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.
That 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.”
| 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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