Of the many challenges facing hospitals today, one of the most difficult and potentially costly may be reducing readmissions. Under the Patient Protection and Affordable Care Act, the Centers for Medicare and Medicaid Services (CMS) has begun monitoring 30-day readmissions for a number of conditions. Hospitals that don’t meet their targets will be subjected to costly penalties.
Although reducing readmissions is a laudable goal, in terms of both cost reduction and patient outcomes, many of the contributing factors are simply beyond the hospital’s control. Others fall outside the boundaries of traditional hospital care, and will require careful coordination and collaboration outside the hospital walls to manage. As author Bob Messenger notes in his article beginning on page 8 of this issue, that is especially the case for respiratory care professionals.
A recent discussion in the RT Magazine LinkedIn group highlighted some of the reasons why. As Messenger explained there, “Of the seven diagnoses that CMS has identified for readmission monitoring, COPD will be by far the most challenging.” While disease management programs and patient education are key factors for all seven conditions, COPD poses additional hurdles, he argued. COPD management not only “requires a change in behavior,” but the COPD patients are also frequently characterized by cognitive challenges and advanced age. “Both of these issues make educating them difficult,” he said. “These patients are going to require multiple educational interventions, both as inpatients, and, probably more importantly, as outpatients.”
COPD educator Pat Christensen, RRT, added that the problem of patient compliance makes ongoing monitoring and education essential. “A certified asthma or COPD educator,” she noted, “can provide both education and monitoring, as well as develop a rapport with the patient and encourage compliance.”
William Howard of Outcomes Solutions Inc, and former director of respiratory care at Tufts Medical Center, noted another key factor: “…the failure to refer these patients to a respective rehabilitation program upon discharge from the hospital. The professional literature suggests that there is a significantly lower readmission rate for patients who complete these programs when compared to patients who do not attend this valuable service.”
Howard added that the “most important and controllable” reason patients are not referred to rehab programs “is the lack of physician buy-in and the failure to refer their qualifying patients to these programs. Education at the physician level appears to be a key variable.”
Howard’s observation on the need for education for primary care physicians is seconded by pulmonologist David Law, MD, whose COPD disease management program at Saddleback Memorial Medical Center (SMMC) in Laguna Hills, Calif, is profiled in a sidebar to Messenger’s article. But in an interview, Law added another much-needed kind of education: that which could be provided by respiratory therapists to patients outside the hospital, if only it were reimbursed.
That’s one reason that readers of RT Magazine should play close attention to a new legislative initiative by the American Association for Respiratory Care. Known as the “Medicare Respiratory Therapist (RT) Access Act,” the proposed bill would “amend Medicare Part B to add coverage of pulmonary self-management education and training services when furnished by qualified respiratory therapists in the physician practice setting to Medicare patients who have been diagnosed with COPD, asthma, pulmonary hypertension, pulmonary fibrosis and cystic fibrosis.”
Given the challenges described above, it seems likely that to make significant progress in reducing COPD readmissions, passage of this bill will be essential. RT
John Bethune is the editorial director for Allied Media and the chief editor of RT Magazine. Comments can be sent to [email protected].