MD Labs Launches Turnkey Rxight® PGx Program for Hospitals in the CMS Cardiac Bundle Program
Target Audience: Hospital Executives, Hospital-based Cardiologists, Quality Directors and Pharmacists
MD Labs is in the process of implementing its turnkey Rxight® Pharmacogenetics (PGx) program in hospitals across the country participating in the Centers for Medicare and Medicaid (CMS) Cardiac Bundle Program. The CMS payment model is designed to financially hold hospitals accountable for the quality and cost of an episode of care for select Cardiac patients. Hospital readmissions is one of the primary drivers of excess cost for Cardiac patients, driving over $1.8 billion of cost.
The benefit of the Rxight® PGx program is reducing medication-related hospital readmissions, which are demonstrated to be reduced by pharmacogenetic testing and pharmacist involvement in Cardiac patient care, which is integral to the Rxight® program. The CMS Cardiac Bundle Program encompasses a range of cardiac conditions and treatments, including myocardial infarction, heart surgery, bypass surgery, coronary artery blockage, and cardiac rehabilitation following a heart attack or heart surgery.
“Stick-and-Carrot” Payment System
Under the CMS cardiac bundled payment system, which is scheduled to go into effect on Oct 1, 2017 at hospitals located in 98 metro areas, hospitals are to be held financially accountable for the quality and cost of an episode of care. There is up to 5% bonus potential for improving quality and reducing episode cost of care in year one (up to 20% bonus in year five). If episode spending exceeds benchmark, then repayment to CMS is required.Almost all Part A and Part B services provided in the 90 days post-discharge are included in the episode of care. The benchmark is based on previous year quality-adjusted episode cost of care, from hospitalization and extending for 90 days following hospital discharge.
PGx Testing with Pharmacist Involvement Reduces Readmission Rates
Studies demonstrate that pharmacogenetic testing and pharmacist involvement prevent hospital readmissions. PGx is proven to reduce 90-Day ER and hospital readmission rates for Cardiac patients by 68%, according to data reported by the University of Illinois Medical Center. (UIC Data, 2015)
The study found a $2,043 savings per patient and approximately $600K overall savings to UIC.In addition, pharmacist involvement has been shown to reduce hospital readmission rates by 50%, according to a study published in American Journal of Health System Pharmacy “Hospital Readmissions Reduction Program: Implications for pharmacy (February 2015). The study highlights programs that have successfully reduced readmission rates as a result of pharmacist engagement in patient care models.
Clinical Support for Clopidogrel and PGx
Twenty-one studies involving 4,520 subjects have shown that CYP2C19 loss-of-function alleles are associated with diminished antiplatelet responses to treatment with clopidogrel (Plavix). According to the FDA-Approved Drug Label for clopidogrel, Plavix at recommended doses forms less of the active metabolite and so has a reduced effect on platelet activity in patients who are homozygous for nonfunctional alleles of the CYP2C19 gene, (termed “CYP2C19 poor metabolizers”). The Rxight® pharmacogenetic test is available to identify patients who are CYP2C19 poor metabolizers and the FDA recommendation is to consider use of another platelet P2Y12 inhibitor in patients identified as CYP2C19 poor metabolizers.
Advantages of Implementing Rxight® PGx Protocol for Your Hospital
Rxight® can help maximize CMS quality-based incentive payments. Implementing the Rxight® program in your hospital has the following advantages:
- No cost to the hospital
- Hospital DRG payment is not impacted
- Cath lab simply adds the PGx test to the Standing Order Set. The physician gets results prior to the patient follow up visit
- Helps optimize bundle payments by reducing hospital readmission rates due to medications
- Improves outcomes and patient satisfaction
- Training and certification in pharmacogenetic counseling for hospital pharmacists is provided
- Genetic guidance on 53 drug classes/200+ medications will benefit patient care ongoing