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Take Your Meds: Strategies for Adherence

By Rose Hoban

One of the most vexing problems for physicians is getting patients to take their medications. But in an era where payment is tied to how patients actually fare as a result of seeing the doctor, now health care practitioners have more of a stake in figuring out how to get patients to take their pills on a regular basis.

PillsThat was the theme of a conference in Cary last Wednesday, sponsored by the N.C. Alliance for Healthy Communities, a group made up of pharmaceutical manufacturers, public health and medical organizations, pharmacy chains and insurers.

For years, doctors would grumble about “non-compliant” patients who didn’t complete a course of antibiotics, who didn’t take blood-pressure medications daily or who skipped doses of insulin, thus ending up sicker, or even in the hospital.

But over time, health care researchers realized that patients weren’t the only ones to blame; there were many reasons patients didn’t take medications, including exorbitant costs and side effects. And health care providers haven’t always done a good job of teaching their patients about their medications, and what the benefits and importance of taking them regularly are.

Now instead of placing all of the responsibility on patients to “comply,” health care experts talk about finding strategies to help patients “adhere” to their medication regimens.

“We did a poll of about 800 consumers back in May, and two-thirds of respondents said they were not adherent to their medications over the previous month,” said Joel White of the Washington, D.C.-based Council for Affordable Health Coverage.

“That means bad things happen in terms of health, hospitalizations, disease progression and, at the extreme end, death,” he said. “On the cost side, if you have a patient who’s not taking his heart medication and he has a heart attack and ends up in the hospital, he’s just cost the health care system $70,000 or $80,000 associated with that admission.”

White said his organization has crunched the numbers: People not taking their medications costs the health care system upwards of $300 billion in avoidable costs per year, some $100 billion of that in the form of hospitalization related to medication non-adherence or adverse reactions because patients were not taking medications correctly.

And the survey showed that 29 percent of the patients who stopped taking their medications didn’t let their doctors know.

Now there are better tools for promoting adherence to medications – everything from cell phones and iPads on the patient side to electronic medical records and designated pharmacists to teach patients about their medications on the provider side.

But what’s really changing behavior is the almighty dollar.

With the implementation of the Affordable Care Act, there are economic incentives to get patients to take their pills on time, every time, the correct way, White said. Doctors and, in particular, hospitals are taking those incentives seriously.

This past year, the Centers for Medicare and Medicaid Services initiated penalties to hospitals that have too many patients cycling back into their beds within 30 days of being discharged. Fifty hospitals in North Carolina were fined by CMS, sometimes to the tune of several million dollars in lost reimbursement. About 30 of those hospitals will pay more in penalties this coming year than last because of increased readmissions.

“And those penalties will ramp up over time, to the point where they’re financially biting” White said.

He described hospitals that have hired pharmacists to sit down with patients being discharged from the hospital to explain what their medications are in an effort to prevent readmission.

New Accountable Care Organizations (ACOs) also receive financial incentives for better patient outcomes, and some of those health care organizations have hired pharmacists who will walk patients through their medications.

Other initiatives include aligning all of a patient’s prescriptions so that they can be picked up on the same day each month, and programs wherein a week ahead of time the patient gets a call from the pharmacist to go over medication changes and possible issues with the regimen.

White said early results are positive. In Medicare, expenditures on hospitalization are down, but it’s too early to say what’s accounting for the drop.

“We were in a fee-for-service environment for a long time, but that culture is changing,” he said. “As new models of care are integrated into the system, people are more willing to try new strategies.”

 

