Medicare, (CMS), has included COPD in its list of disorders that will result in penalties to hospitals should a patient be readmitted within 30 days. It is feared that this policy will disproportionally effect the poor, since they are less likely to be able to afford proper medications and care outside of a hospital or emergency room setting. The fact that COPD patients tend to experience more and more frequent exacerbations as their disease progresses, coupled with CMS’s own policies that tend to restrict access to necessary oxygen to heavy users, will, in my opinion, result in the punishment of hospitals for situations that are completely out of their control.
The theory, of course, sounds good at first blush. If a hospital is to be penalized if a discharged patient returns within 30 days, the natural tenancy of said hospital would be to insure that the patient and/or their caregivers are knowledgeable about medication usage and self-care. They will, in theory, do more to insure that the patient remains healthy for a longer period after they leave the institutional care.
None of this, of course, answers the initial question. How, indeed, can COPD readmissions be avoided? That can only happen if the exacerbations, the infections and pneumonias that lurk out there, waiting for weak lungs or a compromised immune system, can be avoided. This can only happen if the patient is compliant with his or her medications, nutrition, exercise, and general activity level. It is quite possible for COPD patients to ward off the downturns that drive them back to the hospital, but by the very nature of the disease, it becomes more and more difficult, requires greater effort to stay strong, to remain compliant as the patient deteriorates.
It is worrisome to ponder just what the reactions of the hospitals will be as their COPD patients grow older, as their diseases insidiously progress. Whatever happens, I don’t think that the outcome will be satisfactory for anyone involved.