Penalizing Hospitals for Chronic Obstructive Pulmonary Disease Readmissions

Abstract

In October 2014, the U.S. Centers for Medicare and Medicaid Services (CMS) will expand its Hospital Readmission Reduction Program (HRRP) to include chronic obstructive pulmonary disease (COPD). Under the new policy, hospitals with high risk-adjusted, 30-day all-cause unplanned readmission rates after an index hospitalization for a COPD exacerbation will be penalized with reduced reimbursement for the treatment of Medicare beneficiaries. In this perspective, we review the history of the HRRP, including the recent addition of COPD to the policy. We critically assess the use of 30-day all-cause COPD readmissions as an accountability measure, discussing potential benefits and then highlighting the substantial drawbacks and potential unintended consequences of the measure that could adversely affect providers, hospitals, and patients with COPD. We conclude by emphasizing the need to place the 30-day COPD readmission measure in the context of a reconceived model for postdischarge quality and review several frameworks that could help guide this process.

Risk of death and readmission of hospital-admitted COPD exacerbations: European COPD Audit

“…Readmission is still considered to be avoidable and led to the establishment of a penalty system for readmission within 30 days in the USA [24][25][26]. However, the prediction of readmission is still poor and most of the published data fail to show any improvement of readmission rates in COPD as a result of financial penalties [26,27]. In our study, readmission was related to the risk factor of previous admissions, thereby possibly reflecting the frequent exacerbator phenotype.…”

Predictors of Readmission in a Period of 30 Days or Less in Acute Exacerbation of Chronic Obstructive Pulmonary Disease

“…36 Although there is no doubt that healthcare costs need to be contained, recent comments make it clear that there is insufficient evidence to support the use of readmission as a measure for purposes of accountability; moreover, reducing costs without understanding the effect on the health of patients with COPD would make little sense. 37 In terms of hospital stay and discharge destination, 2 studies 38,39 carried out on patients aged 65 years and above with COPD found two variables to be relevant in the determination of the readmission rate; patients discharged to the community (in contrast to domicile) 38 and patients with a length of stay of 4 to 6 days (in contrast to patients with a hospital stay of <4 d) 39 were less likely to be readmitted within 30 days of discharge. Some interventions or approaches have shown their importance in the management of certain clinical aspects in stable COPD patients; in this context, education in self-management, 40 integrated care, 41,42 and closer management between specialists and primary care physicians 43 have been shown to be valid care options.…”

Year in Review 2014: Patient Safety

“…The inclusion of pneumonia and COPD impact the practice of RTs. In 2014, Feemster and Au 29 critically assessed the use of all-cause 30-d COPD readmissions as an accountability measure, discussing benefits and highlighting the substantial drawbacks and unintended consequences of the measure that could adversely affect providers, hospitals, and patients with COPD.…”