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December 15, 2017

HHS' latest approach to reducing readmissions: A new medication management program

Daily Briefing

    HHS' Office of Inspector General (OIG) in an advisory opinion issued Monday said it will allow some pharmacists to access patient discharge information in an effort to help pharmacists develop care plans aimed at reducing readmissions.

    Medicare 101: Cheat sheets for Parts A through D

    According to Modern Healthcare, HHS' OIG issued the opinion in response to an unnamed drugmaker's request for the office's perspective on whether a proposed pilot program that would give pharmacists access to patient discharge information would violate any federal anti-kickback laws, because the program ultimately could lead pharmacists to recommend the drug manufacturers' products.

    Program details

    Under the proposed pilot program, the drugmaker would partner with a hospital system, a Medicare Advantage (MA) prescription drug plan, and a trade association. Pharmacists that work for the MA plan would be able to access in real time certain electronic discharge information for the plan's beneficiaries. The pharmacists then would provide medication therapy management services to the beneficiaries. Those services would include a care plan that encompasses drugs, non-drug therapies, and lifestyle modifications.

    The pilot program would focus on beneficiaries admitted to the hospital for one of the five diagnoses tracked under Medicare's Hospital Readmission Reduction Program. Those diagnoses are:

    • Acute myocardial infarction;
    • Congestive heart failure;
    • Chronic obstructive pulmonary disease;
    • Elective total hip or knee arthroplasty; and
    • Pneumonia.

    The program initially would evaluate a minimum of 200 patients.

    HHS' OIG weighs in

    HHS' OIG in its advisory opinion said there is a slight chance the proposed program could violate federal anti-kickback laws, but the office ultimately approved the program. The opinion stated, "Based on the facts certified in your request for an advisory opinion and supplemental submissions, we conclude that, although the proposed arrangement could potentially generate prohibited remuneration under the anti-kickback statute … the OIG would not impose administrative sanctions."

    According to Modern Healthcare, the program's approval only applies to the unnamed parties included in the proposal, and it is unclear whether HHS' OIG would approve similar programs and whether parties looking to implement similar programs could get HHS' OIG's expedited approval (Dickson, Modern Healthcare, 12/11; Morse, Healthcare Finance News, 12/12).

    Medicare 101: Cheat sheets for Parts A through D

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