Investing Dollars that Make Sense
Part 3 (Read part 2)
With reductions in reimbursement for pulmonary rehab a couple of years ago, some may be contemplating whether opening a program is worth the effort. Certainly in today’s dollars-conscious heath care environment, every decision must have a demonstrable ROI or the CFO won’t even blink. But now that readmission penalties are in play for COPD, that ROI may just have become, well, justifiable.
The literature is replete with the causal relationship of PR to decreased incidence of 30 day readmissions for COPD. Revitt O, Sewell L, Morgan MD, Steiner M, Singh S. conclude in a 2013 study that PR produces “statistically significant improvements” and discovered that “the number of admission was significantly less in the 12-month post-pulmonary rehabilitation compared to the previous 12 months.” Dr. John M Seymour et al., discovered that the proportion of patients re-admitted to the hospital with an exacerbation, was 33 percent in the UC (usual follow up care) group compared with seven percent in those receiving PEPR (post exacerbation pulmonary rehab). The proportion of patients that experienced an exacerbation resulting in an unplanned hospital attendance (either admission or review and discharge from the emergency department) was 57 percent in the UC group and 27 percent in those receiving PEPR.
A year ago, an article in Becker’s Hospital Review on the cost of readmission by condition listed this fascinating tidbit, “The average cost for a COPD readmission from COPD as a principle diagnosis is $8,400, with a readmission rate of 7.1 percent. The average cost of a COPD readmission from a diagnosis including COPD is $10,900, with a 17.3 percent readmission rate. The average COPD readmission costs 118 percent of an initial COPD admission, which averages $7,100.” To make the math easy, for every 100 COPD admissions, 17 will readmit to the hospital to the tune of $185,300. A pulmonary rehab program that decreases that amount by 73 percent is sure to get the necessary double take. This does not even account for the actual dollars taken in by the program nor any savings in readmission penalties. Investing in pulmonary rehab is only investing dollars that make sense.