In an April, 2018 letter from the American Medical Association (AMA) to Centers for Medicare and Medicaid Services (CMS) top administrator Seema Verma, a “reduced reporting period for future MIPS program years in order to reduce administrative burden” was requested, further illustrating the stress felt by practices bracing for a sea change.

Capitol Hill staffers cited physician workload and administrative burden as the primary catalysts for physician meeting requests with their congressman in an October 11, 2018 meeting with PharmD Live®’s executive team. They further described the uptick in administrative burden due to increased QPP reporting requirements as the root cause.  

Dr. Paul Williams, PharmD Live®’s Chief Medical Officer, stated, “Many QPP measures focus on between-visit care, which can add significantly to the physician’s workload. Many practices have chosen to partner with third-party vendors, such as PharmD Live®, which have the potential to reduce physician burden and boost quality metrics while increasing direct and indirect practice revenue.”

But how does a partnership with PharmD Live® alleviate the administrative burden and reduce physician workload?

PharmD Live®’s chronic care management services are designed to ease the transition to value-based care. As you know, Medicare reimburses for chronic care management and complex chronic care management delivered via telehealth between office visits. PharmD Live®’s board-certified pharmacists deliver between-visit care and are medication experts capable of making high-level clinical decisions. Pharmacists are available around-the-clock to deliver care, answer questions and tend to patient needs.

Because the PharmD Live® technology solution is integrated with the physician’s electronic health record (EHR), patient information is updated in real time. PharmD Live® provides billing reports and metrics data to streamline Medicare billing and communications.

To learn how a partnership with PharmD Live® can ease your transition to value-based care, schedule a demo.

The post Reducing Burden In A Value-Based Care Model: What Physicians Need To Know appeared first on Pharmdlive.

Value-Based Care is not as complicated as it sounds.  “The Affordable Care Act (ACA) in 2010 was the first legislation to make mention of the change to Value-Based Care.”² However, the changes took nearly a decade to implement. .  FFS theoretically caused physicians to emphasize the number of procedures and patients, which led to suspicions that FFS was driving up medicine’s overall cost. .  “Value-Based Care is a ‘new’ healthcare payment model that shifts medical provider’s reimbursement from Fee-for-Service to Fee-for-Value, with value defined as care quality, cost, efficiency, and effectiveness. Physician reimbursement will be tied directly to care quality, patient outcomes and overall cost-efficiency, rather than to the act of performing tests or procedures — i.e., physicians will only receive full reimbursement from insurers for effective care.”

The Merit-based Incentive Program System (MIPS) is one of two payment tracks under the Quality Payment Program (QPP). The other compensation track is Value-Based Care (VBC). There is some expectation that VBC may drive down patient billings.  It may be more accurate to say that billings might remain flat for some time .

VBC should have the effect of reallocating a practice’s time, focusing on optimizing care instead of numbers. FFS was adequate, but VBC will drive clinical quality.    As you will see in this analysis, compensation will not differ significantly  under VBC.  The new model proposes that physicians spend more time with the elderly and the chronically ill, especially those age 65 and older.  This change will lower the morbidity of those groups and reduce their likelihood of ER or hospital visits.  Physicians (expert caregivers) can concentrate on improving outcomes for these  high-risk patients.  In turn, they will see improved Quality Payment Program (QPP) measures in their practices.  

When high-risk patients are under an expert and watchful eye, metrics such as “hospital readmissions” can improve for patients on four or more drugs. Overprescribing is out of control and everyone involved needs to check and check again.  With this change of focus in mind, let’s talk briefly about designing a VBC compensation plan. 

Constructing a compensation plan to motivate and reward physicians and other staff can be straightforward.  “There are many factors to consider when selecting quality metrics, but best practices are measures that drive desired physician performance improvement to those that influence reimbursement. Maintain a coordinated strategy for quality metrics…to ensure payer requirements overlap and focus on a low number of measures.”³ Creating only a few metrics is the best way to keep staff focused and motivated.  Practices want them to succeed and be optimistic about the new measures.  “Value-based performance incentives are most often tied to quality measures, chosen by a collaboratively derived physician committee.”⁴  It is essential to include the ability for staff to achieve full or half credit on quality measures.   

We encountered several sample compensation plans online.  The most common element in those plans is that 80% of compensation is positioned to be guaranteed.  Incentives on various metrics can allow staff to earn back the remaining 20%.  Administrators are working with physicians so that they are reasonably able to earn what they earned under FFS.  There does not seem to be a punitive nature to the new compensation.  One consideration is that practices are measured on the whole, not on the contributions of individual physicians.   But are there ways to improve the viability of the entire practice?

One way that we have alluded to here relates to elderly patients with more than one chronic illness.  Among your practice, these patients tend to be 65 and older, standing out because of their polypharmacy and frequency of hospitalizations.  What if there was a way to protect their health?  What would that do to your quality measures?  Chronic Care Management (CCM), is a Medicare program that can improve 80 different MIPS measures while improving the health of the age 65 and older population.  The priority of CCM is to provide special attention and medication management to this at-risk population.  Because this group typically takes multiple medications, increased medical oversight is indicated and recommended by Medicare.  Medicare has announced billing codes for CCM patient care intended to occur between their regular office visits.  CCM patients can receive remote care through telehealth, or other technology, from doctors, advanced practice registered nurses and other practitioners.  CCM partner companies can handle the regular care and monitoring of these patients.  A number of firms offer CCM outsourcing.  One company, PharmD Live®, specifically employs clinical pharmacists as direct care providers. Pharmacists are highly trained in medication management to ward off Adverse Drug Events (ADEs). The PharmD Live® pharmacy team uses proprietary Artificial Intelligence software to find impending ADEs and disease care gaps.  Since medication is key to chronic care, their staff focuses on improving medication management and adherence.

PharmD Live®’s pharmacy staff assists the patient where they are: at home, in a facility, or in transition.  Keep in mind that many medication errors happen when patients move.  PharmD Live®’s CCM solution reinforces the physicians’ treatment plan and instructions to their patients.  Our CCM goals are to improve patients’ health and bolster ties to their physicians.  PharmD Live® engages with the patient to create health goals to be included in a Care Plan for the patient that are billable to Medicare.  In summary, the increased attention of CCM is life-improving and enables the patient to spend more time at home with loved ones.  Taken further, CCM, under Value-Based Care, will improve practice quality scores and increase compensation opportunities.

Medicare studies have shown that CCM creates better outcomes. VBC is already rewarding better outcomes.  CCM means an additional profitable revenue stream for practitioners.   PharmD Live®’s technology is HIPAA-compliant and enables a bi-directional patient data flow in real-time.  PharmD Live®’s implementation team is experienced and will set up CCM care with minimum disruption.  If you have barriers to starting CCM, like limited time or technology, PharmD Live® can help your practice succeed.   We provide optimal healthcare with efficiency, sensitivity, and the right telehealth solutions.  CCM is a way to increase MIPS Scores, VBC participation, and population health.  With so many changes in healthcare, keep your practice ahead of future trends and technology.  Find out about CCM with PharmD Live®.    

