Understanding Why Patients With COPD Get Readmitted

A Large National Study to Delineate the Medicare Population for the Readmissions Penalty Expansion

      BACKGROUND

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

      METHODS

      Medicare claims data from 2006 to 2010 in seven states were analyzed, with an index admission for COPD defined by discharge International Classification of Diseases, Ninth Revision, codes as stipulated in the HRRP guidelines. Rates of index COPD admission and readmission, patient demographics, readmission diagnoses, and use 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 one-half of the reasons for readmission, and COPD was the most common diagnosis, explaining 27.6% of all readmissions. Patients discharged home without home care were more likely to be readmitted for COPD than patients discharged to PAC (31.1% vs 18.8%, P < .001). Readmitted beneficiaries were more likely to be dually enrolled in Medicare and Medicaid (30.6% vs 25.4%, P < .001), have a longer median length of stay (5 days vs 4 days, P < .0001), and have more comorbidities ( P < .001).

      CONCLUSIONS

      Medicare patients with COPD exacerbations are usually not readmitted for COPD, and these reasons differ depending on PAC use. Readmitted patients are more likely to be dually enrolled in Medicare and Medicaid, suggesting that the addition of COPD to the readmissions penalty may further worsen the disproportionately high penalties seen in safety net hospitals.

      ABBREVIATIONS:

      AECOPD ( acute exacerbation of COPD), AMI ( acute myocardial infarction), CCS ( Clinical Classifications Software), CHF ( congestive heart failure), CMS ( Centers for Medicare & Medicaid Services), HRRP ( Hospital Readmissions Reduction Program), ICD-9 ( International Classification of Diseases, Ninth Revision), IPPS ( inpatient prospective payment system), LOS ( length of stay), PAC ( post-acute care), SNF ( skilled nursing facility)
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