Policy Corner Policy Corner

The COPD Foundation recognizes that public policy affects the entire spectrum of COPD care each and every day. From the intricacies of oxygen and the Affordable Care Act to pending legislation to the larger Hospital Readmissions Reduction Program which may have brought you to PRAXIS, public policy shapes not only our internal policies but the tangible processes and procedures that stem from them.

The COPD Foundation has built these pages to bring you closer to the public policy that impacts COPD care. In the sections below, we will bring you the latest policy developments as well as digestible interpretations of their impact on your field and practice. You will learn more about the COPD Foundation’s advocacy stances and access our position papers on a variety of issues central to your work; read more about colleagues working with the Foundation to engage in two-way communication with both state and federal agencies to benefit the person with COPD and her provider; and learn about ways you can incorporate COPD advocacy into life beyond your practice.

This just in:

The COPD National Action Plan

In early 2016, NHLBI convened dozens of stakeholders to map out priorities and next steps in our work to find a cure and reduce the burden of COPD: the first-ever COPD National Action Plan. The official plan has now been published and will serve as a blueprint for the national COPD community to effect change for those impacted by these diseases! Read our official press release and download the final document here.   

2018 Readmissions Penalties

This year, 2,573 hospitals -- or 80 percent of hospitals included in the analysis -- failed to meet the established thresholds for preventable readmissions across six conditions: myocardial infarction, heart failure, pneumonia, chronic obstructive lung disease, hip or knee replacements and coronary artery bypass graft surgery. Read more here.

What types of public policy issues are important to the COPD community?

Read the new COPD Foundation call to action on our community's most pressing issues.

Is the Hospital Readmissions Reduction Program working?

New AHRQ-funded research out of Yale and New York University suggests that HRRP penalties may be associated with a decline in readmission rates. 

Deciphering HRRP

Understandably, changes in policy and legislation can be confusing, particularly when they are as significant as the Hospital Readmissions Reduction Program (HRRP) has been. We have compiled the following frequently asked questions to help you better understand the program and its impact on your work.

What does HRRP stand for?plus

HRRP stands for the Hospital Readmissions Reductions Program.

What is HRRP?plus

HRRP is an initiative of the Centers for Medicare & Medicaid Services (CMS) to reduce preventable hospital readmissions through financial penalties for hospitals that exceed established rates of 30-day readmissions for select conditions. The legislation to support HRRP is part of the Affordable Care Act (2010).

What conditions are under consideration as part of HRRP?plus

In October 2012, CMS began reducing payments for three index conditions: myocardial infarction, congestive heart failure and pneumonia. In October 2014, COPD exacerbation and total hip or knee arthroplasty were added as penalizable conditions.

What data are used to determine these penalties?plus

In Year 1 of HRRP (2012), readmissions data from July 2008 to June 2011 were used in determining penalties. Data from June 2009 through July 2012 were analyzed for Year 2; Year 3 calculations used data from June 2010 through July 2013.

What penalties are enforced?plus

In Year 1, CMS implemented a 1% penalty on all Medicare payments to hospitals with excessive readmissions rates (not just payments for the HRRP-included conditions). In Year 2, this grew to 2%; in Year 3, the rate was 3%.

What are seen as the positive aspects of the program? plus

Proponents identify several positive aspects of the HRRP:

  • Burden reduction. Hospital readmissions are incredibly burdensome to both patients and the healthcare system, so efforts that could effectively reduce these burdens are worthy of consideration.
  • Availability of data. The data required for HRRP analysis and reporting are relatively easy to obtain.
  • Comparability across organizations. The existence of these data at all organizations makes it possible to compare rates between healthcare facilities and systems.
  • Discrete time interval to target interventions. This discrete interval allows for a relatively immediate response (and also allows administrators and providers to gauge the success of their interventions relatively quickly).

Source: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3983837/

What are seen as some of the drawbacks of the program?plus

Critics of the program have identified several drawbacks to its implementation, including:

  • Data form an incomplete picture. A patient’s hospital experience is only one of many factors thought to influence their potential for a readmission; HRRP criteria also do not consider a patient’s overall health status in their analysis.
  • Program improvement. If a hospital is penalized under HRRP, how do they know what adjustments need to be made to their standard of care? In addition, the community acknowledges that there is no definitive program that is the gold standard in preventing readmissions. Last, critics note that, while it seems logical, we do not know definitively that reducing readmissions leads to better health outcomes for all patients.
  • Data validity issues. Critics of HRRP also raise concerns about the validity of ICD-9 codes that were used to code COPD exacerbations; in addition, there is the possibility that concern about HRRP may have led staff to selectively code or hold patients in observation status to avoid increasing actual admissions. Of additional concern is an absence of clear data on how many readmissions can be considered preventable.
  • Health disparities. Even with risk adjustments initiated by CMS, data indicate that safety net hospitals, large facilities and teaching institutions are more likely to be penalized under HRRP given that measures do not take all major patient socioeconomic variables into account. Critics often identify this as a major concern given the possibility that this could only deepen the health disparity divide.

Source: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3983837/

How are the nation’s hospitals performing overall?plus

While the overall national Medicare readmissions rate is decreasing (19.5% in 2009 to approximately 18% in January 2014), a record number of hospitals were penalized in Year 3 of the program (2,610 institutions or 78% of hospitals).

Source: http://innovation.cms.gov/Files/reports/patient-safety-results.pdf

How do the COPD readmissions data look so far?plus

Overall readmissions rates for COPD have decreased slightly. In FY2013 the readmissions rate for COPD exacerbations was 23%; it fell to 21% in FY2015. We do not yet understand what variables account for this decrease in readmissions.

Where can I learn more about HRRP and ask questions?plus

The PRAXIS Resource Repository contains many items devoted to better understanding HRRP as well as the discussion surrounding its implementation and future. To access these items, enter the PRAXIS Resource Repository and click on the HRRP tag on the left navigation bar. This will show you all resources devoted to this specific topic.

You can post reactions to the resource entry itself and can also discuss HRRP with your colleagues in the PRAXIS social group.

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