1. https://www.medicaleconomics.com/view/bringing-value-based-compensation-your-medical-practice
2. https://vittana.org/17-fee-for-service-pros-and-cons
3. https://hbr.org/2005/07/the-balanced-scorecard-measures-that-drive-performance
4. https://cokergroup.com/understanding-value-based-compensation-models/

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Chronic Care Management Reimbursements are Generous 

CCM will see the most remarkable change in 2022, with reimbursement increases as high as 60% (see chart below). CMS increased reimbursement rates generating substantial revenue for physician practices.*  Let’s put that into context: 

2022 CCM REIMBURSEMENT RATES 

[wptb id=3829]

An easy way to gauge potential revenues for your practice is the 40-40-20 rule: 40% of your CCM patients will require 20 minutes of time, 40% will require 40 minutes of time, and 20% will require an hour or more, per month.

Remote Patient Monitoring CMS Reimbursement Adjusted

CMS adjusted pricing downward for their reimbursement model for RPM CPT codes. Despite these lower rates (see chart below), RPM is still a beneficial program to include in your practice both from the perspective of improved health for your chronic care patients and your bottom line. 

2022 RPM REIMBURSEMENT RATES 

[wptb id=3830]

Despite handsome CMS reimbursement rates for chronic disease management, only 5% of the $40 billion CMS incentive dollars have been disbursed to physician practices around the country. That’s because many practices  believe there is excessive investment of their time and technology required to get a chronic disease management program implemented. This is where PharmD Live® can help. We provide turn-key CCM and RPM solutions with personalized chronic care coordination and medication management through board-certified pharmacists who function as an extension of your team. We charge no upfront costs or monthly subscription fees. We are paid based on your CMS monthly reimbursement.

Contact us today to determine how much additional annual income your practice can earn.

The post New 2022 Rates Position CMS’ Chronic Care Programs Are Ripe for Increased Revenue, Improved Outcomes appeared first on Pharmdlive.

The vaccines indicated for patients 65+ are: Fluzone High-Dose Quadrivalent and adjuvanted flu vaccines (FLUAD and FLUAD Quadrivalent). The Fluzone High-Dose Quadrivalent (HD) is a four-ingredient, inactivated vaccine that contains four times the antigen to provide extra protection for those 65+. It’s manufactured using an egg-based process and is one of the more expensive options at approximately $64 for each prefilled syringe.

FLUAD and FLUAD Quadrivalent vaccines contain the ingredient squalene that helps increase immune response and allows the manufacturer to use less virus in the vaccine to produce a greater supply. Similarly, these are also made with the egg-based process and cost approximately $60 for both the quadrivalent or standard dose adjuvant vaccine.

In addition to the ones above, there are a number of other less costly options available for standard flu vaccines (SD) priced at around $20. So the question remains: is the high-dose or adjuvanted vaccine better than the standard dose for the senior population?

“Efficacy of High-Dose versus Standard-Dose Influenza Vaccine in Older Adults” was a phase IIIb-IV, multicenter, randomized, double-blind, active-controlled trial that compared the SD vs HD vaccine with an enrollment of 31,989 patients for the trial. The results were statistically significant with the HD trial resulting in 228 influenza cases versus the SD trial’s 301 cases. Similarly, hemagglutination inhibition immunogenicity was measured for the two groups. A month after vaccination, the HD showed significantly higher levels than the SD.

The second trial discussed in this article is by Gravenstein PS, Davidson HE, Taljaard M, et. al. They performed a single-blind, pragmatic, comparative effectiveness, cluster-randomized trial. The study compared HD versus SD in nursing home residents with the primary outcome being hospital admissions. The respiratory-related hospital admissions were significantly lower in the facilities in which the residents received HD than in those that received SD. To expand, there were 185/1000 residents hospitalized in the HD versus 211/1000 in the SD group.

The third study, “Prevention of serious events in adults 65 years of age or older”, was a double-blind, randomized, active-controlled, multicenter trial. Participants were adults ≥65 years, randomized to receive trivalent HD or trivalent SD. The trial length followed participants 6 to 8 months post-vaccination and the primary endpoint was lab-confirmed influenza. The randomization of participants was as follows: 15,991 to IIV-HD and 15,998 to IIV-SD. The rate of all-cause hospitalization was 6.9% (95% CI, 0.5–12.8%) lower in the HD cohort. Likewise, there were 71 pneumonia events in HD vs 118 in SD.

As far as the data for the adjuvant vaccine, a meta-analysis was conducted including all prospective, randomized, and observer-blinded clinical studies. A total of 20 trials were included over the span of 2 years. In each of these studies, a single dose of FLUAD or control vaccine (standard vaccine) was given to each patient. The study population was those aged 65+ and mostly ambulatory patients. The results of the study were statistically significant in that the adjuvant vaccine had a higher immunogenicity than the SD. Another analysis performed showed that patients with cardiovascular diseases, respiratory diseases, or diabetes had a greater benefit from the adjuvant vaccine than SD.

Which leads us to the next question: is the high dose or adjuvant vaccine really better for patients 65 and older? To date, there are no trials comparing the high-dose against the adjuvant vaccine, and the CDC does not recommend one vaccine over another for this age group.

In summary, the trials discussed above have shown that all approved flu vaccines are efficacious at preventing the flu. When comparing the two, however, the HD performed better than the standard dose in patients over 65 years of age. For the prevention of influenza cases, hospitalizations, or pneumonia, the HD was superior.

On the other hand, the adjuvant vaccine also performed better than the standard dose vaccine and resulted in higher rates of immunogenicity in the elderly. However, the CDC does not recommend or prefer one influenza vaccination over another. The most important recommendation one can make as a provider is ensuring that patients over 65 receive one of these vaccinations annually.

In conclusion, both the high dose and adjuvant vaccines are generally well-tolerated and efficacious and are the preferred choice when choosing a vaccine for the elderly population.

References

Estimated Influenza Illnesses, Medical visits, Hospitalizations, and Deaths in the United States – 2019–2020 Influenza Season. Centers for Disease Control and Prevention. https://www.cdc.gov/flu/about/burden/2019-2020.html. Published October 6, 2020. Accessed October 17, 2020.

Fluzone High-Dose Seasonal Influenza Vaccine. Centers for Disease Control and Prevention. https://www.cdc.gov/flu/prevent/qa_fluzone.htm. Published September 3, 2020. Accessed October 17, 2020.

Influenza Virus Vaccine (Inactivated). Lexi-Drugs. Lexicomp. Wolters Kluwer Health, Inc. Riverwoods, IL. Available at: https://www.reliasmedia.com/articles/143915-influenza-cases-rising-what-clinicians-need-to-know. Accessed October 20, 2020.

