Reduce spending in 2024 with healthy discharge plans after ER visits | Viewpoint

As health system administrators and executives look toward the new year, many issues are on the table: hospital worker burnout, rising prices and lower reimbursements, ever-thinning margins – the list goes on.

Health systems can save money and reduce readmissions by focusing on the discharge plans after an ER visit, Miranda Rochol writes. (Image credit: Prescryptive Health)

Many may see only doom and gloom, but there’s one topic I’m optimistic about: ER visits.

Health systems can make an impact on the all-important hospital readmission rate through emergency departments by focusing on the discharge plans after an ER visit. The goal at ER discharge should be the patient not returning to the ER or being readmitted to the hospital.

In 2024, here’s how to take a good look at the ER discharge process, the “meds to beds” scenario, and the role of your outpatient pharmacy to impact overall spend.

Impacting overall spend through ER visits

With razor-thin margins as the new normal, any impact that executives can make on one piece of the puzzle can positively impact overall hospital spend. So why not start with ER visits, with a focus on medication adherence in your discharge plans?

First, let’s talk about medication adherence and how it’s related to ER visits. When patients don’t take their medication, it can become an emergency, and they go to the ER. When patients are out of refills, they may go to the ER. One study on ER visits found that more than 16% of visits were due to nonadherence, and another on older adults found that one in seven ER visits were medication related, and of these, three-quarters were preventable.

And if patients don’t adhere to medication, they may wind up back in the ER — or the hospital. One study found that patients with low and intermediate medication adherence had 2 times higher odds of readmission compared to those with high adherence.

So where’s the disconnect? It could be in the original discharge from the ER. Patients not having clear instructions can be a reason they return to the ER, and we must assume that medication management is part of that. By implementing a formal medication management program with a goal of having a digital front door for patient engagement, in turn helping them become consumers of their healthcare, health systems can decrease ER visits and decrease overall spend.

Discharge plan: ‘Meds to beds’ should embrace healthcare consumerism & technology

The concept of “meds to beds” – the moment when the patient is leaving the hospital and a medical professional, ideally a pharmacist, puts the right medications in their hand rather than relying on the patient to fill the prescription – is a key moment to impact other metrics.

For instance, let’s say a patient visits the ER and then gets admitted because their diabetes is out of control. They go through a resolution inside the hospital. On their way out, let’s say they need to change their insulin, add a pump, and a heart problem is diagnosed. In “meds to beds,” a pharmacist or tech fills the prescription in the hospital and sends the patient home with it.

Now, augment that scenario with technology. In addition to the pharmacist or tech handing off the medication, they can also enroll the patient in a mobile or digital health experience that allows the patient to take control of the medication themselves – a digital medicine cabinet, if you will, with refills, prescription information, price information, and more. Technology like this can help bridge the gap after the patient gets home, helping them stay on track and reducing that readmission rate.

As the patient leaves the hospital, they not only have a prescription in their hand – but they also are empowered to adhere to those medications as prescribed. The technology can follow the patient where the medical professionals cannot, driving up adherence and driving down the need to visit the ER again.

Bottom line: Key moments like meds to beds are the way to embrace technology to drive healthcare consumerism forward. By putting the patient in the process, the health system can turn them from a patient to a consumer at discharge.

Consider the role the outpatient pharmacy

Many health systems consider pharmacy as an expense rather than a profit area – with some health systems even recently shutting down their outpatient pharmacies. But in a moment like meds to beds, the outpatient pharmacy can play a bigger role. In addition to providing a high-touch interaction with the patient, outpatient pharmacies can also support profitability.

Technology again is important here. Through a digital front door experience that encourages patients to fill the prescription at the health system’s pharmacy, not only can the health system support healthcare consumerism but also drive patients to the outpatient pharmacy on-site. This would increase scripts to the outpatient pharmacy and introduce other clinical services and even disease or wellness programs.

Every prescription is an opportunity

ER visits and readmission rates are just two metrics in the complicated calculus of running a health system. But every prescription written in a health system provides an opportunity to capture, engage, and retain patients in digital formats.

And as a patient is leaving the hospital, prescriptions in hand and empowered to take them appropriately and stay on them, it’s a moment that can impact every outcome down the line.

Miranda Rochol is the senior vice president for provider solutions at Prescryptive Health.