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Readmissions, the drug store and a sleep-deprived patient Date: 04/04/13

By Eric Whitney

In February I did a story for NPR about hospitals turning to retail pharmacy chains to help them reduce readmission rates. It was a pretty straightforward business story – or so I thought.  It was newsy because it was about a big, familiar company, Walgreens, responding to a significant policy change within the Affordable Care Act.  When Medicare started cutting payments to hospitals with high 30-day readmission rates for specified conditions, Walgreens saw a market opportunity and launched a new line of business.

Not so straightforward was the improvising I had to do when things started going awry.

I previously reported on how hard it is for hospitals to prevent “unnecessary” readmissions. While there’s no single tactic that prevents boomerang patients, proper prescription management can help a lot.  So when I got a press release from Walgreens describing how it was marketing post-discharge medication management to hospitals, I thought it would be a story worth pursuing and pitching.

Walgreens was piloting the program at a few hospitals and said it was effective. The company’s claim was plausible. Enough research existed on the role medication plays in readmissions that I could talk about the concept without simply trumpeting Walgreens’ rosy numbers – which were based on very preliminary and proprietary data.

No hospitals in my home state of Colorado were trying Walgreen’s new service, but Washington Adventist just outside the District of Columbia was. I was already planning a trip to D.C., so I called the hospital for a pre-interview and found their chief medical officer to be an articulate and engaging speaker. He explained that the service was effective and saved his hospital money.

Health policy stories are particularly challenging on radio, so good talkers are essential. Our ability to paraphrase is limited by our need to pace a story to keep listeners engaged. Narration longer than 30 seconds can put people to sleep, so you need great sound bites to keep things moving and to trigger the visuals in peoples’ imaginations that we can’t supply with video.

I had similar luck pre-interviewing a Walgreens executive.  He was a good talker, made a good case and admitted there were still some unknowns.  At the same time I looked for an independent researcher who could verify that prescription reconciliation can reduce readmissions.

The one I ended up interviewing for the story describes this as a physician or pharmacist “cross-walking” or reconciling the list of medications a patient is on before admission with the list of drugs they’re given while in the hospital to spot anything that could cause problems –unnecessary or duplicative drugs, drugs that could interact etc. And then they check to make sure there are no red flags from any new post-discharge changes to medications. Failure to reconcile drugs contributes to nearly a third of all readmissions. (Medicare patients who get sick enough to be at risk for multiple hospitalizations typically take numerous prescription drugs.)  

The researcher also told me there was evidence to suggest the Walgreens’ strategy of having pharmacists follow up with patients three times in the month after leaving the hospital would improve outcomes.

So, simple story: New government policy has hospitals worried; pharmacy chain offers a solution; a hospital that’s trying it says it works and an independent, third-party expert says it seems to make sense. Throw in a patient to illustrate the problem the Medicare readmission policy aims to solve and we’ve got three-and-a-half minutes of interesting, informative radio.

But, it’s never that simple.

The Walgreens executive I pre-interviewed was not the one the company wanted to talk on tape. I should have told them I’d need a pre-interview with the second guy, to verify his radio-friendliness, or insisted on taping the first executive who was so articulate. The taped interview with the new guy took twice as long as the pre-interview because I had to keep fishing for anything that would make a good sound bite – he was not a natural talker. Finally I got him to abandon his corporate jargon and say, “This is your father’s Walgreen on steroids.”  That gave me something to move the story along.

During my visit to Washington Adventist, the hospital’s public relations staff set me up with a patient who was being enrolled in the prescription management program. He was great, and I got good “scene” tape of a hospital staffer explaining the program to him. Unfortunately, he died two days later and his widow didn’t want us to use his interview. And I had just left D.C.

I tried to punt by taping one of the phone consultations Walgreens pharmacists have with recently discharged patients. That was a disaster. I got nothing I could use on the air.

A heroic and helpful producer at NPR in D.C. went back to the hospital for me a few days later and got the awesome tape of the patient we eventually used in the story – a woman who hadn’t been able to sleep well in the hospital, a common problem. When sleep-deprived patients are handed a bunch of prescriptions upon discharge, medications can be overwhelming to manage. That gave us the crucial human face listeners need to relate to a story like this.

There was also an error message that rendered my audio recorder useless midway through my hospital visit. I always carry a backup recorder and was able to get the rest of the tape I needed, but there were several terrifying hours where I thought I might have lost my crucial interview with the hospital executive. Luckily that was not the case, and the story actually aired.

I’ve found that reporting on readmissions is a great opportunity to springboard beyond one easy-to-grasp concept that’s an underlying theme in health reform:  changing payment schemes to reward quality, encouraging teamwork across care settings and engaging patients in their own care.

There are dozens of innovative strategies being tried across the country. Some will work, some won’t. Broad reporting on the topic will help audiences better understand one place where health care is failing, and why solutions aren’t always simple.

Eric Whitney is a health reporter at Colorado Public Radio.