COPD: Most Hospital Readmissions Not Due To COPD

Tina Shah, MD University of Chicago Medicine Department of Pulmonary and Critical Care University of ChicagoMedicalResearch.com Interview with:
Tina Shah, MD
University of Chicago Medicine
Department of Pulmonary and Critical Care
University of Chicago

Medical Research: What is the background for this study? What are the main findings?

Dr. Shah: The reason why we undertook this study is to better understand the Medicare COPD population that falls under the purview of the CMS Hospital Readmissions Reduction Program (HRRP). This program places up to a 3% penalty on all Medicare revenues for hospitals that take care of beneficiaries should a hospital exceed its “expected readmission rate.” Previously 30 day readmissions after index admissions for congestive heart failure, acute myocardial infarction and pneumonia fell subject to the HRRP. As of October 2014, COPD has been added to the list, despite minimal evidence to guide hospitals in how to curb COPD readmissions. The goal of this research was to provide an epidemiological background for this population and identify trends as a hypothesis generating first step to predict who is most likely to be readmitted and to identify targets for successful future interventions on this group. Our study population is unique in that we longitudinally look at about 1/2 of all Medicare admissions for COPD exacerbations, using the CMS guideline definition which is based on discharge ICD-9 codes. As described in previous literature, there is a large discrepancy between identification of COPD by provider versus coding algorithm, however since the Hospital Readmissions Reduction Program is based on discharge coding it is important to examine this particular group.

Dr. Shah:  Our paper has 3 main findings:

First, Although COPD was the leading cause of rehospitalization within 30 days of an initial index admission, the majority of readmissions were not due to COPD and include a wide array of reasons.

Second, patients who used post-acute care, including home care and skilled nursing facilities were readmitted for different reasons than those who were discharged to home.

Third, patients who were readmitted were likely to be dually eligible for Medicare and Medicaid, posing the potential for a disproportionately high penalty on hospitals who care for a large percentage of patients who are generally sicker, poorer and have less community access to health resources. This finding adds to the growing concern in other literature about the lack of standardization by socioeconomic status in the current penalty.

The application of this study’s findings for clinicians and patients is a better understanding of the patient related factors including dual eligibility status that are associated with a higher risk of readmission and to take a closer look at the use and appropriate triage of patients to levels of care upon discharge. Our study highlights a need for research looking into the role of post acute care on readmissions, a next area of investigation that our research group is undertaking.

Citation:

Understanding why copd patients get readmitted: a large national study to delineate the medicare population for the readmissions penalty expansion

Published online December 24, 2014.
Shah T, Churpek MM, Coca Perraillon M, Konetzka R.

doi:10.1378/chest.14-2181.