DiazGranados CA, Dunning AJ, Kimmel M, et al. Efficacy of high-dose versus standard-dose influenza vaccine in older adults. N Engl J Med. 2014;371(7):635-645. doi:10.1056/NEJMoa1315727

Gravenstein S, Davidson HE, Taljaard M, et al. Comparative effectiveness of high-dose versus standard-dose influenza vaccination on numbers of US nursing home residents admitted to hospital: a cluster-randomised trial. Lancet Respir Med. 2017;5(9):738-746. doi:10.1016/S2213-2600(17)30235-7

Izurieta HS, Chillarige Y, Kelman J, et al. Relative Effectiveness of Cell-Cultured and Egg-Based Influenza Vaccines Among Elderly Persons in the United States, 2017-2018 [published correction appears in J Infect Dis. 2019 Jun 5;220(1):179]. J Infect Dis. 2019;220(8):1255-1264. doi:10.1093/infdis/jiy716

DiazGranados CA, Robertson CA, Talbot HK, Landolfi V, Dunning AJ, Greenberg DP. Prevention of serious events in adults 65 years of age or older: A comparison between high-dose and standard-dose inactivated influenza vaccines. Vaccine. 2015;33(38):4988-4993. doi:10.1016/j.vaccine.2015.07.006

Adjuvanted Flu Vaccine. Centers for Disease Control and Prevention. https://www.cdc.gov/flu/prevent/adjuvant.htm. Published August 21, 2020. Accessed October 20, 2020.

Podda A. The adjuvanted influenza vaccines with novel adjuvants: experience with the MF59-adjuvanted vaccine. Vaccine. 2001;19(17-19):2673-2680. doi:10.1016/s0264-410x(00)00499-0

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Currently, there are two vaccines approved to prevent shingles: the shingle zoster vaccine live (Zostavax) and shingles recombinant zoster vaccine (Shingrix). Between the two, the Advisory Committee on Immunization Practice prefers Shingrix. The FDA approved Shingrix on October of 2017 as an intramuscular 2-dose vaccine series that is recommended for immunocompetent adults ≥ 50 years³. The effectiveness of Shingrix was evaluated in a two-part, phase III, multicenter trial that evaluated Shingrix efficacy with more than 30,000 participants. The ZOE-50 trial group results concluded that the vaccine efficacy after the 1st year was greater than 97% compared to placebo⁴. The ZOE-70 trial results concluded that vaccine efficacy was about 90% in patients older than 70⁵. In a pooled analysis of both studies in patients over 70, results showed that vaccine efficacy against herpes zoster was 91.3% and 88.8% against postherpetic neuralgia.

Based on findings from the shingles studies, the Centers for Disease Control and Prevention (CDC) published core recommendations for patients ≥ 50 years to receive the Shingrix vaccine⁵, with the second dose of the vaccine being administered 2 to 6 months after the initial dose. While Shingrix is not recommended in patients that have an active acute episode of herpes zoster, it is recommended for patients with a resolved previous infection of herpes zoster. For patients that have had a previous Zostavax vaccine, it is best to wait at least 8 weeks before administering Shingrix. The only known contraindication for the vaccine is for patients that have a severe allergic reaction to the contents of the Shingrix. Finally, it is recommended that any adult with an acute illness wait to receive their vaccine until their illness is resolved.

The two-dose Shingrix vaccine series has an estimated cost of $280, based on most drug store chain pharmacies. While most insurance companies cover the cost of the vaccine for patients, some still require a co-pay. The vaccine must be reconstituted to a 0.5 mL dose prior to injection. Pharmacists play a crucial role in reminding the patient to complete the full series by calling patients to remind them of their second dose within 2-6 months of their initial Shingrix injection.

PharmD Live® telehealth solutions, including Chronic Care Management (CCM) and Medicare Annual Wellness Visits, emphasize the importance of vaccinations, thereby reducing the disease burden on our patient population. We provide patients and their healthcare providers with 24/7 access to a clinical pharmacist, who can assist the patient if he or she experiences a common adverse reaction such as injection site redness, swelling, fever, or upset stomach. The patient’s benefit for receiving the shingles vaccine generally outweighs the risk, and this is assessed during an initial visit with a PharmD Live® clinical pharmacist.

PharmD Live® Blog for Providers offers insight on topics of interest to the healthcare community. Researched by our team of clinical pharmacists, this blog references information that is current as of the date of posting. For further information, please visit the references below, or contact our pharmacy team on the Contact page. Thank you for reading!References1. Yawn BP, Saddier P, Wollan PC, St Sauver JL, Kurland MJ, Sy LS. A population-based study of the incidence and complication rates of herpes zoster before zoster vaccine introduction. Mayo Clin Proc 2007;82:1341–9. DOI: 10.4065/82.11.13412. Food and Drug Administration. Shingrix [package insert]. Silver Spring, MD: US Department of Health and Human Services, Food and Drug Administration; 2017.3. Lal H, Cunningham AL, Godeaux O, et al. ; ZOE-50 Study Group. Efficacy of an adjuvanted herpes zoster subunit vaccine in older adults. N Engl J Med 2015;372:2087–96. DOI: 10.1056/NEJMoa15011844. Cunningham AL, Lal H, Kovac M, et al. ; ZOE-70 Study Group. Efficacy of the herpes zoster subunit vaccine in adults 70 years of age or older. N Engl J Med 2016;375:1019–32.DOI: 10.1056/NEJMoa16038005. Centers for Disease Control and Prevention. Shingrix Recommendations. Accessed October 26, 2020.

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Prevnar 13 (PCV13)  is used primarily with children and in some high-risk adults. It helps protect against multiple Streptococcus pneumoniae serotypes.  Specifically it targets Streptococcus pneumoniae serotypes 1, 3, 4, 5, 6A, 6B, 7F, 9V, 14, 18C, 19A, 19F, and 23F. Studies have shown that the US incidence of invasive pneumococcal disease had declined by 87% since the introduction of Prevnar 13 in 2010. This intramuscular injection is given to children as a four dose series: at 2, 4, 6, and somewhere between 12 to 15 months. Additionally, adults 19 to <65 can be given Prevnar 13 if they are immunocompetent, immunocompromised or if they have functional or anatomic asplenia. Routine vaccination for adults >65 with Prevnar 13 is not recommended. However, ACIP advises the decision to be clinician driven if they feel Prevnar 13  is appropriate for that age group; only patients who are at high risk are often given the vaccine. They include nursing home patients, those residing in low pediatric PCV13 uptake and those traveling to regions where there is no PCV13 immunization program. 

Pneumovax 23 (PPSV23) is used for adults greater than 50 years old and >2 years old who are at an increased risk of pneumococcal disease. This vaccine targets Streptococcus pneumoniae serotypes 1, 2, 3, 4, 5, 6B, 7F, 8, 9N, 9V, 10A, 11A, 12F, 14, 15B, 17F, 18C, 19F, 19A, 20, 22F, 23F, and 33F.  A 14-year retrospective study found that PPSV23 resulted in a 57% reduction of disease in adults with certain chronic conditions. This vaccine can be given either intramuscularly or subcutaneously. A single dose of Pneumovax 23 is recommended in adults 19-64 who are at an increased risk for pneumococcal infections like chronic heart disease or alcohol use disorder.  Additionally, Pneumovax 23 vaccine is indicated for all adults >65 years old since incidence increases after this age. 

