IHD Journal Watch: Reasons for COPD Readmission

Journal Source: Shah T, Churpek MM, Coca Perraillon M, Konetzka RT. Understanding why COPD patients get readmitted: A large national study to delineate the Medicare population for the readmissions penalty expansion. Chest, 2014 Dec 24, https://journal.publications.chestnet.org/article.aspx?articleid=2087937.

Background—The Hospital Readmissions Reduction Program (HRRP) penalizes hospitals for 30-day readmissions and was extended to chronic obstructive lung disease (COPD) in October 2014. There is limited evidence available on readmission risk factors and reasons for readmission to guide hospitals to initiate programs to reduce COPD readmissions.

Methods—Medicare claims data from seven states were analyzed from 2006 to 2010, with an index admission for COPD defined by discharge ICD-9 codes as stipulated in the HRRP guidelines. Rates of index COPD admission, readmission, patient demographics, readmission diagnoses and utilization of post-acute care (PAC) were investigated.

Results—Over the study period, there were 26,798,404 inpatient admissions, of which 3.5% were index COPD admissions. At 30 days, 20.2% were readmitted to the hospital. Respiratory-related diseases accounted for only half of the reasons for readmission, and COPD was the most common diagnosis, explaining 27.6% of all readmissions. Patients discharged home without home healthcare were more likely to be readmitted for COPD than patients discharged to PAC (31.1% v. 18.8%). Readmitted beneficiaries were more likely to be dually enrolled in Medicare and Medicaid (30.6% v. 25.4%), have a longer median length of stay (5 v. 4 days), and have more comorbidities.

Conclusion—Medicare patients with COPD exacerbations are usually not readmitted for COPD, and these reasons differ depending on PAC utilization. Readmitted patients are more likely duals, suggesting the addition of COPD to the readmissions penalty may further exacerbate the disproportionately high penalties seen in safety-net hospitals.

Analysis

Around 12.7 million U.S. adults are estimated to have COPD.¹ However, close to 24 million U.S. adults have evidence of impaired lung function, indicating an underdiagnosis of COPD.² The average cost for a COPD readmission from COPD as a principal diagnosis is $8,400, with a readmission rate of 7.1%. The average cost of a COPD readmission from a diagnosis including COPD is $10,900, with a 17.3% readmission rate. The average COPD readmission costs 118% of an initial COPD admission, which averages $7,100.³ These statistics illustrate why CMS included COPD in the readmission penalty bundle.

The authors note only half of the 30-day readmissions from a primary ICD-9 diagnosis of COPD were due to a primary respiratory ailment. They also point out patients with home health had lower readmission rates than patients discharged without post-acute care.

Although the primary basis for this study was to describe the potential negative impacts on hospitals subject to the HRRP as a result of dually eligible patients, their results also make a compelling argument about ensuring a holistic, integrated and collaborative approach to managing COPD patients in the post-acute care setting. This could involve a combination of clinical, educational and even social service care to minimize the risk of the comorbidities leading to readmission.

—Analysis by Matt Zavadsky

References

1. Centers for Disease Control and Prevention, National Center for Health Statistics. National Health Interview Survey Raw Data, 2011. Analysis performed by the American Lung Association Research and Health Education Division using SPSS and SUDAAN software.

2. Centers for Disease Control and Prevention. Chronic Obstructive Pulmonary Disease Surveillance United States, 1971–2000. MMWR, 2002 Aug 2; 51(SS06): 1–16.

3. Rizzo E. 6 Stats on the Cost of Readmission for CMS-Tracked Conditions. Becker’s Infection Control & Clinical Quality, www.beckershospitalreview.com/quality/6-stats-on-the-cost-of-readmission-for-cms-tracked-
conditions.html.