Impact of a COPD Bundled Payments for Care Innovation Program on Readmissions and Inpatient Care Quality

Abstract

Background

One-fifth of US patients hospitalized for acute exacerbations of COPD (AECOPDs) are readmitted within 30 days, contributing to high morbidity and costs. Medicare included COPD in their Hospital Readmissions Reduction Program (HRRP) in 2014 and offered voluntary value-based COPD care programs (Bundled Payments for Care Innovation [BPCI]).

Research Question

Was our COPD HRRP effective in preventing hospital readmissions and improving inpatient care quality at our medical center?

Study Design and Methods

We performed a single-center, retrospective cohort study using Medicare data of BPCI-eligible hospitalizations for AECOPDs occurring pre-BPCI (October 2013-September 2014) and during BPCI (October 2015-September 2018) implementation. Our interprofessional COPD HRRP includes inpatient consultation and postdischarge interventions. We compared outcomes between BPCI program recipients and nonrecipients including inpatient COPD care quality metrics derived from international COPD guidelines and program-specific interventions using multivariable regressions. We evaluated 30- and 90-day all-cause readmission rates with multivariable logistic regression and 2-stage least squares instrumental variable analysis.

Results

Of 287 AECOPD hospitalizations (pre-BPCI: n = 57; BPCI: n = 230), 132 received the COPD HRRP. Patients were more likely to receive inhaler education (pre-BPCI: 12.0% vs BPCI: 71.8%; P < .01), tobacco cessation therapy (pre-BPCI: 24.3% vs BPCI: 71.8%; P < .01), and predischarge oxygen walk test (pre-BPCI: 49% vs BPCI: 81.0%; P < .01). In instrumental variable analysis, controlling for unobserved confounders correlated with receiving the COPD HRRP, our intervention was associated with a significantly lower adjusted 30-day all-cause readmission rate (pre-BPCI: 28.6% vs BPCI: 6.6%; P < .05; absolute decrease, −22.0%; 95% CI, −43.6 to −0.5) but not in 90-day readmissions.

Interpretation

The implementation of an evidence-based BPCI COPD program was associated with significant decrease in 30-day all-cause readmissions. Future studies are needed to assess individual interventions that may impact readmission reduction.