In conclusion, the need to vaccinate against pneumococcal disease is essential to lessen the likelihood of getting the infection. Streptococcus pneumoniae is the main bacterial cause of pneumonia which causes both morbidity and mortality globally. Both Prevnar 13 and Pneumovax 23 help protect against the disease. However, having a basic understanding of when to give each vaccine and to whom is extremely challenging and at times confusing. 

Below is a concise guide summarizing the main highlights of this article of when to give each vaccine and to whom:

Prevnar 13 (PCV13)

• Types of bacteria it targets: 13 types of pneumococcal bacteria
• Who is it for: Primarily for children. At times for high-risk adults
• Administration: Intramuscularly
• When it should be given:
  • 4 dose series for children: 12-15 months, ages 2, 4 and 6
  • >19YO with the below: cochlear implants, CSF leaks, congenital or acquired asplenia, sickle cell disease, chronic renal failure, congenital or acquired immunodeficiency, generalized malignancy, HIV infection, Hodgkin disease, Iatrogenic immunosuppression, leukemia, lymphoma, multiple myeloma, nephrotic syndrome, solid organ transplant

Pneumovax 23 (PPSV23)

• Types of bacteria it targets: 23 types of pneumococcal bacteria

• Who is it for: only for adults
• Administration: Subcutaneously or intramuscularly
• When it should be given:
  • 19-64 with: Alcoholism, chronic heart disease, chronic liver disease, chronic lung disease, cigarette smoking, diabetes
  • If >19 YO patient received PCV 13, then >/=8weeks PPSV23 is given and revaccination of PPSV23 is done >/= 5 years after initial PPSV23 for patients with asplenia and immunocompromised patients
  • >65 YO: PPSV23 to be given. If the provider has decided to give PCV 13 then wait 1 year to give PPSV23

For more information on how PharmD Live® can help identify patients in need of pneumococcal vaccines, please contact us!

References: 

Merck Vaccines. Indication for Pneumovax 23. 2020 Merck Sharp & Dohme Corp. Accessed October 28, 2020. https://www.merckvaccines.com/pneumovax23/

Musher, M Daniel.  Pneumococcal Vaccination in Adults.  In: File, Thomas and Bond Sheila. UpToDate. UpToDate, Inc.; 2020. Accessed October 28, 2020. https://www.uptodate.com/contents/pneumococcal-vaccination-in-adults?search=pneumovax%2023&source=search_result&selectedTitle=2~84&usage_type=default&display_rank=1#H4126861631

PfizerPro. Prevnar13. 2020. Wyeth Pharmaceuticals. Accessed October 28, 2020. https://www.pfizerpro.com/product/prevnar13pediatric/hcp

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The Social Determinants of Health in the African-American community include all of the factors of the U.S. Government’s Healthy People 2030, a set of data-driven national goals for improving health for all Americans. Included is a focus on the Merit-based Incentive Pay System (MIPS). 

From poverty to food insecurity and violence, the history of racism can’t be ignored as a social determinant of health today. Enslavement established conditions that put little value on health, living conditions, and the people themselves.¹ Hundreds of years later, the effects linger. Mistrust of the system based on objective and fabricated truths runs deep. Gaining trust among African American patients is a high hurdle that we must clear. 

Louis Israel Dublin wrote in 1928, “An improvement in Negro health, to the point where it would compare favorably with that of the white race, would at one stroke wipe out many disabilities from which the race suffers, improve its economic status and stimulate its native abilities as would no other single improvement. These are the social implications of the facts of Negro Health.” ² 

The entire U.S. medical system is fractured but especially affects African Americans and other underserved populations. Patients have multiple physicians and access to medications:

• Multiple prescriptions
• Samples
• Numerous pharmacies
• Over-the-counter drugs
• Herbal remedies and vitamins

In addition, the communication system to share analysis and the patient’s state is mediocre. 

The confluence of these realities collides to create Adverse Drug Events, among other issues, with medical consequences for the patient’s health and cost to the patient, the system, and the economy. 

The Federal Government’s effort to move Medicare and Medicaid from fee-for-service to quality-oriented Value-Based Care, the Merit-based Incentive Pay System (MIPS), separates those who must participate from those who are exempt. Since its introduction in 2017, physicians and clinicians have become more experienced in the rules and tools for transformation. 

When the patient population is large but poor, this can be a blessing or a curse for African Americans and other underserved populations–if it doesn’t drive resources (i.e., hospitals and clinics) even further afield because of expense, rules, and regulations.²

Clinics with a stake in underserved or rural communities are familiar with the potential rewards and penalties associated with the new model. Some can’t afford to adopt the technologies that would help most, or the staff it takes to administer for compliance–or they are simply exempt. Yet, for larger population areas, participation is likely required. 

How do we advance good health among African American communities through the health care system as it exists today? 

With the population age 65+ growing, so are the number of chronic care management needs. The reality of mistrust and avoiding the medical community exacerbates the number and degree of chronic conditions in the African American population. 

Chronic Care Management Services: A Bold Proposal

Pharmacists are being incorporated increasingly as clinical partners and are among the most trusted by patients in the medical field. Use these practitioners for their knowledge of the clinical setting. Use pharmacists for chronic care management. 

PharmD Live®^® implements MIPS solutions for various health organizations, from private practices to ACOs. The ability to apply a pharmacist’s depth of pharmacological knowledge with its patented algorithm for flagging potential medical issues provides a means to participate in MIPS with success.

Chronic Care Management Services is another piece of the government quality initiative. A PharmD Live® partnership can create financial stability for clinics that treat Medicare patients with two or more chronic conditions. For a clinic that operates on the slimmest of margins, the potential gain of a well-managed MIPS program in conjunction with a CCM program can support the financial needs of the clinic itself. 

A closer look at chronic care management services

There are two Medicare programs at work within this disease management construct: Chronic Care Management and Remote Patient Monitoring. 

The cost to a clinic is $0 for setting up the IT, patient management staff, tracking and collecting data with a PharmD Live® plan in place. All Medicare patients who are eligible for the CCM and RPM programs are singled out for enrollment. Board-certified pharmacists (PharmD) coordinate all the interactions with patients and their primary care provider and any specialists. 

Once armed with information about all medications and therapies earlier identified as part of the fractured system, pharmacists analyze the medical history and discuss with patients what drugs they take, and ensure they understand the role they play in making their treatment plan work.

Tens of millions of Americans have Low Health Literacy (LHL). As a percentage of the total African American population, nearly six in 10 have LHL compared to less than half that amount among non-Latin White Americans. Working one on one with a PharmD can help bring up the health literacy of these patients and engage them in their own well-being.