Hospital Penalties for Too Many Readmission within 30 Days
Source: Centers for Medicare and Medicaid Services
Name 2014 Penalty (Y/N) Annual Increase Decrease or No Change
CAROLINAS MEDICAL CENTER-NORTHEAST No Penalty Decreased Penalty
DUKE HEALTH RALEIGH HOSPITAL No Penalty Decreased Penalty
LENOIR MEMORIAL HOSPITAL No Penalty Decreased Penalty
SPRUCE PINE COMMUNITY HOSPITAL No Penalty Decreased Penalty
PRESBYTERIAN HOSPITAL MATTHEWS No Penalty Decreased Penalty
GRACE HOSPITAL INC No Penalty Decreased Penalty
CAROLINA EAST MEDICAL CENTER No Penalty Decreased Penalty
DURHAM REGIONAL HOSPITAL No Penalty Decreased Penalty
MOSES H CONE MEMORIAL HOSPITAL No Penalty No Change In Penalty
WAKEMED CARY HOSPITAL No Penalty No Change In Penalty
ALBEMARLE HOSPITAL AUTHORITY No Penalty No Change In Penalty
CALDWELL MEMORIAL HOSPITAL No Penalty No Change In Penalty
CAROLINAS MED CENTER-MERCY No Penalty No Change In Penalty
FORSYTH MEMORIAL HOSPITAL No Penalty No Change In Penalty
FRANKLIN REGIONAL MEDICAL CENTER No Penalty No Change In Penalty
FRYE REGIONAL MEDICAL CENTER No Penalty No Change In Penalty
MARGARET R PARDEE MEMORIAL HOSPITAL No Penalty No Change In Penalty
MEDICAL PARK HOSPITAL No Penalty No Change In Penalty
MEMORIAL MISSION HOSPITAL AND ASHEVILLE SURGERY CE No Penalty No Change In Penalty
NEW HANOVER REGIONAL MEDICAL CENTER No Penalty No Change In Penalty
NORTH CAROLINA SPECIALTY HOSPITAL No Penalty No Change In Penalty
PARK RIDGE HOSPITAL No Penalty No Change In Penalty
PERSON MEMORIAL HOSPITAL No Penalty No Change In Penalty
PRESBYTERIAN-ORTHOPAEDIC HOSPITAL No Penalty No Change In Penalty
SAMPSON REGIONAL MEDICAL CENTER No Penalty No Change In Penalty
VALDESE GENERAL HOSPITAL INC No Penalty No Change In Penalty
WILMINGTON TREATMENT CENTER No Penalty No Change In Penalty
WAKEMED RALEIGH CAMPUS Penalty Increased Penalty
WILSON MEDICAL CENTER Penalty Decreased Penalty
RANDOLPH HOSPITAL Penalty Decreased Penalty
SOUTHEASTERN REGIONAL MEDICAL CENTER Penalty Decreased Penalty
CARTERET GENERAL HOSPITAL Penalty Decreased Penalty
FIRSTHEALTH MOORE REGIONAL HOSPITAL Penalty Decreased Penalty
MARTIN GENERAL HOSPITAL Penalty Decreased Penalty
HERITAGE HOSPITAL Penalty Decreased Penalty
ANSON COMMUNITY HOSPITAL Penalty Decreased Penalty
REX HOSPITAL Penalty Decreased Penalty
WAYNE MEMORIAL HOSPITAL Penalty Decreased Penalty
DAVIS REGIONAL MEDICAL CENTER Penalty Decreased Penalty
SCOTLAND MEMORIAL HOSPITAL Penalty Decreased Penalty
BRUNSWICK COMMUNITY HOSPITAL Penalty Decreased Penalty
UNIVERSITY OF NORTH CAROLINA HOSPITAL Penalty Decreased Penalty
CAROLINAS MEDICAL CENTER-UNION Penalty Decreased Penalty
GASTON MEMORIAL HOSPITAL Penalty Decreased Penalty
DUKE UNIVERSITY HOSPITAL Penalty Decreased Penalty
NORTHERN HOSPITAL OF SURRY COUNTY Penalty Decreased Penalty
ROANOKE CHOWAN HOSPITAL Penalty Decreased Penalty
WATAUGA MEDICAL CENTER Penalty Decreased Penalty
THOMASVILLE MEDICAL CENTER Penalty Decreased Penalty
CENTRAL CAROLINA HOSPITAL Penalty Decreased Penalty
MOREHEAD MEMORIAL HOSPITAL Penalty Decreased Penalty
CAROLINAS MEDICAL CENTER/BEHAV HEALTH Penalty Decreased Penalty
HUGH CHATHAM MEMORIAL HOSPITAL Penalty Decreased Penalty
SANDHILLS REGIONAL MEDICAL CENTER Penalty Decreased Penalty
RUTHERFORD HOSPITAL INC Penalty Decreased Penalty
NASH GENERAL HOSPITAL Penalty Decreased Penalty
LEXINGTON MEMORIAL HOSPITAL INC Penalty No Change In Penalty
CATAWBA VALLEY MEDICAL CENTER Penalty Increased Penalty
CHEROKEE INDIAN HOSPITAL AUTHORITY Penalty Increased Penalty
NORTH CAROLINA BAPTIST HOSPITAL Penalty Increased Penalty
KINGS MOUNTAIN HOSPITAL INC Penalty Increased Penalty
VIDANT BEAUFORT HOSPITAL Penalty Increased Penalty
THE MCDOWELL HOSPITAL Penalty Increased Penalty
LAKE NORMAN REGIONAL MEDICAL CENTER Penalty Increased Penalty
CAROLINAS MED CTR-UNIVERSITY Penalty Increased Penalty
CAROLINAS MEDICAL CENTER-LINCOLN Penalty Increased Penalty
DUPLIN GENERAL HOSPITAL Penalty Increased Penalty
PITT COUNTY MEMORIAL HOSPITAL Penalty Increased Penalty
HAYWOOD REGIONAL MEDICAL CENTER Penalty Increased Penalty
GRANVILLE MEDICAL CENTER Penalty Increased Penalty
CAPE FEAR VALLEY MEDICAL CENTER Penalty Increased Penalty
PRESBYTERIAN HOSPITAL HUNTERSVILLE Penalty Increased Penalty
C J HARRIS COMMUNITY HOSPITAL Penalty Increased Penalty
MARIA PARHAM HOSPITAL Penalty Increased Penalty
STANLY REGIONAL MEDICAL CENTER Penalty Increased Penalty
HIGH POINT REGIONAL HOSPITAL Penalty Increased Penalty
IREDELL MEMORIAL HOSPITAL INC Penalty Increased Penalty
ALAMANCE REGIONAL MEDICAL CENTER Penalty Increased Penalty
MURPHY MEDICAL CENTER INC Penalty Increased Penalty
ROWAN REGIONAL MEDICAL CENTER Penalty Increased Penalty
CLEVELAND REGIONAL MEDICAL CENTER Penalty Increased Penalty
ONSLOW MEMORIAL HOSPITAL Penalty Increased Penalty
BETSY JOHNSON REGIONAL HOSPITAL Penalty Increased Penalty
PRESBYTERIAN HOSPITAL Penalty Increased Penalty
HALIFAX REGIONAL MEDICAL CENTER INC Penalty Increased Penalty
WILKES REGIONAL MEDICAL CENTER Penalty Increased Penalty
JOHNSTON MEMORIAL HOSPITAL Penalty Increased Penalty
COLUMBUS REGIONAL HEALTHCARE SYSTEM Penalty Increased Penalty

 

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