Experts agree critical medication mistakes occur during transitions from acute to post-acute care. Many are associated with multiple diagnoses and miscommunicated medication orders.

Under the Patient Driven Payment Model, nursing homes have a relatively short window to get everything right, and it’s more important than ever to do it right the first time. The diagnosis — and prescribed medications associated with it — must be correct and consistent. If the information is coded wrong, it could put payment, quality and compliance at great risk, experts emphasize. A botched ICD-10 coding means a facility could be stuck with a CMS-assigned default payment rate that could cost the facility over $300 per day in lost revenue.

Through the lens of medication management, diagnoses have not been assigned such a level of criticality as they are now. 

“They’ve emerged as the red-headed stepchild,” acknowledges Marti Wdowicki, PharmD, director of clinical operations for PharMerica, a long-term care pharmacy services company. 

“Prescribers didn’t pay as much attention to diagnoses in the past. It was more a nice thing to have, but optional. There is no real repository accurately linking drugs to diagnoses. And while PDPM underscores the importance of both, we haven’t moved technology along to match it. Now there’s a gap.”

Consequently, problems are resolved retroactively, “but it becomes like a game of whack-a-mole,” Wdowicki adds. “Next time they may know they’re missing diagnoses on transplant patients because they didn’t properly identify transplant medication in time.”

Facilities will need to work more closely with prescribers and pharmacists.“If nursing homes can get more familiar and their prescribers can get more accustomed to providing a diagnosis code when they’re prescribing, then downstream, it makes a lot of things easier for them,” says Stephen Creasy, PharmD., director of clinical services for PharMerica.

Meanwhile, Erin Marriott, RPh, of Guardian Pharmacy Services, believes “a deeper and more efficient medication reconciliation process will be a higher priority over the coming months.”