This entire process is tracked and coded by the pharmacist who monthly uploads an automated report to the clinic for reporting to CMS.

The targets set by CMS are included in the data platform the pharmacists use, and the broad number of quality targets used for achieving quality targets as a whole within the clinic are supplemented by the CCM and RPM reimbursement requests. 

The financial and patient health upside of the MIPS tracking paired with the CCM and RPM reimbursements is demonstrable. Pharmacists should take their place among the efforts being made to meet and overcome challenges to good health for African Americans. 

Back to Main Blog

 Citations:

1. Paradies Y, Ben J, Denson N, Elias A, Priest N, Pieterse A, et al. Racism as a determinant of health: a systematic review and meta-analysis. PLoS One. 2015;10(9):e0138511. Pubmed Central PMCID: 4580597. https://publichealthreviews.biomedcentral.com/articles/10.1186/s40985-016-0025-4#ref-CR14
2. Dublin L. The health of the Negro. Ann Am Acad Pol Soc Sci. 1928;140:77–85. See also: Essay – Transforming American health care to improve end …. https://www.inmed.us/wp-content/uploads/Marginalized-African-American-People-Khalid-Eddahiri.pdf

Bibliography

What is Shortage Designation?  https://bhw.hrsa.gov/shortage-designation/hpsas

Noonan, A.S., Velasco-Mondragon, H.E. & Wagner, F.A. Improving the health of African Americans in the USA: an overdue opportunity for social justice. Public Health Rev 37, 12 (2016). https://doi.org/10.1186/s40985-016-0025-4 https://publichealthreviews.biomedcentral.com/articles/10.1186/s40985-016-0025-4#ref-CR14

Figures

Fig 1. Noonan, A.S., Velasco-Mondragon, H.E. & Wagner, F.A. Improving the health of African Americans in the USA: an overdue opportunity for social justice. Public Health Rev 37, 12 (2016). https://doi.org/10.1186/s40985-016-0025-4  https://publichealthreviews.biomedcentral.com/articles/10.1186/s40985-016-0025-4#citeas

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Remote patient monitoring (RPM) is not just a trend but a core pillar of modern US healthcare. By 2025, over 71 million Americans (26% of the population) are expected to use RPM services, with the US market projected to double to $29+ billion by 2030. RPM delivers proven clinical benefits: reducing hospital admissions by 38% and ER visits by 51%, with patient satisfaction exceeding 90%. Yet, as RPM and its billing become ubiquitous, federal scrutiny and compliance risks are mounting, putting practices’ revenue and reputations on the line.

The Compliance Squeeze: Why RPM Billing Is Under the Microscope

Federal Oversight Intensifies
In late 2024, the Department of Health and Human Services Office of Inspector General (OIG) announced sweeping audits of Medicare Part B RPM services, targeting billing accuracy and service delivery. This crackdown follows a revealing OIG report revealing that 43% of Medicare RPM patients did not receive all three required service components—education/setup, device supply, and treatment management. Even more alarming, Medicare lacked records of the ordering provider for 44% of enrollees, exposing vast oversight gaps.

The Hidden Risks
Many compliance failures stem from:

• Vendor shortcuts: Some RPM vendors manipulate device software to log “phantom” readings—counting automated alerts as patient data to meet billing thresholds, a practice explicitly flagged by CMS as noncompliant.
• Improper device billing: Vendors may advise billing for CPT code 99454 (device supply) even when the practice hasn’t paid for the device, risking fraud allegations.
• Incomplete service delivery: Failing to provide all three core RPM components not only jeopardizes patient care but also exposes providers to audit risk and financial penalties.

“Partnering with an unreliable RPM vendor can expose healthcare providers to significant risks. Fraudulent or noncompliant vendors may submit false claims on behalf of providers, leading to Medicare audits, financial penalties, and potential exclusion from federal programs.”

Real-World Impact: The Cost of RPM Billing Mistakes

• Financial Fallout: Medicare audits can result in clawbacks, penalties, or even exclusion from federal programs, which is catastrophic for small and mid-sized practices.
• Reputational Damage: Patients trust providers to recommend safe, compliant solutions. A vendor’s missteps can erode patient trust and satisfaction.
• Operational Strain: The 2025 Medicare Physician Fee Schedule slashes reimbursement rates by 2.83%, intensifying the need for efficient, compliant RPM workflows to protect margins.

Industry Snapshot: RPM in 2025

Building Trust: What Makes an RPM Partner Truly Reliable?

Key Qualities to Demand:

• Compliance Mastery: Up-to-date knowledge of CMS and OIG rules; transparent, audit-ready billing.
• Full-Service Delivery: Education, device supply, and treatment management for every patient.
• Data Security: HIPAA-compliant, with robust privacy protocols.
• Proven Track Record: Documented success, strong references, and positive client outcomes.

PharmD Live®: Setting the Standard for RPM Integrity and Innovation

PharmD Live® stands out with its pharmacist-led multidisciplinary care model and AI-driven telehealth platform, addressing both compliance and clinical excellence. By integrating pharmacists into the RPM workflow, PharmD Live® ensures:

• Thorough patient education and device setup
• Continuous, clinically relevant monitoring—not just device “pings”
• Proactive medication management to reduce adverse events and readmissions
• Transparent, compliant billing aligned with the latest CMS guidance

As reimbursement rates tighten, PharmD Live®’s approach empowers practices to thrive in value-based care, improving patient outcomes while safeguarding financial health.

Action Steps: Protecting Your Practice in 2025

• Vet RPM Vendors Rigorously: Demand transparency, compliance documentation, and references.
• Audit Your Billing Workflows: Ensure device usage, patient engagement, and service delivery meet CMS/OIG standards.
• Educate Your Team: Regularly update staff on regulatory changes and best practices.
• Leverage Trusted Partners: Collaborate with organizations like PharmD Live® that combine clinical expertise with regulatory savvy.

Stay Ahead Or Risk Falling Behind

RPM is transforming US healthcare, but the hidden risks in billing can undermine even the best clinical intentions. By prioritizing compliance, transparency, and partnership with proven leaders like PharmD Live®, practices can capture RPM’s full value without jeopardizing their future.

Ready to safeguard your RPM program and maximize outcomes?

