Difficult Discharges to Skilled Nursing Facilities Attributed to Multiple Sclerosis Medications: An Observational...

Area of Science:

• Neurology
• Health Economics
• Healthcare Policy

Background:

• High costs of multiple sclerosis (MS) disease-modifying therapies (DMTs) and symptomatic treatments like dalfampridine (DFP) pose significant financial challenges.
• Consolidated billing models in skilled nursing facilities (SNFs) mandate that these medication costs be covered post-hospitalization, creating potential financial burdens.

Purpose of the Study:

• To determine the frequency of suboptimal discharge in MS patients due to pharmaceutical costs.
• To quantify the impact of medication discontinuation, limited supplies, or forgone rehabilitation on patient outcomes.

Main Methods:

• Retrospective chart review of MS patients admitted to an academic medical center from 2013-2017.
• Analysis focused on patients on DMTs and/or DFP with SNF rehabilitation recommendations.
• Quantification of suboptimal discharge events related to medication and rehabilitation access.

Main Results:

• Of 57 admissions involving MS patients on DMT/DFP recommended for SNF rehab, 39 (68%) experienced suboptimal discharge.
• Medication discontinuation occurred in 29 (65%) of these admissions.
• Discharge to a hospital-owned SNF was associated with routine discharge without medication lapse (11/15 vs. 7/36, P < .001).

Conclusions:

• The high cost of MS medications, coupled with SNF consolidated payment models, creates misaligned incentives.
• These financial factors frequently result in medication discontinuation and suboptimal discharge for MS patients.
• Addressing these cost and payment structures is crucial for improving patient care continuity.