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Economy affects dosing decisions, trickles across sites

Medicare & Reimbursement Advisor Weekly, May 20, 2009

The weakened economy has begun to affect treatment decisions in a new way. Hospitals have begun to tighten formularies for financial reasons. “What we’re seeing more of is the economy cutting down on different dosage strengths in the hospital formularies,” says Ross Brickley, RPh, CGP, president of CCRX of North Carolina.

After changing the dosage, hospitals are then including the lower dosage in the patient’s discharge plans and orders for the next level of care—be it rehab, a nursing facility, or back home. More than eighty-six percent (86.2%) of 912 hospital discharge planners that HCPro polled on this topic said they have seen lower dosage strengths in discharge plans as a result of economic changes in their institutions.

For example, the discharge summary will have an order for the patient’s physician or a facility medical director for a lower dose. Nursing homes, in particular, follow hospital orders. The problem from an access, quality, and safety perspective is that more nursing homes are experiencing rapid admissions, and in this faster pace, nurses and staff members can easily follow the order and miss the fact that the hospital lowered the dose for financial reasons. Brickley is encouraging providers to be detectives.

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