Discover how PharmD Live®’s RPM expertise can protect your practice today

Reference List

1. Centers for Medicare & Medicaid Services. (2025, April). Telehealth & remote patient monitoring (MLN Booklet ICN: MLN901705). https://www.cms.gov/files/document/mln901705-telehealth-remote-patient-monitoring.pdf
2. U.S. Department of Health & Human Services, Office of Inspector General. (2024, September). Additional oversight of remote patient monitoring in Medicare is needed (Report No. OEI-05-22-00180). https://oig.hhs.gov/documents/evaluation/10004/OEI-05-22-00180.pdf
3. U.S. Department of Health & Human Services, Office of Inspector General. (2024, March). Medicare could strengthen oversight of telehealth services provided by behavioral health practitioners (Report No. OEI-02-23-00260). https://oig.hhs.gov/documents/evaluation/10004/OEI-02-23-00260-highlights.pdf
4. MarketsandMarkets. (n.d.). US remote patient monitoring market worth US$29.13 billion by 2030 with 12.8% CAGR. https://www.marketsandmarkets.com/Market-Reports/remote-patient-monitoring-market-19962812.html
5. Media.Market.us. (2025). Remote patient monitoring statistics 2025 by telemedicine, users, activities. https://media.market.us/remote-patient-monitoring-statistics/
6. Physicians Practice. (n.d.). Remote patient monitoring under scrutiny: Top compliance mistakes to know. https://www.physicianspractice.com/view/remote-patient-monitoring-under-scrutiny-top-compliance-mistakes-to-know
7. PharmD Live®. (2025, January 15). Adapting to the 2025 Medicare Physician Fee Schedule reduction: How PharmD Live® supports providers in value-based care [Blog post]. https://www.pharmdlive.com/blog/medicare-physician-fee-schedule-reduction/
8. AASM. (2024). OIG releases report on remote patient monitoring in Medicare. https://aasm.org/oig-releases-report-on-remote-patient-monitoring-in-medicare/

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Remote Patient Monitoring (RPM) is revolutionizing chronic care management by improving patient outcomes and unlocking sustainable revenue streams for healthcare providers. But in 2025, RPM patient consent compliance is more than a billing formality; it is a legal, regulatory, and ethical imperative.

Without documented patient consent:

• Claims can be denied
• Medicare reimbursement is forfeited
• Practices face potential audits, penalties, or disqualification from CMS programs
• Trust between providers and patients erodes

These consequences are what no executive or practice manager can afford to ignore.

Therefore, RPM programs must prioritize consent not only to meet regulations but to build integrity into care delivery.

Regulatory Requirements: CMS and Medicare Consent Guidelines

The Centers for Medicare & Medicaid Services (CMS) explicitly require documented patient consent before initiating RPM services. Whether verbal or written, consent must be captured and retained in the patient’s record, including:

• The purpose and benefits of RPM
• What data will be collected and how it will be used
• HIPAA-compliant data privacy protections
• Patient responsibilities, rights, and opt-out procedures
• Date, time, method, and personnel involved in the consent

Importantly, consent may be obtained by auxiliary staff under general supervision, and CMS permits it to be secured at the time RPM services begin, provided it is documented properly. 

Providers must ensure patients understand the full scope of RPM, including data use and privacy protections, before enrollment.

Failure to meet these requirements puts practices at risk of non-compliance, and CMS audits increasingly scrutinize consent documentation.

Explore more: CMS Remote Patient Monitoring Coverage

The Hidden Risks of Poor Consent Practices

Financial and Legal Consequences

Many practices mistakenly treat consent as a checkbox task. Vague documentation like “patient consented” fails under audit scrutiny. Instead, robust consent logs should capture:

• Who explained the RPM program
• What exactly was shared with the patient
• When and how consent was obtained

Failure to comply with RPM patient consent compliance 2025 can lead to:

• Claim denials and loss of reimbursement
• Regulatory fines and penalties
• Legal vulnerability under HIPAA and the False Claims Act
• Potential exclusion from Medicare programs

CMS requires detailed, traceable records for every enrolled patient to withstand audits and investigations.

Provider Accountability
Outsourcing RPM services to third-party vendors, providers retain full responsibility for compliance. This includes:

• Reviewing vendor workflows for adherence to consent protocols
• Maintaining medical supervision
• Ensuring all consent aligns with CMS and HIPAA regulations

Building Trust: Ethical and Legal Dimensions

Beyond regulatory mandates, patient consent is fundamentally an ethical obligation. It is also about transparency and trust.

RPM involves continuous biometric monitoring and data sharing across various platforms and third-party devices. Unfortunately, many patients are unaware of how their data is stored, accessed, or utilized for commercial purposes.

To ethically deploy RPM in 2025:

• Providers must clearly explain how data flows across the care team
• Patients should know what third parties (e.g., device vendors) are involved
• Consent materials must be accessible, understandable, and rights-focused
• An effective consent process reflects respect for autonomy, critical in a data-driven healthcare environment.

In 2025, patient-centered RPM programs must prioritize clear, accessible, and patient-friendly consent processes.

PharmD Live®: Raising the Bar in RPM Consent Compliance

PharmD Live®, a clinical intelligence and virtual care platform, exemplifies industry-leading RPM consent and compliance. Our pharmacist-led model integrates clinical insight, automation, and regulatory safeguards into every enrollment.

PharmD Live®’s RPM platform ensures:

 Comprehensive patient education with personalized consent scripts
 HIPAA-compliant documentation embedded into workflows
 Real-time oversight of enrollment, documentation, and patient interactions
 Continuous auditing to flag and address consent gaps

By embedding compliance into every RPM touchpoint, PharmD Live® reduces risk and improves patient confidence.

Explore PharmD Live®’s RPM Compliance Solutions

Actionable Steps for Healthcare Leaders

To stay compliant and confident in 2025, practices must take strategic action:

Standardize Consent Workflows

• Use clear, patient-friendly language in consent forms
• Document verbal and written consent with date, time, and detailed explanation

Train Your Teams

• Train clinical and administrative teams on CMS documentation and HIPAA privacy requirements
• Emphasize the importance of thorough consent to prevent claim denials

Perform Regular Compliance Audits

• Regularly review RPM records for completeness and accuracy
• Identify and resolve compliance gaps proactively

Audit consent logs monthly. Verify completeness, clarity, and traceability.

Partner with Compliant Vendors

• Partner with compliance-focused RPM vendors like PharmD Live®
• Ensure vendor workflows are traceable and HIPAA-aligned

Conclusion: Consent Is the Cornerstone of RPM Success in 2025

In 2025, RPM patient consent compliance is no longer optional. It is the foundation of ethical, effective, and billable remote care. Practices that treat consent seriously will safeguard reimbursement, reduce audit risk, and foster long-term patient trust. Those who don’t will fall behind.

By prioritizing consent and partnering with leaders like PharmD Live®, healthcare organizations can align care, compliance, and confidence in a rapidly evolving digital health landscape.

References (AMA Style with Embedded Links)

1. Tashnek D. Remote patient monitoring under scrutiny: top compliance mistakes to know. Physicians Practice. April 15, 2025. [Accessed June 26, 2025].
2. Centers for Medicare & Medicaid Services (CMS). Telehealth & Remote Patient Monitoring: MLN901705. 2025. [Accessed June 26, 2025].
3. CMS. Remote Patient Monitoring Coverage Guidelines. [Accessed June 26, 2025].
4. U.S. Department of Health and Human Services, Office of Inspector General (OIG). Additional Oversight of Remote Patient Monitoring in Medicare Is Needed. 2024. [Accessed June 26, 2025].
5. Kruse CS, Soma M, Pulluri D, Nemali NT, Brooks M. The effectiveness of remote patient monitoring on adherence, hospital readmission, and mortality: a systematic review. J Patient Cent Res Rev. 2021;8(1):51-59. [Accessed June 26, 2025].
6. PharmD Live®. Remote Patient Monitoring Solutions. [Accessed June 26, 2025].
7. Smart Meter. CMS Reimbursement & Consent for Remote Patient Monitoring. [Accessed June 26, 2025].
8. LinkedIn. Post-Sept 2025 RPM Regulatory Changes Overview. [Accessed June 26, 2025].

