Medication reconciliation is the process of reviewing the patient’s complete medication regimen at the time of admission, transfer, and discharge and comparing it with the new regimen being considered. This process is critical for ensuring a safe and smooth transition from one care setting to another, and for preventing hospital readmissions.
Hospital readmissions cost the United States healthcare system approximately $52.4 billion a year. A 2021 Joint Commission report found there were 3.8 million 30-day all-cause adult hospital readmissions in 2018, the most recent year for which data was available. This number represents a 14% readmission rate with an average cost of $15,200 per readmission.
There are a number of factors that put patients at risk of readmission, including social determinants of health (SDOH) such as limited transportation access, housing insecurity, and income inequality. SDOH impacts the ability to afford medication. Affordability can pose a major challenge, potentially blindsiding patients who are already dealing with a tumultuous transition.
During the discharge process, a clinician typically goes over a patient’s prescribed medications, discussing potential side effects and drug interactions. The patient is sent off with a thick stack of papers that includes all their prescriptions, but no idea about what they’ll be expected to pay.
Even a few new medications may constitute a substantial hit to a person’s budget, especially if they’ll need to take these drugs on an ongoing basis. Faced with an inability to pay, many people make their decisions at the pharmacy without checking back with the hospital care team to let them know they will not be taking some or all of their prescriptions.
This does not help patients—nor does it help hospital leaders who want to provide the best possible patient experiences, boost adherence, and avoid costs associated with readmission. Yet, cost conversations are not typically part of discharge planning.
Engaging patients around costs—and helping them access available assistance—should be a key part of a hospital’s discharge strategy.
Addressing Affordability at Discharge in Six Steps
Addressing affordability at discharge can be challenging. The patient is not seeing their usual doctors, but a hospitalist who doesn’t know their history or circumstances. Once the doctor decides to discharge the patient, a member of the nursing staff typically communicates the post-discharge treatment plan. However, nursing administrators and staff might not feel comfortable or have adequate training to discuss cost concerns with the patient—or they simply may not have enough time because they are already overburdened by labor shortages and increased workloads.
While some health systems do have in-house pharmacies that serve those being discharged from the hospital, this is not the norm. Prescriptions are typically sent to the patient’s local pharmacy (like Walgreens or CVS), and the patient has no knowledge of their out-of-pocket costs until they go to pick up their medications.
When hospital staff know how to engage patients around costs at the time of discharge, they can identify potential financial barriers to care and handle them before they become a problem—and reduce the risk of readmission. Here are six steps to consider when addressing affordability:
1. Identify Financially At-Risk Patients
Some patients are more likely than others to have difficulty affording their medication after discharge. Flagging these patients—including those without insurance and those who have been prescribed a high-cost medication such as a brand-name or specialty drug—at the time of discharge gives clinicians and patients an opportunity to identify assistance opportunities.
2. Coordinate Efforts to Reduce Medication Costs
The discharge process can be disjointed, with physicians, nursing staff, and pharmacy staff not necessarily in sync. To address affordability, teams should work to break down silos. For example, if a nurse has flagged a patient as being at-risk, this information should be communicated to the pharmacy tech (if there’s an internal pharmacy), as the pharmacy tech is often the person searching for free drug programs and other assistance options.
3. Enlist Social Workers and Financial Counselors
Nurses are typically the ones communicating directly with patients, but they may not have time or feel comfortable discussing cost concerns. Social workers are qualified to work with patients to address social determinants of health affecting affordability. The hospital may also have financial counselors who are qualified to address basic cost concerns.
Hospital leaders should consider providing ongoing education and training to ensure these social workers and counselors have the knowledge to help patients find assistance—or consider hiring a navigator to work with patients during discharge. Some hospitals and health systems have financial navigators on staff, but they typically work in chronic care settings, with patients who require ongoing treatment. Unlike financial counselors, navigators are trained to handle financial concerns holistically and are usually more familiar with the various assistance options. While hospitals may be reluctant to add a navigator to the inpatient care team, the costs avoided by improving adherence and reducing hospital readmissions would likely make it a worthy investment.
4. Educate Patients About Costs and Coverage
Education is key to helping patients afford their medications. If the patient is on Medicare, find out if they’re eligible for the Low-Income Subsidy (“Extra Help”) program and let the patient know. Go over how long they’ll need to take prescribed drugs, and the associated costs. For example, look at whether they were prescribed a medication for 14 days or if they will need to take it long-term for a chronic condition.
Involve caregivers in the discussion, and teach patients how to advocate for themselves so they feel empowered to have a conversation with a doctor about prescribing a generic or lower-cost medication.
5. Assess Cost Concerns & Explore Assistance Options
Ask the patient questions such as:
- Will you be able to pay for your medications and buy groceries?
- Will you be able to pay your rent?
- Will you be able to put gas in your car?
- Will you be able to come back and have follow-up visits?
If the answer is no, identify money-saving opportunities—including manufacturer copay assistance, foundation assistance, and free drug programs, as well as grants that help patients afford transportation and other costs of living—and help the patient access them.
6. Follow Up to Ensure Adherence
The day after a patient is discharged, the financial counselor, social worker, or other staff should follow up with a phone call and ask, “Were you able to pick up your medications?” They should then be willing to take it a step further and help those patients who say they never picked up their prescription or abandoned it at the pharmacy due to costs.
Leveraging Technology to Improve Access
For hospital staff who are working with patients to help them afford their medications after leaving the hospital, technology can be an invaluable tool. It helps busy and often overburdened nurses, social workers, financial counselors, and pharmacy techs quickly search for and match patients with available assistance.
Piecing Together the Post-Discharge Puzzle
The financial and clinical pieces of a patient’s post-discharge care puzzle must fit together. If the patient is unable to continue with their treatment because they can’t afford it, the entire puzzle comes apart. Working with patients at the time of discharge to address affordability helps keep the puzzle together. When patients have the means to adhere to care after leaving the hospital, they’re less likely to be readmitted, which benefits the entire healthcare ecosystem.