Hospital readmissions are a major driver of spending in the Medicare program.
Hospital readmissions are a major driver of spending in the Medicare program. The Centers for Medicare and Medicaid Services (CMS) added chronic obstructive pulmonary disease (COPD) to this year’s list of conditions for which hospitals can be penalized. These penalties are designed to encourage the implementation of practices to reduce readmission rates.
An overview of CMS readmission penalties and strategies for reducing readmission rates for patients with COPD were presented in the session “Are You Ready for CMS Readmission Penalties for COPD?” at the 2015 APhA annual meeting. Presenter Dennis Williams, PharmD, of the University of North Carolina Health Care, described some of the many ways pharmacists can improve outcomes for patients with COPD.
The CMS Readmissions Reduction Program, which began in October 2012, defines COPD readmission as admission to a hospital within 30 days of a discharge. Last year, acute myocardial infarction, heart failure, and pneumonia were on the program’s condition list. In fiscal year 2015, the expanded list will include elective total hip arthroplasty, total knee arthroplasty, and acute exacerbation of COPD.
Improving outcomes for patients with COPD helps prevent readmission and minimizes institutions’ risk for readmission penalty. COPD exacerbations can have a financial penalty and a negative impact on patient quality of life: each exacerbation can increase the progression of disease.
Readmission reduction strategies for discharge planning should include the following:
• Discharge medication reconciliation
• Face-to-face discharge counseling to set the stage for phone follow-up
• Use of the teach-back method in demonstrating inhaler technique
• Provision of a discharge medication list to patients
Pharmacists can have a positive effect in managing COPD patients through patient education, assistance with tobacco cessation, vaccination, monitoring, and performing medication therapy management, noted Dr. Williams. Smoking cessation alone has the greatest capacity to positively influence the natural history of COPD, and pharmacotherapy and nicotine replacement increase long-term smoking abstinence rates.
Educating patients about disease and pharmacotherapy is key to ensuring that patients understand the role of each medication. For example, the greatest benefit of long-acting bronchodilators is the reduction of COPD exacerbations, and one class of bronchodilators is not clearly superior to another, Dr. Williams emphasized. Medication therapy management services should be offered to patients.
In addition, vaccines should be recommended and administered. For example, pneumococcal polysaccharide vaccine should be given to all patients with COPD (patients older than 65 years should receive the pneumococcal conjugate vaccine [PCV 13] first, and then PPSV 23 in 6 to 12 months).
Pharmacists need to assess each patient’s ability to recognize and act on symptoms of worsening disease. Does a patient have problems with access to care? These factors greatly affect readmission rates.
COPD is the 4th leading cause of death in the United States, but it is a preventable and manageable chronic disease. COPD exacerbations hasten disease progression and increase mortality risk. With numerous opportunities to improve outcomes for patients with COPD, pharmacists can be key players in avoiding readmission penalties for their organizations and in collaborating with other clinicians to improve patient health.
"Ensuring a smooth transition from the hospital to home for a patient treated for a COPD exacerbation offers an excellent opportunity for pharmacists working collaboratively with other clinicians," said Dr. Williams. "A community pharmacist should explore needs and opportunities through working with hospitals and health systems in their own community."