Given the significant financial penalties associated with Medicare and 30-day COPD readmissions, “hospitals must continue to implement strategies aimed at reducing them,” says Sharon Cornelison, RCP, RRT-NPS, a pulmonary transitional care specialist at Wake Forest Baptist Health in Winston-Salem, North Carolina.
Yet many providers are overlooking important steps that can help guide proper COPD treatment and therefore, reduce admissions and readmissions.
The good news is that prudent, effective, and value-based care for chronic obstructive pulmonary disease (COPD) can be easily incorporated into a managed healthcare setting, says Jill Ohar, MD, a professor of medicine at Wake Forest University in Winston-Salem.
Here are four reasons many COPD patients aren’t receiving appropriate treatment:
1. Failure to perform pulmonary function testing
“First, you need to confirm a diagnosis, based on pulmonary function testing,” she says. “Simple spirometry costs only about $25 and is covered by insurance. It is really the only way to make a definite diagnosis of COPD.”
Nonetheless, Ohar points out that many labeled COPD patients, even those hospitalized, “have no objective documentation of the presence of COPD or the severity of the disease from pulmonary function testing.”
Ohar says this revelation is “absurd, because a diagnosis is the only way to know what therapies to use. Decisions are predicated on severity of lung disease and pulmonary function testing.”
2. Not incorporating pulmonary rehabilitation
Ohar says it is also important to incorporate pulmonary rehabilitation into patient care, not only post-hospitalization but probably at the time of diagnosis as well. “Most patients already have fairly significant severe deconditioning by the time they are diagnosed,” she states.
In fact, one study found that lung function was reduced to slightly more than half of normal at the time of first diagnosis of COPD. “You can only imagine the number of people who have altered their lifestyle to accommodate a growing disability for several years, if not decades," Ohar says.
Therefore, after diagnosis, instituting appropriate therapy of bronchodilators and pulmonary rehab is cost-effective.
Cornelison says pulmonary rehabilitation, “is a comprehensive physical conditioning, education, and disease management program.”
Such a program not only improves the patient’s quality of life through medically-directed exercise and social interaction with other lung disease patients, “it teaches important skills such as managing oxygen therapy devices, identifying early signs/symptoms of a COPD flare, stress/anxiety management, tobacco cessation, breathing techniques, and respiratory medications/correct inhaler techniques,” she says. .
Unfortunately, Cornelison observes, many clinicians remain unaware or unconvinced as to how this intervention can benefit the lives of their COPD patients. “However, this line of thinking must be changed in today’s healthcare climate,” she states.
Cornelison says the keys to improving patient access to this beneficial therapy include educating providers about pulmonary rehab, ensuring everyone has access to an accredited program from the American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR), and working with insurers to reduce copays and increase financial affordability so that more patients can participate.
“In our experience here at Wake Forest Baptist Health, our COPD patients who participate in pulmonary rehab tend to be more active partners in their healthcare, more compliant with their treatment plan, have fewer hospital admissions, and generally consume less healthcare resource dollars as compared to patients who do not participate in pulmonary rehab,” Cornelison says.
3. Not educating patients about proper inhaler use
Inhaler instructions are key. “Inhalers are quite expensive,” Ohar says. “If you purchase one over the counter, it can cost more than $300. However, most physicians do not take time to teach patients how to use inhalers. Often, the patients’ use of their device is faulty and thus they receive little or none of the medication that they have paid large amounts of money for.”
Further, it is important that clinicians impart on patients that many COPD therapies not only improve lung function, “but they reduce exacerbations that can be quite costly and can lead to hospitalizations,” Ohar notes.
4. Failure to incorporate smoking cessation education and programs
Smoking cessation will also reduce overall costs. “Why would you pour hundreds of thousands of dollars of medicines in a patient and then still let them smoke, realizing that people who smoke and develop COPD lose lung function five times more rapidly than a normal nonsmoker?” Ohar says. “Enroll your patient is an effective smoking cessation program.”