ScriptPro dispensing system as early as possible, so the prescriptions can be prepared and provided to the patient without delaying discharge. ScriptPro captures these e-prescriptions via the EMR interface and prioritizes them in the UK Pharmacy.

    UK systematically implemented M2B using functionality shown in the above flow diagram.

    UK Pharmacy manages the M2B program with 10 staff members out of an office space adjacent to the retail pharmacy. Chain of custody is tracked from the UK Pharmacy to the patient via ScriptPro mobile applications that capture patient signatures and credit card payments. ScriptPro also generates invoices for patients who are unable to provide payment at the time of discharge.

    The above referenced procedures coordinate discharge prescription related tasks, and nursing staff views M2B as an efficient step in the discharge process. This work has also increased medication related HCAP scores by 50%.

    To date, this service has required the patient to “opt in” (enroll) to the M2B program during the patient interview upon admission. However, based on this readmission data the hospital now will auto-enroll every admitted patient and allow the patient to “opt out” if they do not wish to receive the service.

    The above calculations do not include revenues generated by added discharge prescriptions. These also can be significant, particularly when 340B or GPO drug pricing is used.

    These M2B functions are managed by ScriptPro’s ambulatory pharmacy platform, as described in the flow diagram.

    Today, most health systems are talking about Meds-to-Beds. Some, like University of Kentucky, are doing something about it. Few, however, have quantified the results the way we see here, and, based on the results, taken initiatives to expand the program for the benefit of patients and the health system they depend on.