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Abstract: TH-PO276

Cost Savings Associated with Post-Hospital Medication Therapy Management Program Dialysis Patients

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Manley, Harold J., Dialysis Clinic, Inc., Nashville, Tennessee, United States
  • Aweh, Gideon N., Dialysis Clinic, Inc., Nashville, Tennessee, United States
  • Weiner, Daniel E., Tufts Medical Center, Boston, Massachusetts, United States
  • Lacson, Eduardo K., Dialysis Clinic, Inc., Nashville, Tennessee, United States
Background

Dialysis Clinic, Inc. implemented a medication therapy management (MTM) program for End-Stage Renal Disease Seamless Care Organization patients following hospital discharge. Prior results suggested a 56% reduction in readmission rate with MTM compared to no MTM. We determined the potential impact of the MTM process on costs associated with readmision.

Methods

We used a propensity score (PS) to match MTM 1:1 to non-MTM discharges based on clinical characteristics and on the day post-discharge MTM was initiated. Actual readmission costs were obtained from claims data; the percent difference between MTM and non-MTM groups were calculated and used to estimate cost impact if MTM process applied to non-MTM discharges. Readmission rates after MTM completed, or similar time at risk in matched non-MTM patients, was determined. Cost estimates incorporated MTM implementation time (median, interquartile range) and assumed 25%, 50% or 75% of reported MTM program impact on readmission rate.

Results

In the original cohort, there were 162 discharges with 17 readmissions costing $253,652 in the MTM group and 586 discharges with 170 readmissions costing $2,161,163 in the non-MTM group. Median time to complete MTM was 11 days. There were 135 PS matched pairs used, with 26 (19.26%) readmissions in MTM patients and 50 (37.04%) in non-MTM patients (p=0.0002). Readmission costs were $202,659 vs. $580,549, respectively (p<0.001). MTM was associated with 12%, 26%, or 49% cost savings if implemented ≥14 days, ≥11 days or ≥7 days post discharge, respectively. Extrapolating results to the entire non-MTM group, savings ranges from $117,586 to $600,642 (see Table). Cost savings with MTM performed within 11 days of discharge assuming 50% impact approximates $286,020.

Conclusion

MTM process is associated with fewer readmissions and lower inpatient costs.
The statements contained in this document are solely those of the authors and do not necessarily reflect the views or policies of CMS. The authors assume responsibility for the accuracy and completeness of the information contained in this document.

Savings estimates if MTM process implemented in 586 no-MTM discharges
 ≥ 14 days≥ 11 days≥ 7 days
25%$117,586$143,010$200,214
50%$235,172$286,020$400,428
75%$352,758$429,030$600,642