The post Patient Consent in RPM: A Non-Negotiable Compliance Step for US Healthcare in 2025 appeared first on Pharmdlive.

Background on Polypharmacy in Seniors

The population of persons 65 years and older is rapidly increasing. Approximately 49 million Americans are age 65 and older, and for the next 19 years,10,000 people will turn 65 every day. Projections estimate that the population of older adults will almost double to 80 million by 2030.¹ Twenty percent of Americans will be older than 65 years, and this Silver Tsunami will remain relatively stable through 2050. 

The senior population is highly diverse and heterogeneous regarding demographics, health characteristics, and status. Several factors such as public health measures, advances in medical technology, promotion of a healthy lifestyle, and improvements in living conditions have contributed to the decline in mortality rate and longevity in seniors², hence the increase in the senior population.

Normal aging is a diverse and complex process. It’s associated with physiological and pathological changes that place people at risk of sensory impairments, such as difficulties with hearing and vision, and multimorbidity³ that includes multiple chronic diseases, among them cardiovascular disease, stroke, and diabetes. Multimorbid patients are likely to have decreased quality of life, lower mobility and functional ability due to chronic conditions, and higher healthcare expenditures. 

Multiple comorbidities require complex therapeutic medications, sometimes from different prescribers. The situation leaves patients vulnerable to “medication overload,” also known as polypharmacy. As a result, we see a high degree of polypharmacy at the intersection of multimorbidity and aging. 

According to the Agency for Healthcare Research and Quality, polypharmacy is likely the most substantial risk factor for Adverse Drug Events (ADEs). ADEs represent the fourth leading cause of death in the United States and cost up to $130 billion annually. The consequences of polypharmacy can be dangerous and can include severe adverse drug reactions, unintentional overdose, and death.

What is Polypharmacy?

Polypharmacy definitions slightly vary from one source to another, so there isn’t a standard or universal definition despite its prevalence. Science and medical professionals often define polypharmacy as:

• The routine and concurrent patient use of five or more medications—including prescription, over-the-counter (OTC), herbals, and supplements. In certain multimorbid patients, polypharmacy may be necessary for short and longer terms. 

Polypharmacy may also refer to medications that do not have a specific current indication:

• they may duplicate other medications, or 
• are not therapeutically effective for the condition for which it was prescribed⁴. 

Simply put, polypharmacy occurs when the patient uses multiple medications that are not necessary and have the potential to do more harm than good.

The World Health Organization⁵ reports categories of polypharmacy as appropriate and inappropriate:

  “Appropriate polypharmacy is present, when:

(a) all medicines are prescribed for the purpose of achieving specific therapeutic objectives that have been agreed with the patient; 

(b) therapeutic objectives are actually being achieved, or there is a reasonable chance they will be achieved in the future; 

(c) medication therapy has been optimized to minimize the risk of adverse drug reactions (ADRs); and 

(d) the patient is motivated and able to take all medicines as intended.” 

“Inappropriate polypharmacy is present, when one or more medicines are prescribed that are not or no longer needed, either because: 

(a) there is no evidence-based indication, the indication has expired, or the dose is unnecessarily high; 

(b) one or more medicines fail to achieve the therapeutic objectives they are intended to achieve; 

c) one, or the combination of several medicines cause ADRs or put the patient at a high risk of ADRs, or 

(d) the patient is not willing or able to take one or more medicines as intended.”

Polypharmacy is also classified based on degree: 

• no polypharmacy (patient on less than 2 medications), 
• minor polypharmacy (2 to 3 medications), 
• moderate polypharmacy (4 to 5 medications), and 
• major polypharmacy (more than 5 medications)⁶.

According to a cross-sectional study of the Centers for Disease Control and Prevention’s Survey from 2009 to 2016, which included over 2 billion geriatric patient visits to ambulatory physicians, polypharmacy was common 65% of the time. Most senior patients over 65 years experienced some degree of moderate and major polypharmacy. A significant proportion of these patients with polypharmacy were also prescribed high-risk medications.⁷

Other categorizations of polypharmacy include chronic polypharmacy (continuous patient exposure to polypharmacy) and persistent (frequent polypharmacy) and, a pseudo-polypharmacy patient may be taking more medications than they really are.⁸

Prevalence of Polypharmacy

Polypharmacy is a significant and rapidly growing public health issue occurring in all US health area settings. The prevalence of polypharmacy reported in several literature sources varies between 10% to 90%:

• Estimates are that roughly 90% of seniors aged 65 and older take at least one medication
• 42% take 5 or more medications, and 
• at least 18% are on10 or more drugs chronically. 

Based on the US prescription drug data analysis, polypharmacy rates are steadily on the increase⁹:

• From 1994 to 2014, the proportion of older adults taking 5+ medications tripled from 13.8 percent to 42.4 percent, and 
• at this rate of increase, almost half of the older population could be affected by polypharmacy by 2030.

The 5 Patient Populations at Most Risk for Polypharmacy

1. Geriatric patients with certain chronic diseases: diabetes, depression, heart disease, hypertension, HIV, shortness of breath, and pain were linked significantly to polypharmacy and excessive polypharmacy in various observational studies.^10,11 
2. Patients in long-term care facilities whose rate of polypharmacy is about 50% higher than older adults living in the community.¹²
3. Geriatric cancer patients: 84% of older cancer patients are on 5 or more medications.^13,14
4. Low-income seniors: Dual-eligibles (patients on both Medicare and Medicaid) have a 25% higher rate of multiple chronic conditions, which increases their polypharmacy risk.¹⁵
5. Patients with limited health literacy and numeracy are at risk.

Drivers of Polypharmacy

A broad array of driving forces explain the rapid increase in polypharmacy, some of which include:

• Increased multimorbidity due to the aging population 
• Care fragmentation, which precipitates a lack of communication and coordination between different healthcare teams 
• Disease-specific clinical guidelines which often encourage the use of several medications to treat one medical condition ¹⁶
• Patients who self-medicate without accurately understanding potential risks. 
• Patients visiting different physicians, facilities, and pharmacies and prescribed multiple medications 

Adverse Outcomes Associated with Polypharmacy 

Several studies have shown the association of polypharmacy with multiple adverse consequences and worsening overall health. The risk of an adverse drug reaction increases exponentially with each new medication added to a patient’s regimen. Older adults taking 5 or more medications are at least 88% more likely to seek outpatient care for an adverse drug event than those taking just 1 or 2 medications.

