Healthcare Industry News Blog: Medication Reconciliation Post Hospital Discharge Becomes a Star Measure in 2018

March 14, 2017

Welcome to MedXM's Healthcare Industry News Blog which draws your attention to the request for public comments on the NCQA recommendation that medication reconciliation post hospital discharge become a star measure in 2018.

Let's review a little background on what constitutes a "star" measure.

Medicare's Star Rating System

The Center for Medicare and Medicaid Services (CMS) developed the performance star rating system to help consumers, families, and caregivers compare Medicare health and prescription drug plans and to enable them to make better choices among the available plans. As part of this process, CMS assigns star ratings to Medicare health and prescription drug plans, ranging from 1-5 stars, with 5 meaning excellent quality and performance. The NCQA's recommendation is that medication reconciliation become a measure of a plan's eligibility for a "star" beginning in 2018.

What is NCQA

The National Committee on Quality Assurance (NCQA) is a private, not-for-profit organization dedicated to improving healthcare quality.

What NCQA Wants to Change

NCQA has requested public comments on its suggested modifications to the Healthcare Effectiveness Data and Information Set (HEDIS®). HEDIS® is the term for performance indicators which evaluate discharges from acute or non-acute inpatient facilities for members 66 years of age and older, for whom a medical professional reconciled medications within 30 days of discharge.

NCQA wants to see Medicare added as a product line to the HEDIS factors and wants medication reconciliation conducted on all Medicare beneficiaries age 18 and over, not just those over age 66.

NCQA also wants examples of medication reconciliation set out in the rules. Doing so will not restrict the type of documentation that professionals may use to show satisfaction of the medication reconciliation rules. Rather, NCQA believes examples will show the type of documentation that medical professionals may find available in a medical record that indicates medication reconciliation.

Medicine reconciliation post-discharge currently only applies to patients with chronic conditions covered under Medicare Advantage Special Needs Plans, individuals with dual eligibility under Medicare and Medicaid, as well as in-patients in institutions.

Why NCQA Wants This Change

Prescription drug use is prevalent among adults of all ages especially those with chronic conditions. NCQA wants to expand the universe to all Medicare beneficiaries who are adults so that CMS will get a better handle on medication reconciliation for all people discharged with conditions requiring medications.

Medication Reconciliation

This term refers to the process of determining the most definitive list of all medications that a patient takes. Medication reconciliation is appropriate at all transitions of care; for example, when discharged from an institution or transferred from one care provider to another. The ideal setting for medication reconciliation is in the home, 48 hours after post hospital discharge during a transitional care visit to go over the medication list.

The medication list includes the name of the medication, the dosage, frequency and delivery method (oral, injection, topical, etc.). A qualified medical professional creates the list by comparing the patient's medical record to a list of medications that the professional obtains from the patient, the hospital or other health services provider.

Medication reconciliation is important for several reasons. University of Colorado Health Science Center (Denver) found that when it studied 375 patients reviewed within 24-72 hours after discharge, 14% of them had at least one medication discrepancy. The study also found that patients with such discrepancies were 2.5 times more likely to need hospital readmission within 30 days of discharge.

More than 1/3 of patients studied (34%) reported medication errors, medical mistakes, or lab errors. The number of patients reporting such errors increased by 14% if they had four or more doctors attending their illnesses.

Medication reconciliation can identify and prevent adverse drug events. Medication problems include non-compliance, non-adherence, communication failures between doctors and patients, and having to track multiple medications all of which can lead to drug overuse, underuse, drug interactions, and adverse drug events.

Related: What is Medication Reconciliation?

If you have any questions on this topic, or anything else, please contact us. We want to help plan members live healthier lives.

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