by Tim Gieseke, MD, CMD

At this year’s annual CALTCM meeting Jennifer Wieckowski of HSAG (Health Services Advisory Group) presented the most recent data on California Hospital 30 day Readmissions.  This October 1, COPD will be added to the penalty list for readmissions with maximum penalty going up to 3%.  In addition, MedPAC (Medicare Payment Advisory Commission) has recommended penalizing SNFs with high admission rates with payment reductions up to 3% as of 2017.  To avoid these penalties facilities will need to focus on patient centered care that improves care transitions upstream and downstream.  One tool being used in my community is the “My COPD Care Plan” tool from the American Lung Association (see attachment).

Dr. Dhanani, Director of Geriatric Evaluation and Management Unit at VA Greater LA Healthcare System, then gave a comprehensive presentation on COPD Care in the Elderly.  This presentation as well as the entire meeting is available on our web site member’s only section.  Tools you should be familiar with include the GOLD Classification Guidelines (See Attachment), the Modified MRC Dyspnea Score, and the BODE index for predicting life expectancy (http://www.qxmd.com/calculate-online/res$pirology/bode-index for mobile device or on the web at Medscape.com/calculator/bode-index-copd).  To take advantage of these tools, you will need to partner with a provider for measuring FEV-1 or bring this capacity in house (cost of < $1500).  Besides the BODE index, a hospital admission with a PaCO2 > 50 has a 33% 6 mo. mortality and 43% 1 year mortality.  Placement on a mechanical ventilator for COPD has a 25% annual mortality.

As a supplement to Dr. Dhanani’s presentation, JAMDA approved our use of an excellent editorial on COPD in the Elderly by Dr. John Morley from March 2014.  This is an excellent reminder that COPD is common (15% of elderly) and is the 3rd leading cause of death.  It has multiple complications that create frail patients high risk for hospital readmission.  These include:  low BMI, malnutrition, anorexia, osteoporosis, poor balance, hip fractures, diabetes, depression, anxiety, social isolation, and reduced cognition.  Ideas for managing these complications are imbedded in the editorial.  This article can be found at jamda.com (for a price) or on our web members only section (see the 2014 Annual Meeting Syllabus - COPD Workshop - Supplemental Reading).

All presenters agreed that Pulmonary Rehabilitation is effective for improving quality of life and reducing readmissions.  I know this is not an option in most SNFs, but partnering with those that do this in your community may become the standard of care.

If you’re still looking for a QAPI project for 2014, COPD Care has plenty of options for measureable QI.

Attachments:

GOLD Pocket Guide 

My COPD Action Plan

BODE Index - Redirect to Medscape