There’s an 82% risk of an adverse drug event occurring when placing patients on 7 or more medications. Polypharmacy contributes to cost increases for both the patient and the payers and can increase medical costs by approximately 30%.¹⁷ 

Potential negative effects of polypharmacy include the following: 

• Higher risk of adverse drug events (ADE) and other safety events such as falls.
• Nonadherence to medications, as patients on 4+ medications are 35% more likely to not adhere to their regimen.¹⁸ 
• Increased health care utilization 
• Frailty¹⁸– a multidimensional syndrome characterized by a non-resilient state and increased vulnerability in older adults 
• Cognitive and functional impairment
• Increased mortality¹⁹ 
• Increased medical cost¹⁷

Strategies to Prevent Polypharmacy 

• Implement medication management and screening system to identify and resolve drug-drug and drug-disease interactions resulting from polypharmacy, which may include a routine and thorough review of the older adult’s medication profile and regular patient engagements in-between visits. 
• Target high-risk and high-cost patients most likely to develop drug-related problems to ensure meeting previously established therapeutic endpoints while discontinuing all unnecessary medications. 
• Maintain an accurate and up-to-date patient medication list in the EHR and ensure that all prescribed medications have a valid indication. 
• A stepwise approach to prescribing:
  • Prescribe the fewest possible medications, the most uncomplicated dosing regimen, at the lowest dose and then titrate slowly. 
  • Avoid initiating potentially harmful medications based on the Beer’s^® Criteria or concurrent use of 3 or more central nervous system (CNS) medications that may result in falls. 
  • Consider goals of care and life expectancy of patients and non-pharmacological alternative treatment strategies. 
• Avoid prescribing cascade-initiating new medications to combat the potential side effects of other medications.
• Implement a team approach that involves the patient/caregivers, the pharmacist, and other care team members to ensure access to the pharmacist for medication-related questions, medication counseling, and reinforcement of the care plan instructions. 
• Ensure accurate and complete medication reconciliation during care transitions, including proper communication handoffs to prevent medication discrepancies, potential ADEs, and treatment failures.

Conclusion 

The rates of prescription drug use and adverse drug events have both increased dramatically over the past decade. The number of people older than 65 years is growing in the United States, and polypharmacy is prevalent in the elderly population. 

Caring for senior patients can be challenging due to multiple chronic conditions requiring complex medication regimens, hence the importance of medication optimization in comprehensive geriatric care to prevent adverse drug events resulting from polypharmacy. 

When evaluating and caring for an older patient, consider any new symptoms drug-related until proven otherwise. This strategy will help decrease prescribing cascades and other adverse outcomes associated with polypharmacy. 

While polypharmacy may be appropriate for some patients, there should be a balance between over-prescribing and under-prescribing, medication appropriateness, patient’s life expectancy, and care goals. 

Polypharmacy management is multi-faceted, necessitating a team-based approach where all stakeholders-physicians, pharmacists, nurses, and other health care professionals play a vital role in driving change that will result in positive patient outcomes. 

Medication overload is a public health crisis and requires a systemic and evidence-based approach to mitigate the risks associated with polypharmacy. Advanced data analytics, innovative clinical strategies, practice standards, and implementation resources for medication optimization can reduce risk.

About the author

Chioma Cynthia Nwaubani is a board-certified geriatric consultant pharmacist. She is the CEO and founder of PharmD Live®. Dr. Nwaubani has a working history delivering high-quality and cost-effective medication management and chronic care services to patients in various healthcare settings.

References:

1. Administration on Aging. Profile of Older Americans: 2017. Found on the internet at https://www.acl.gov/sites/default/files/Aging%20and%20Disability%20in%20America/2017OlderAmericansProfile.pdf

2. Olshansky SJ. The demography of aging. In: Cassel CK, Leipzig RM, Cohen HJ, Larson EB, , Meier DE, eds.Geriatric Medicine: An Evidence-based Approach, 4th ed. New York: Springer-Verlag; 2003:37–44

3. Cefalu CA. Theories and mechanisms of aging. Clin Geriatr Med. 2011 Nov;27(4):491-506. doi: 10.1016/j.cger.2011.07.001. Epub 2011 Sep 22. PMID: 22062437

4. Shah BM, Hajjar ER. Polypharmacy, adverse drug reactions, and geriatric syndromes, Clin Geriatric Med, 2012;28:173–186

5. World Health Organization report: https://apps.who.int/iris/rest/bitstreams/1235792/retrieve

6. Eric H. Young, Samantha Pan, Alex G. Yap, Kelly R. Reveles, Kajal Bhakta  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0255642

7. Polypharmacy prevalence in older adults seen in United States physician offices from 2009 to 2016

Eric H. Young, Samantha Pan, Alex G. Yap, Kelly R. Reveles, Kajal Bhakta  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0255642

8. Masnoon N, Shakib S, Kalisch-Ellett L, Caughey GE. What is polypharmacy? A systematic review of definitions. BMC Geriatr. 2017;17(1):230. Published 2017 Oct 10. doi:10.1186/s12877-017-0621-2

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13. Nightingale, Hajjar E, Swartz K, Andrel-Sendecki J, Chapman A. Evaluation of a pharmacist-led medication assessment used to identify prevalence of and associations with polypharmacy and potentially inappropriate medication use among ambulatory senior adults with cancer. Journal of Clinical Oncology 2015

14. Balducci L, Goetz-Parten D, Steinman M. Polypharmacy and the management of the older cancer patient. Annals of Oncology 2013; 24(7): vii36-vii40

15. Segal M, Rollins E, Hodges K, Roozeboom M. Medicare-Medicaid Eligible Beneficiaries and Potentially Avoidable Hospitalizations.

16. Laurie E. Davies, Gemma Spiers, Andrew Kingston, Adam Todd, Joy Adamson, Barbara Hanratty,

Adverse Outcomes of Polypharmacy in Older People: Systematic Review of Reviews,

Journal of the American Medical Directors Association.

17. Akazawa, M.; Imai, H.; Igarashi, A.; Tsutani, K;. Potentially inappropriate medication use in elderly Japanese patients. The American Journal of Geriatric Pharmacotherapy. 2010; 8:146–160.

18. Rollason, V.; Vogt, N.; Reduction of polypharmacy in the elderly: a systematic review of the role of the pharmacist. Drugs & Aging. 2003; 20:817–32.

19. Clegg A, Young J, Iliffe S, Rikkert MO, Rockwood K. Frailty in elderly people. Lancet. 2013 Mar 2;381(9868):752-62. doi: 10.1016/S0140-6736(12)62167-9. Epub 2013 Feb 8. Erratum in: Lancet. 2013 Oct 19;382(9901):1328. PMID: 23395245; PMCID: PMC4098658.

20. Richardson K, Ananou A, Lafortune L, Brayne C, Matthews FE. Variation over time in the association between polypharmacy and mortality in the older population. Drugs Aging. 2011 Jul 1;28(7):547-60. doi: 10.2165/11592000-000000000-00000. PMID: 21721599.

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